AccountId: 011433970860
ContactId: b01a3c6d-1874-4aba-806c-167b0e6306f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 778460 ms
Total Talk Time (AGENT): 201710 ms
Total Talk Time (CUSTOMER): 159695 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/b01a3c6d-1874-4aba-806c-167b0e6306f6_20250515T13:31_UTC.wav
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[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], I have a problem with the, uh, one of my claims.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I want to discuss.
[AGENT][POSITIVE] All right, I'm happy to check.
[CUSTOMER][NEUTRAL] Uh, you need to
[CUSTOMER][NEUTRAL] You need the claim number.
[AGENT][POSITIVE] Sure, that'll work.
[CUSTOMER][NEUTRAL] 36012
[CUSTOMER][NEUTRAL] 09
[AGENT][NEUTRAL] All right, let me pull that up here. Give me just a moment, please.
[AGENT][NEUTRAL] All right. On the policy, can I please verify name and date of birth?
[CUSTOMER][NEUTRAL] Uh, her name, you want her name because she's the one that was in the hospital.
[AGENT][NEUTRAL] That's, yeah, you can give me, it doesn't matter either or.
[CUSTOMER][NEUTRAL] Or do you want mine?
[CUSTOMER][NEUTRAL] She, she's my, my name is [PII].
[CUSTOMER][NEUTRAL] What else do you need?
[AGENT][NEUTRAL] Uh, date of birth, please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then can I verify your address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you so much. OK.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] It's a critical illness claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] My wife had a heart attack.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She was, uh, in the ambulance giving her CPR, then they had to shock her.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then they took her and put her and then they put a stent in the right artery.
[CUSTOMER][NEUTRAL] And y'all are saying you're paying $50 and that's according to my.
[CUSTOMER][NEUTRAL] Uh, benefits claim you should be paying $7500.
[AGENT][NEGATIVE] So it looks like there were 2 denials on the claim. It looks like we need an itemized bill.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I sent you an itemized bill.
[AGENT][NEUTRAL] Mm, OK, let me take a look.
[CUSTOMER][NEUTRAL] I sent you an itemized bill from the hospital and I sent you an itemized bill from the uh.
[CUSTOMER][NEUTRAL] Coronary, uh, coronary.
[CUSTOMER][NEUTRAL] Institute of the South or yeah.
[CUSTOMER][NEUTRAL] Did it at the same time that I filed a well, uh, a, uh, hospital indemnity claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And was on the phone with the person that told me she had received it.
[CUSTOMER][NEUTRAL] And they haven't asked for anything else.
[AGENT][NEUTRAL] The only other thing I see is.
[AGENT][NEUTRAL] It does say the enclosed claim form must be completed by you and your physician and returned.
[AGENT][NEUTRAL] The claim forms should be used.
[CUSTOMER][NEUTRAL] I asked that
[CUSTOMER][NEUTRAL] I asked the lady
[CUSTOMER][NEUTRAL] That I talked with when I called in there if I needed to fill that form out, she said, no, we have all that information.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Because I was gonna fill it out online.
[CUSTOMER][NEUTRAL] But, but you have all that information from the other claim I.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And it told me that y'all had received everything.
[CUSTOMER][NEUTRAL] According to the, uh, you know, according to your website to where you track it and everything.
[AGENT][NEUTRAL] Yeah, I know. I mean, I see the upload. I'm looking at the pages that were submitted now.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I mean it should be pretty easy.
[CUSTOMER][NEUTRAL] I mean the other claim was to I I can give you both claim numbers if you want.
[CUSTOMER][NEUTRAL] Because it was the same, you know, same itemized bills that I've sent to both of them.
[CUSTOMER][NEGATIVE] Doesn't make sense.
[AGENT][POSITIVE] Mhm. Yeah, absolutely.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Um, we can do two different things on this, [PII]. So, I mean, it does say.
[AGENT][NEUTRAL] About the claim form, I hear what you're saying as far as when you spoke to the representative, they said it wasn't needed. I do see that it is asking for that.
[AGENT][NEUTRAL] Um, I see the upload on the receipt, the 8 pages. Um, I can call over to a claims examiner and have them look at this with you on the line. I can have somebody call you back and then if there was an error on our part, you know, have it reprocessed. What would you prefer to do?
[CUSTOMER][NEUTRAL] Well it's an error on your part apparently so if you wanna put somebody on the line, let's talk about it now because I have to go to work.
[AGENT][POSITIVE] OK, let me get somebody on the line for you. What's a good call back number if anything happens?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Alright, thank you so much. Give me one moment please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][NEUTRAL] Thank you for calling American Public Life. This is [PII]. Who am I speaking with?
[AGENT][NEUTRAL] Hi, [PII]. This is [PII] in customer care. How are you doing this morning?
[CUSTOMER][NEUTRAL] Good and yourself?
[AGENT][POSITIVE] I'm good, thanks. Um, I have an insured on the line a little frustrated about a denied claim, and he'd like to speak to somebody about it. I was hoping you could help.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, policy number is gonna be 21820887.
[AGENT][NEUTRAL] Should come up for [PII], that's who we're speaking to is [PII]. The claim is for [PII] though.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the claim number is gonna be 360.
[AGENT][NEUTRAL] 1209.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So, I did advise him that it was asking for the critical illness like claim form. He got super frustrated saying that he spoke to somebody and they told him that wasn't needed. I did apologize.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and then I said, you know, I gave him the other denial stating, you know, hey, we need, it looks like an itemized bill.
[AGENT][NEUTRAL] Uh, with diagnosis, and he's like, I gave you a bill. Well, I see the bill, but I just see CPT codes and I don't see a diagnosis unless I'm missing something, but he thinks it's an error on our side.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, he
[AGENT][NEUTRAL] Cause he said he uploaded, I guess the same thing on his.
[AGENT][NEUTRAL] Indemnity policy.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Oh no, he's been told we need the claim form, so OK, let me pull the.
[CUSTOMER][NEUTRAL] the claim
[CUSTOMER][NEUTRAL] It's weird that there's no diagnosis code has all the itemized.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] I didn't see anything like when I scrolled, yeah, when I scrolled through it, so.
[CUSTOMER][NEUTRAL] Uh, yeah, me neither.
[CUSTOMER][POSITIVE] OK, well, I'm ready when you are have everything pulled up.
[AGENT][POSITIVE] OK, here he comes, thank you.
[CUSTOMER][POSITIVE] Alright, no problem.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi, this is [PII] uh in the, uh, claims department. How can I help you?