AccountId: 011433970860
ContactId: b19ab7eb-d70b-4311-bd8c-8c62b12b82a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 476480 ms
Total Talk Time (AGENT): 211205 ms
Total Talk Time (CUSTOMER): 148458 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/b19ab7eb-d70b-4311-bd8c-8c62b12b82a4_20250107T17:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] How you doing today [PII] uh, yeah, I got a um.
[CUSTOMER][NEUTRAL] I got a question for you. Uh, they sent me, well, not that you guys sent me uh.
[CUSTOMER][NEUTRAL] Uh, what is this called? Let me see. It's called the explanation of, of benefits.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] All right, and it's a uh on the back it says uh.
[CUSTOMER][NEUTRAL] Uh, the receipt of your claim is acknowledged, however.
[CUSTOMER][NEUTRAL] To provide further consideration of your claim, we will need out of mass treatment received. Do you, uh, probably, you probably need my name first, huh? That would be smart.
[AGENT][POSITIVE] Yes sir, can you please give me your name and your callback number just in case the call gets dropped off I can call you right back.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, uh, my name is [PII].
[CUSTOMER][NEUTRAL] [PII] Last name [PII].
[CUSTOMER][NEUTRAL] You need the claim number?
[AGENT][NEUTRAL] Um, can I get
[AGENT][NEUTRAL] first and then we'll get the claim number [PII].
[CUSTOMER][NEUTRAL] 937.
[CUSTOMER][NEUTRAL] 267
[CUSTOMER][NEUTRAL] 0402.
[AGENT][NEUTRAL] OK, and then what is the claim number sir?
[CUSTOMER][NEUTRAL] It's uh 35.
[CUSTOMER][NEUTRAL] 444
[CUSTOMER][NEUTRAL] 80
[AGENT][NEUTRAL] OK, and then also can you give me your policy number, sir?
[CUSTOMER][NEUTRAL] Policy number OK it's uh 02.
[CUSTOMER][NEUTRAL] 42
[CUSTOMER][NEUTRAL] 7155.
[AGENT][NEUTRAL] OK, let me pull your policy in real quick for us so we can check that claim for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'll need for you to verify some information for me. Can you give me your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you sir and then also I'll need for you to please verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] Uh, the address is [PII].
[CUSTOMER][NEUTRAL] And what else did you ask for?
[AGENT][NEUTRAL] Your email address?
[CUSTOMER][NEUTRAL] Yeah, so my
[CUSTOMER][NEUTRAL] Uh, my my email address is uh [PII].
[CUSTOMER][NEUTRAL] S H U G
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then the um phone number you provided for me to call you back if we get disconnected is that your cell phone number, sir?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][POSITIVE] OK, thank you so much. Alright, let me pull this claim in so I can get you some help.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, there's um I'm seeing.
[AGENT][NEUTRAL] Two remarks on the claim.
[AGENT][NEUTRAL] Um, we need toothache.
[CUSTOMER][NEUTRAL] Yeah, I'm looking at the remark.
[AGENT][NEUTRAL] Yes, so in order for, in order for them to finish processing the claim, the claim needs to be completed by you, your physician.
[CUSTOMER][NEUTRAL] What's that?
[AGENT][NEGATIVE] You and your physician and it needs to be returned back to our office.
[AGENT][NEUTRAL] And it would be used um.
[AGENT][NEUTRAL] Proof of loss for your critical illness diagnosis.
[AGENT][NEUTRAL] And then the other thing that I'm seeing that you need to send in.
[AGENT][NEUTRAL] Is that my statement?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] There's a whole statement?
[AGENT][NEUTRAL] For the treatment the itemized bill for your treatment received and medical records for the data service.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So, you can get that from the facility that you.
[CUSTOMER][NEUTRAL] Should, shouldn't you have that, shouldn't you?
[CUSTOMER][NEUTRAL] I, I, I think I said that I had the hospital, I had the hospital send that before to you.
[AGENT][NEUTRAL] Sir.
[AGENT][NEGATIVE] Um, according to the remarks on the claim, we have not received it.
[CUSTOMER][NEUTRAL] Uh, yeah, I, I figured you had to when you uh.
[AGENT][NEUTRAL] So they'll need
[CUSTOMER][NEUTRAL] Your phone going in and out.
[AGENT][NEUTRAL] Yes, sir. According to, according to, yes, sir, can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah, I hear you now. I, I do.
[AGENT][NEUTRAL] So, OK. Sorry about that, [PII]. So we'll need the auto.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] and we'll also need your medical records and we'll need both you and your physician to fill out the claim form.
[CUSTOMER][NEUTRAL] So, uh, I did that and it's saying that if you, if you keep reading the notes and say, uh, please submit a lighter copy, I don't understand.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, let me see what that says. No, I don't see that, um.
[CUSTOMER][NEUTRAL] You see that on there?
[AGENT][NEUTRAL] That would have been added.
[AGENT][NEGATIVE] I don't see receiving a letter copy.
[CUSTOMER][NEUTRAL] It's like we received the itemized seat.
[AGENT][NEUTRAL] Is that from our, uh-huh.
[CUSTOMER][NEUTRAL] It say we received the itemized bill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Your claim benefit, we need admission and discharge summary notes including the results of all tests.
[CUSTOMER][NEUTRAL] For hospitalization.
[CUSTOMER][NEUTRAL] But I'm saying when I got uh when I got one insurance check for the for the uh for the, what was that maybe like the accident part.
[CUSTOMER][NEUTRAL] Uh, I sent all that in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm saying like,
[AGENT][NEUTRAL] OK, alright, so what, yes sir, so what I'm going to do is I'm gonna go ahead and transfer you on over to the claims department so you could speak to an examiner, um, since you're telling me that you've sent all the information in them already and you've got notes that I can't see so I'm gonna get them to help you assist you further so you can get some answers.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome. It's gonna be a brief hold while I transfer you on over, Mr. [PII], and I thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you too.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] For calling APL, this is [PII]. How may I assist you today?
[AGENT][NEUTRAL] Hi [PII], it's [PII] in the care team. I've got um Mr. [PII] on the phone.
[AGENT][NEUTRAL] His policy number is 242-715-5.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He is calling.
[AGENT][NEUTRAL] Claim number 354-448-0.
[AGENT][NEUTRAL] I read him the remarks on the claim and he needs further assistance.
[CUSTOMER][POSITIVE] OK. All right. Uh, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're welcome. It's gonna be a brief hold while I transfer him over. Thank you.