AccountId: 011433970860
ContactId: 788dc905-d719-45de-8134-5b49793288ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 902059 ms
Total Talk Time (AGENT): 370095 ms
Total Talk Time (CUSTOMER): 187585 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/788dc905-d719-45de-8134-5b49793288ea_20250408T16:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, this is [PII], uh, with the city of [PII], and I am calling because my husband and I are both employed here with the city. We haven't filed a claim in a long time for accidental. Can you check the verification of my benefits?
[AGENT][POSITIVE] OK, sure, I can assist you with benefits. And Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh yes, [PII].
[AGENT][NEUTRAL] Alright. And do you have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh, no, I'm not quite sure where I could find that. That's why I was calling you.
[AGENT][NEUTRAL] OK um let's see.
[AGENT][NEUTRAL] One moment, let me do a search.
[AGENT][NEUTRAL] And that's [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said the first name is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] on this.
[CUSTOMER][NEUTRAL] So I am the policy holder, right?
[AGENT][NEUTRAL] More than likely. Um, OK, it looks like, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I did find a policy. I just need to verify some other information just to make sure that it is your policy. May I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, mailing address is [PII], and my email is [PII].
[AGENT][POSITIVE] Perfect. Thank you, Ms. [PII]. Yes, this is your policy and you did say it was for accident?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, OK, this is an accident policy. Um, let me go ahead and pull the benefit information on this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I have that policy number so I can write it down?
[AGENT][NEUTRAL] Mm, sure, yes. Let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK. Policy number is 00.
[AGENT][NEUTRAL] 44.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 90
[AGENT][NEUTRAL] 36.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] One moment, I'm trying to locate the benefit information.
[AGENT][NEUTRAL] Oh yeah, this is a really old policy.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, it's gonna be one more minute. I'll have to search this a different way.
[AGENT][NEUTRAL] Um, yeah, it's just a really old so it's from [PII]. So, um, yeah, the documents are not in the new system, but let me check and see if I can find.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The back file documents.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] um.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] 8.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 82 here we go.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer and it looks like with this one thing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so there's a specific benefits, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] It benefit.
[AGENT][NEUTRAL] This is the implement. Let me see if there's anything else.
[AGENT][NEUTRAL] Hm, OK, let me go over this policy really quick. OK, one moment. Uh, let's see, uh, do you mind holding for me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this one is a specific um so um.
[AGENT][NEUTRAL] Are you looking to, are you looking for a specific benefit or you want me to just go over all the benefits? OK.
[CUSTOMER][NEUTRAL] Well, what it is, I'm just trying to see because, well, because what it is, I'm not, uh, we, we haven't turned one in in a while and we're doing two accidentals one for me and one for him. So what are the benefits on that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. What, what type of accident was it? Was it like just um regular cut or dislocate?
[CUSTOMER][NEUTRAL] He he had a head, yeah, he had a head injury in mine was, uh, my knee.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm, was it any fractures or any dislocations or it's just
[AGENT][NEUTRAL] Did you just fell and uh fell to the ground. No, OK. So it was, it was just a regular accident. OK, so let's skip all this part then because that's all fractures and all that, so that's not gonna be it. OK. So did you go to, uh, were you hospitalized or you just went to a physician?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just to a physician.
[AGENT][NEUTRAL] OK, alright, so let's get to that part. OK.
[AGENT][NEUTRAL] All right. So the physician's benefit for accident is, um,
[AGENT][NEUTRAL] 250 is the maximum benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] After all those years it still has never gone up then mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, that's what I wanted to make sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So, so it is still 250.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, and so how do I go about turning in my claims?
[AGENT][NEUTRAL] OK, so we're gonna need a claim form and an itemized bill with the diagnosis codes and procedure codes, um, and you can get this form through our website at [PII] or I can send you one by email, um, and you can send in the claim by fax, by mail, or if you have registered through our website, you can upload your claim online.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, if you wanna email that to me.
[AGENT][NEUTRAL] OK, [PII]et me go ahead and do that. Um, one moment, let me do that right now. Uh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Or I can mail them in as well, right?
[AGENT][NEUTRAL] You can either fax it, mail it, or you can upload it to your account. The instructions are on the form, um, so everything is gonna be like exactly what you need and uh where to send it and all that is gonna be in the form, OK? So let me just go ahead and send this out to you before I let you go, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Let me one more minute let me attach the form.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] All right. Do you want to check and see if you got that form?
[CUSTOMER][NEUTRAL] OK, give me one moment. Did, oh, you, you mailed it to mine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I was gonna have you email it to my work email, but that's fine.
[AGENT][NEUTRAL] Oh, I can send it as well to your work email if you can give it to me.
[CUSTOMER][NEUTRAL] OK, it's gonna be R, they're all gonna be lower case. It's [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] [PII] I mean TX I'm sorry.org.
[AGENT][NEUTRAL] OK, I'm just gonna forward the same one I send you. I'm just gonna send it to that one, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was [PII]. Mhm.
[CUSTOMER][NEUTRAL] Yeah, TX, uh huh.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me send it out. It's gonna be a minute.
[CUSTOMER][NEUTRAL] Can I help you?
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] OK. So.
[CUSTOMER][POSITIVE] Yeah she yeah she always wants you to help her, OK.
[AGENT][NEUTRAL] OK, so I send them both to your personal and your work email.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] You wanna check and see if you got it or you're gonna check later on?
[CUSTOMER][NEUTRAL] Uh, let's see, hold on just a minute.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] OK, I haven't got it yet.
[CUSTOMER][NEUTRAL] Let me see if I've gotten it in there.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Email.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Your
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I haven't gotten it yet. It may be taking a little bit so.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I, I still don't have it.
[AGENT][NEUTRAL] OK, the person I send that it went through, but the other one is like working on it.
[CUSTOMER][NEUTRAL] I'll see if it comes through.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if you want to wait just a few more minutes, and if you don't get it, I will say, you know, about 5 minutes you can give us a call back and we can try to send it again, but yeah, OK, but I send it on both emails, OK? You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] All right thank you so much uh huh.
[CUSTOMER][POSITIVE] No, that's it thank you so much bye bye.
[AGENT][POSITIVE] You're welcome and thank you for calling APL.