AccountId: 011433970860
ContactId: 7e8f77fb-142c-4525-9d0c-5c8da39ab94c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1020460 ms
Total Talk Time (AGENT): 398218 ms
Total Talk Time (CUSTOMER): 493261 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/7e8f77fb-142c-4525-9d0c-5c8da39ab94c_20250226T14:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, I just wanted to see where I'm at with the status of my accident claim. I was needing to turn in some documents and so I'm turning one so far just seeing where I'm at.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with your claim status. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Yeah, my name is uh [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Yeah, 244-4567.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the, um, I'm sorry, can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Yeah, [PII]. Uh, mailing address is uh [PII]. Email [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So there's two claims here, um, one was received on [PII], the other on [PII]. Are we looking at both?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Just seeing where I'm at. I need to turn in some kind of receipts. I turned in one. I'm waiting on another one to come from, uh, doctor I see, but just where I'm at with it accidentally.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does it say anything?
[AGENT][NEUTRAL] The one that was received on the [PII], it looks like it was um denied stating that it does not appear that an accidental bodily injury occurred.
[CUSTOMER][NEUTRAL] Look at the one then beforehand. I turned in.
[CUSTOMER][NEUTRAL] Uh, um, uh, you know.
[CUSTOMER][NEUTRAL] Uh, MRI. I don't understand what this accident is, doesn't appear. I was asked to turn in receipts.
[CUSTOMER][NEUTRAL] Of it. Could you look at the one before that then?
[AGENT][NEUTRAL] Now, the one before, yes, I do see where it's saying the item um requesting the itemized charges.
[CUSTOMER][NEUTRAL] Yes, and I sent in the charges.
[CUSTOMER][NEUTRAL] And I showed on the first one that I got an MRI done.
[CUSTOMER][NEUTRAL] And sent in the date. And now I'm, I'm gonna send in a what you call.
[CUSTOMER][NEUTRAL] Just a second, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah, I don't understand the problem. I'm, I'm gonna cancel this. I, I've been paying for this, and when now that the accident, I'm getting thrown all over the place because I, the first day I turned in my MRI showing that I did, I had an accident.
[CUSTOMER][NEGATIVE] And now this one, and y'all say turning receipts. I turning receipts. Now you're saying it's saying it's not showing I had an accident.
[AGENT][NEUTRAL] Let me take a look at this. Hold on one moment. So is this, hold on one second, OK?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Wait a minute.
[AGENT][NEUTRAL] I need to look at the policy certificate because if he's saying.
[AGENT][NEUTRAL] Accident as in like an accident or he's talking about like a car accident.
[AGENT][NEUTRAL] And even if it is a car accident Is covered.
[AGENT][NEUTRAL] Cause they're saying it's not bodily injury, not saying you are in an accident.
[AGENT][NEUTRAL] Right, OK. So is MVA.
[AGENT][NEUTRAL] No, that's what I thought.
[AGENT][NEUTRAL] E
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you so much for holding. I apologize for the wait. I was just taking a look at the policy, um, so that I could understand if this is like a, cause the, the denial reason is saying bodily injury, but you're saying like you were in like an actual accident.
[CUSTOMER][NEGATIVE] Yeah, I was in an accident and an accident like what I'm paying for on my knee and I tore my meniscus. And so the first day that you see that I turned in and was showing that I had a meniscus tear, uh, went to got an MRI done. So then I'm waiting on here and then I call you guys to, I need receipts, OK? And on the [PII] is the one I sent receipts. Now, now you're saying it's saying.
[CUSTOMER][NEUTRAL] I have no proof of battery injury. I, I don't get it.
[CUSTOMER][NEGATIVE] It seemed like 25 different people ain't on the same page and looking at something.
[AGENT][NEUTRAL] Wait a minute. Hold on. These are two different things because this data service is [PII]. This is something different.
[CUSTOMER][NEGATIVE] And look at [PII]. I don't know why they, I don't know why they put [PII]. I didn't turn those in [PII]. [PII] was the day I went in for an MRI.
[AGENT][POSITIVE] This is funny.
[AGENT][NEUTRAL] Right, so that's what I'm looking at. So I'm trying to see if this is two different things, if this is the same thing. So this is two different things that
[CUSTOMER][NEUTRAL] All of us should be under the same umbrella.
[AGENT][NEUTRAL] But these are, when I say different things, I'm saying in terms of providers, we have to split them up, so.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] 11 is a diagnostic, which is a different.
[CUSTOMER][NEUTRAL] Really?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, benefit. So for the diagnostic benefit, they're asking for the itemized billing, which is what you said. So they're going to reprocess that. And then for the second one,
[AGENT][NEUTRAL] What is this?
[CUSTOMER][NEGATIVE] And, and I got another bill, man. I got another bill I'm waiting for in the mail for the diagnostic billing as well. She just can't send it to me through email she sent it to me through mail.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So when you send those in, then they, um, as soon as we receive them, they'll just go ahead and um reprocess the one that's asking for the bills. Now these other, the one that I'm looking at now that that's for [PII].
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] What's the problem with this?
[AGENT][NEUTRAL] Now, for this one, if you'd like, I can get a claims examiner on the line to try to explain it further for you, cause for this it's saying it's because there's no bodily injury, but I do see the um benefits for like for the X-ray and like the diagnostic benefits. So,
[AGENT][NEUTRAL] I'm not an examiner. Maybe these benefits are if there is a bodily injury from the accident, then this comes into play. Um, so I can definitely get an examiner if you'd like to explain, you know, that more.
[CUSTOMER][NEUTRAL] Yeah, I mean,
[CUSTOMER][NEGATIVE] It's that's the reason it's a bodily injury because I had an MRI done proving it's a bodily injury, you see what I'm saying? That proves that the extra fees or receipts that was needed is from me going to the doctor's appointment that so if you go to a doctor's appointments or you go to the doctor for those bodily injuries, maybe I'm wrong, you don't turn in those receipts, that's what that's about.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, I understand. That's why I, I'm, to me, I'm confused on it because I see the MRI is under major diagnostic screening, you have that benefit.
[CUSTOMER][NEUTRAL] Do you turn in those or not?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's the proof
[CUSTOMER][NEUTRAL] Yeah, that's the proof.
[AGENT][NEUTRAL] And that's what you sent in.
[AGENT][NEUTRAL] So I just
[CUSTOMER][NEGATIVE] And then any doctor's receipts for seeing the bodily injury, that's what I'm starting to turn in because I didn't know when I first was turning those in. I didn't know I needed to turn in receipts. I turned them in through an agent, you see what I'm saying, or whoever you guys represent. So I turned in and that person turned them in to you guys. I wasn't hearing nothing. So I started getting letters back saying decline I'm like, well, what's wrong? Then I come, I call you guys personally. You guys saying, well, I, I need receipts.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So now I'm calling the doctors back, you know what I'm saying? I'm calling the first doctor I went to see. I'm calling the diagnostic place that I went to. Hey, can you guys give me receipts? So the first doctor, which I sent in on the [PII], he hurried up and gave me a receipt. That's one. Now the second doctor, the diagnosis, the one I'm waiting on in the mail, that'd be 2, that you, they, they all line in with that one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, like you're just proving what why that was needed, right, I understand. I think the best thing to do would be to speak with the claims examiner because they are the ones that examine it. I mean, I know what I see, but I might be looking at some, they're looking at something I'm not, you know, so I can.
[CUSTOMER][NEUTRAL] You, you with me now, yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Because I don't know.
[CUSTOMER][NEUTRAL] I don't know, I'm thinking this.
[CUSTOMER][NEUTRAL] I'm thinking they thinking I'm turning that in under a totally different claim.
[CUSTOMER][NEUTRAL] You know I'm just turning in a receipt, that's it.
[CUSTOMER][NEUTRAL] But I don't have no bodily injury. I'm thinking they don't understand those dates are not the same, but those are in line with that same.
[CUSTOMER][NEGATIVE] Injury, those receipts, and I'm thinking they, they're two different people or so many two different people, whoever people are doing it, they're not seeing how they're connected. They're more probably just seeing like, well, he's turned in a new claim, he just turned in on a receipt, but that receipt don't show no bodily injury as far as an accident and they just bam, stamped it to my opinion, I don't think they see it lining up.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Now, I can, uh, go ahead.
[CUSTOMER][NEUTRAL] Can I
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][POSITIVE] I can go
[CUSTOMER][NEUTRAL] Now, I was gonna go on a different, I was gonna go on a different topic as well with the, with the, uh,
[CUSTOMER][NEGATIVE] With the uh short term disability because again, I was asked to turn in a document. I want to see, I hope this one don't happen. I was asked to turn in something from my employer that was a, a paper that was missing. I turned in that 3 days ago.
[CUSTOMER][NEUTRAL] I'm hoping they don't, they, they see where that lines up with the missing documents and don't say, well, you turned into one with the employer, but where's the ones with the doctor?
[AGENT][NEUTRAL] Oh, no, now.
[AGENT][NEUTRAL] No, this is, I do. Disability, um, though, no, they're used to now that happens all the time, they're used to that, um.
[CUSTOMER][NEUTRAL] You with me, you with me, you see what I'm saying.
[CUSTOMER][NEUTRAL] Really? OK, they are, they're used to stuff happening like that then, OK.
[AGENT][NEUTRAL] Yeah, because a lot of times the insured doesn't know that all three need to be signed, one from the doctor, one from the, so yeah, they come in all different times.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, OK. So.
[AGENT][NEUTRAL] But once we get everything, then that's when they they um process it. So you're OK on the um disability. I do see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK. Well, can you, I'm OK.
[CUSTOMER][POSITIVE] You do see that I'm OK on that then.
[AGENT][NEUTRAL] Yes, one was received on the [PII] and then one on the [PII]. They're in processing now.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Yeah, cause those, yeah, cause those were separate. I didn't know, like you said, I'm glad it happened because I didn't know that either, you know what I'm saying? So those are sent differently. Now here's, now, well, let's go back to the accident, cause you're right, now you see where my point is on this. All of these are in line with that same, that same uh thinking, but it's just with the accident. Those receipts that I'm about to turn in are still in line with that MRI giving you proof.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Showing I had a meniscus tear with an accident.
[AGENT][NEUTRAL] So this is what I'll do. Let me go ahead and um I'm gonna send.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna send these to.
[AGENT][NEUTRAL] I'm not saying I'm gonna send it back for reprocessing, but I am gonna send it back to claims for research, so that they can look into this into both of them.
[CUSTOMER][NEUTRAL] Do what you need to do for me and help them to understand they're all one. You see what I'm saying?
[AGENT][POSITIVE] Right, and I'm gonna explain that to them and then I'm gonna have them give you a call and make it urgent, and I'm gonna have them give you a call, um, urgent is 24 hours at the most, um, to go over the claim with you and then if this was a case of they just didn't notice it was all one, we can go ahead and reprocess it for you. If there's anything else that's needed, they can let you know so that we can try to get some resolution on this.
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEGATIVE] Yeah, cause, yeah, because I don't understand the problem when I'm turning in proof and now now they said I was missing receipts. OK, now I'm turning in receipts, you know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I do understand.
[CUSTOMER][NEUTRAL] And I got one more to turn in from the diagnosis place which they're mailing to me I'm expecting within 2 days or so. So yeah, so if I, if that, that receipt and all this is under the same umbrella. So whatever you can do to get it started, help them to see all, even if I don't care if you gotta reprocess it all under one umbrella, man, that'd be fine. I just need them to understand this is everything that's tied to that, that they were asking, yeah.
[AGENT][POSITIVE] I sure can. That's not a problem at all. And um that's what um we're here for and claims will be more than happy to take a look at it and go over and if we, you know, have made an error or there's something more we can do, we're gonna do it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, there you go, [PII].
[CUSTOMER][POSITIVE] Yeah, that way, cause it's all kind of spreading out, but I'm glad you did tell me it's normal is different under disability than it is with I, I'm glad you did mention that cause I, I got worried there for a minute.
[AGENT][NEUTRAL] Oh yes, sir.
[CUSTOMER][NEUTRAL] Like, oh man.
[AGENT][NEUTRAL] No, that happens all the time and we, most of the time we get it with the employee section and then we are either missing the employer or the or the doctor. So, once we get it all together then they process the claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] How is that going? Is this is just still in processing basically.
[AGENT][NEUTRAL] Yes, um, so for, um, disability is 7 to 10 business days, um, from the day that we receive it, you should have a decision.
[CUSTOMER][NEUTRAL] Got you, OK.
[CUSTOMER][POSITIVE] Got you OK.
[AGENT][NEUTRAL] So I'm sending this over to claims for some claim research. I'm I'm gonna explain to them that this is all together.
[AGENT][NEUTRAL] Um, showing proof of the meniscus tear and then um ask them to give you a call with an update, um, or to reprocess and then give you a call with an update.
[CUSTOMER][POSITIVE] Right, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you I appreciate that.
[AGENT][NEUTRAL] You're very welcome. And is the phone number, hold on, um, [PII] the best contact number for you?
[CUSTOMER][POSITIVE] Yes it is, yes it is.
[AGENT][POSITIVE] OK, so I'll have them give you a call on that number and I did make this urgent for you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK thank you I appreciate it mhm.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, I just let them know there is another receipt coming as well that that's tied with the with the diagnostics, you remember the one I was sent in the mail, so just.
[AGENT][NEUTRAL] That's in the mail, OK.
[CUSTOMER][NEGATIVE] Yes, in the me coming, yep, because I was late knowing I needed to do it, turn them in. Nobody don't explain all this stuff to you. I just would have waited and did it all at once and it would have looked better, you know, but alright that.
[AGENT][NEUTRAL] Right, that's true.
[AGENT][POSITIVE] But we live and learn now we know.
[CUSTOMER][NEUTRAL] OK, yeah, that's it. Now I know if it happened I just round it all up and bam, here's everything, so yeah.
[AGENT][NEUTRAL] Right
[CUSTOMER][POSITIVE] OK appreciate it.
[AGENT][POSITIVE] All right. You're very welcome. Well, thank you so much for calling APL Mr. [PII]. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, that'll be it thank you thank you so much.
[AGENT][POSITIVE] All right. Well, thank you for calling API. Have a good day.
[AGENT][NEUTRAL] Bye bye.