AccountId: 011433970860
ContactId: 7885df74-ca51-4ab3-943c-e3260cabd1ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 466579 ms
Total Talk Time (AGENT): 189499 ms
Total Talk Time (CUSTOMER): 208636 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/7885df74-ca51-4ab3-943c-e3260cabd1ec_20250409T15:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, um, I wanted to know how long does it take a claim to process?
[AGENT][NEUTRAL] Um, our typical turnaround time is about 7 to 10 working days.
[CUSTOMER][NEUTRAL] OK, can you tell me if my claim is gonna be um.
[CUSTOMER][NEUTRAL] I don't know if y'all are going to pay on it or not.
[CUSTOMER][NEUTRAL] You want me to give you.
[AGENT][NEUTRAL] OK, do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. 254-584-6. [PII].
[AGENT][NEUTRAL] OK, [PII], and what is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have a good callback number?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And just need a few other pieces of information. What is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then your email address.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Um, looks like I have a different email.
[CUSTOMER][NEUTRAL] Oh, it might be [PII]. Is that what I have?
[AGENT][NEUTRAL] OK, that's what, yep, that's what I have.
[CUSTOMER][POSITIVE] That's, that's OK. That's good.
[AGENT][NEUTRAL] OK, it looks like we received a claim on [PII]. Um, I, I don't show it processed yet, so I can't tell it's in, it's in line to be processed, so I would give it a few more working days and we should have it processed with a determination.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Well, let me ask you this. I got in a car wreck and I, my airbag didn't come out, so it hit me in the chest. I hit the steering wheel and I I had a bruised rib cage.
[CUSTOMER][NEUTRAL] And the doctor asked me. I went to my GP doctor, and then it hurt my knees and let's see what else. That's basically that was it, I guess. But anyway, so I went to the doctor and he said that he said, I can send you for an X-ray, but even if your ribs are broken, he said there's nothing they're going to do about it. You're going to have to just deal with it.
[CUSTOMER][NEUTRAL] And so I didn't go get it X-rayed, so is that, will that make my claim be denied?
[AGENT][NEUTRAL] Um, let's see. So what, did you just go to the doctor? Was there any kind of treatment or?
[CUSTOMER][NEGATIVE] There was nothing he could do because I had a bruised rib cage.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And he said they don't tape them up anymore, and he said even if you've got a cracked rib, he said it wasn't broken because I didn't have trouble breathing.
[CUSTOMER][NEUTRAL] So he knew that it wasn't broken.
[CUSTOMER][NEUTRAL] And um
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And my, it jarred my back, but that's, I finally got that straightened out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see. So, let me look at your policy, and this is not a guarantee of payment, it's a basic outline of your policy. So what's required is we look at the diagnosis on the claim.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, and if that indicates an accident, then it, it wouldn't matter if you had an X-ray. It's more what was the diagnosis for the claim. So if it was an accident.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, I sent in
[AGENT][NEUTRAL] OK. Go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I sent in my doctor after visit information and I didn't have the accident report yet, so I sent in the information from the state police saying it's an accident and listing all the parties, you know, and he put the accident report, but it was, it wasn't ready.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I didn't have that to send.
[AGENT][NEUTRAL] OK, I know we will require an uh an actual diagnosis because we have to be, be able to determine that that diagnosis was an accident. So, if, if you didn't submit that, you'll need that.
[CUSTOMER][NEUTRAL] Yeah, but I, I
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Hold on a minute, um.
[CUSTOMER][NEUTRAL] I sent in they had a diagnosis on there.
[AGENT][NEUTRAL] OK, well, if, if that's included, then it it should be processed. I was just saying that that's what we need.
[CUSTOMER][NEUTRAL] I don't have to have the police report.
[AGENT][NEUTRAL] No, we just, we're looking for a diagnosis that indicates it was an accident and then we look at what procedure or what like what was performed and then we pay it out according to your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it it should be processed in a few working days and then we'll have a determination on it.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK, let me look real quick because I might have to get um.
[CUSTOMER][NEUTRAL] Let me see if I can find what I sent to y'all.
[CUSTOMER][NEUTRAL] 00, it says you're gonna look at your files don't it?
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Doesn't it say that?
[AGENT][NEUTRAL] Let me see if I can see what we got.
[CUSTOMER][NEUTRAL] View files.
[CUSTOMER][NEUTRAL] The Ashner Pass visit details is what it is.
[CUSTOMER][NEUTRAL] I went in there with a rib injury.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then he wrote on there that I had had a wreck an automobile accident.
[AGENT][NEUTRAL] Um, let me
[CUSTOMER][NEUTRAL] Yeah, I see.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] That's so much crap in here.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, I'm looking through it as well.
[CUSTOMER][NEUTRAL] It says no, it says no diagnosis found.
[CUSTOMER][NEUTRAL] On my sheet
[AGENT][NEUTRAL] Yeah, OK, yeah, we will be looking for probably the easiest thing to be if you could contact the provider and get the actual claim form, so the claim from the provider has the information we would need. It's called a CMS 1500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's gonna have the actual diagnosis on it, what you're, what procedure you were seeing for like if it was an office visit or, or whatever, um, but it's a CMS 1500, that's gonna give us exactly what we need.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and that's on the on this site.
[AGENT][NEUTRAL] No, the, the doctor's office where you went, the doctor who you visited, they'll have the claim. That's, and that's, that will contain the information we need.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, that's what I need. It's like that printout thing of.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Well, they don't typically put it on their website, so you'll have to call and ask for it, or, or explain to them you need the actual diagnosis of the visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] I can do that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can, OK, yeah, that, that.
[CUSTOMER][NEUTRAL] And that's all I need, huh?
[CUSTOMER][NEUTRAL] No ma'am, that's it that's the first time I ever filed anything.
[AGENT][NEUTRAL] OK, yeah, I understand. Yeah, so that's.
[CUSTOMER][NEUTRAL] And what's the name of the form?
[AGENT][NEUTRAL] It's a CMS 1500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well let me call him and get that, OK? Thank you.
[AGENT][POSITIVE] OK, well, thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you too, bye.