AccountId: 011433970860
ContactId: 9875ba51-4a6b-4075-a2dc-574e424b738c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 447570 ms
Total Talk Time (AGENT): 187377 ms
Total Talk Time (CUSTOMER): 158280 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=2.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/9875ba51-4a6b-4075-a2dc-574e424b738c_20250418T15:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. How are you? This is [PII].
[AGENT][NEUTRAL] Hi [PII], how are you?
[CUSTOMER][NEUTRAL] I'm good, thank you. Um, I have a member on the line with an accident, uh, claim, and she said that she did send all the information that we underpay the, the, the claim. Um, can you take a look at into this and see what happened?
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Absolutely, what's possible.
[CUSTOMER][NEUTRAL] On the policy number, OK. It's 258439997.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And is it for which member part 4?
[CUSTOMER][NEUTRAL] Cora, part 4. Yes, yes. Mhm. Yeah, it looks like she had an emergency room visit and then she had a follow-up appointment, um, which it looks like we paid $100 for the um physician.
[CUSTOMER][NEUTRAL] And we paid $200 for the ER, um, it looks like the ER visa I'm not sure. But, and based on the benefits, she said that it's supposed to be $300 for the ER visit.
[CUSTOMER][NEUTRAL] And she wants to know what we underpay.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I have to pull the policy up and take a look and everything's been verified.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I did verify all the information. The callback number is the [PII].
[AGENT][NEUTRAL] [PII] sorry.
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty, and it's [PII] I'm speaking to [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, [PII]. Mhm yes.
[AGENT][NEUTRAL] Some like that, OK.
[AGENT][NEUTRAL] Alright, you can go ahead and transfer.
[CUSTOMER][NEUTRAL] OK dokey. Here she comes.
[AGENT][POSITIVE] Thank you so much sir have a good day.
[CUSTOMER][POSITIVE] You're welcome. Have a good day. You too. Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you for holding and being patient for me, Ms. [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] I got Ms. [PII] on the line. She's in the claims support team and she's gonna assist you from here, OK?
[CUSTOMER][POSITIVE] OK, great. Thanks so much. You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Hi, hi, Ms. [PII]. My name is [PII]. I'm on the claim support team. Doing well, thank you. How are you?
[CUSTOMER][NEUTRAL] Hi how are you?
[CUSTOMER][POSITIVE] Good, thank you.
[AGENT][NEUTRAL] And just taking a look at the claim if you'll bear with me for just a moment.
[AGENT][NEUTRAL] And it looks like there's a question about uh the benefit amount that was paid for chorus claim, is that right?
[CUSTOMER][NEUTRAL] Yes, I had submitted two claims. The first one was for a follow-up appointment after her emergency room to her ENT, and that one was paid out as 100, which looked correct to me based on the benefits I had seen associated with the plan, and I had called back asking what else I needed to show for the emergency room visit and so I included the same paperwork with the.
[CUSTOMER][NEUTRAL] And after summary notes from her emergency room visit, and that was paid out, but it was paid out for 200, so I was under the assumption that the emergency room visit.
[CUSTOMER][NEUTRAL] Paid out 300 and then any follow up associated with the accident paid 100.
[AGENT][NEUTRAL] OK, just bear with me for one moment.
[AGENT][NEUTRAL] Because sometimes it's different when it's a dependent the benefit changes, but that doesn't appear to be, let's see.
[AGENT][NEUTRAL] I'm looking at the policy documents now, so just bear with me for one moment.
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] Sometimes it's a different schedule when it's um dependent and so that's what I'm checking now.
[CUSTOMER][POSITIVE] Got you. OK, no problem.
[AGENT][NEUTRAL] And I do see the office treatment is the $100 you're correct with that. Now I do show on the schedule though it should have been $300. So let me um.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Just gonna go to the policy document that just bear with me for one extra minute and like I said I do believe that you are correct um according to what I'm seeing uh.
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] And Ms. [PII], can you tell me, um, the callback number that you provided us, the [PII], is that a good contact number for you?
[CUSTOMER][NEUTRAL] Um, it actually the, the last four are not correct, so it's [PII].
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] [PII] OK [PII] in the [PII].
[CUSTOMER][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so what I'm gonna do at this point is I'm gonna send this back to the adjuster that processed it, have her review that benefit, um, and if, um, if I may just give you a call back once I make that contact, um, and just uh have that reviewed and um reprocess it if need be, but I will call you back and give you the uh results of that inquiry if that's OK with you.
[CUSTOMER][NEUTRAL] Sure, and how can I reference this? Is there, uh, can I get your name? Should I use the phone number that I called in?
[AGENT][NEUTRAL] Certainly, yeah, I was just.
[AGENT][NEUTRAL] Yeah, I will just give you my name and again I'm on the claim support. I'm the only [PII] here is [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but I'm gonna reach out now. I'm sending that message as we speak, so I'm just not, I don't wanna leave you on the phone to hold or anything, but I will definitely give you a call back either way and uh let you know what the uh outcome of the inquiry is.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] And it should be today hopefully uh very soon but it will definitely be today but I'll give you a call back shortly and just like I said, let you know uh what that inquiry uh you know provided for me, OK?
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][NEUTRAL] You're welcome. And did you have any other questions at this time, just let me know?
[CUSTOMER][POSITIVE] No, no, that's it, thank you.
[AGENT][POSITIVE] You're welcome I'll call you back shortly thank you.
[AGENT][POSITIVE] Thank you for your patience bye bye.
[CUSTOMER][POSITIVE] Thanks bye bye.