AccountId: 011433970860
ContactId: b242f830-3fd2-4fa3-b946-e012401a8396
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356010 ms
Total Talk Time (AGENT): 170733 ms
Total Talk Time (CUSTOMER): 140549 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/b242f830-3fd2-4fa3-b946-e012401a8396_20250513T19:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi Miss. [PII], this is [PII] on the care team. How are you today?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][NEUTRAL] It all right so far, thank you. Uh, I've got a member on the line. I'm sorry, she's a little bit irate, so I think you're gonna have to talk to her. I'm sorry ahead of time. Um, I, I don't think it's anything that major, um, so she's calling about an accident claim.
[AGENT][NEUTRAL] Oh boy.
[CUSTOMER][NEUTRAL] And she had submitted the original claim I guess she submitted more information regarding follow up and it's just stating that we need the claim form completed and she's arguing that she had already completed the claim form and so she doesn't know why we need that.
[AGENT][NEUTRAL] OK. Um, what's that policy number?
[CUSTOMER][NEUTRAL] It is 02507767.
[AGENT][NEUTRAL] OK, let's
[CUSTOMER][NEUTRAL] And to add to the confusion, um, the most recent claim has several dates of service, um, but she's stating that she's only wanting it for.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Which I, I looked back at the other one and I don't even see that one listed, so that's why I'm, I don't know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I guess she means from the like the claim form was from the actual accident like the initial accident.
[AGENT][POSITIVE] Got you. OK, I'll see what I can.
[AGENT][NEUTRAL] I'll see what I can find. Let's see here.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And it's Ms. [PII], correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so.
[AGENT][NEGATIVE] My system's so slow. I'm sorry.
[CUSTOMER][NEUTRAL] No, no, no, you're fine.
[AGENT][NEUTRAL] I'd love to blame it on the weather, but I don't even know if it is the weather.
[CUSTOMER][NEUTRAL] I ran out of things to blame. That's just, I'm like, man, I'm out of it today, but I'm like, when have I been in it in the last 10 years? Like I can't keep saying that.
[AGENT][POSITIVE] Valid point, valid point.
[AGENT][NEUTRAL] Oh, I feel that.
[CUSTOMER][NEUTRAL] I mean, I will keep saying it but.
[AGENT][NEUTRAL] Right, you know.
[AGENT][NEUTRAL] OK, so the accident occurred is [PII] fell while walking on the steps at an event venue and fractured her left ankle.
[AGENT][NEUTRAL] And we're saying claim form with disk of accident we need to enclosed claim form completed by the insured given a detailed.
[AGENT][NEUTRAL] Yeah, we have that because this is 3:21.
[AGENT][NEUTRAL] Oh my God. Why? Why Jesus.
[CUSTOMER][NEUTRAL] OK, well, OK, I'm glad you said that though because I, it made sense where she was coming from, but I didn't know if we would need a sep I wouldn't think we'd need a separate claim form if it was for the same initial accident. OK, OK.
[AGENT][NEGATIVE] Not for follow ups.
[AGENT][NEUTRAL] Yeah, so we have a claim form that was submitted in April. It says that the date her accident occurred was [PII] and then we have the initial ER X-rays, her fracture, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And then we have accident follow-ups beginning 324, 4/7, more X-rays like all of it's all done. The thing is that they didn't.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] She doesn't have to. I can let her know. I mean, let me, yeah, it's signed, it's dated.
[AGENT][NEGATIVE] That she even got the provider, no, her employer to fill out their portion and the provider.
[AGENT][NEUTRAL] So like she, she did more than most accident claim. Yeah, she's good. If you want to let her know that this is gonna be um.
[CUSTOMER][POSITIVE] So she's good. OK.
[CUSTOMER][NEUTRAL] I can tell her that we'll just reprocess it.
[AGENT][NEGATIVE] Yeah, yeah, just tell her that we'll go back through and reprocess um it looks like so on the one that was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We're needing a claim form, but it looks like we've already paid initial ER.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So like, I, I don't know if she feels she needs.
[CUSTOMER][NEUTRAL] I think like those others, the most recent she did say that the 25th was all she cared about so I was like there's a lot of data to service so I think she might have just accidentally resent maybe the same information or something.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Everything? OK. So, so 4:25 is the only thing she's needing, is that what you said?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, that's what she said, yeah.
[AGENT][NEUTRAL] OK, OK, alright, tell, um, I mean I can talk to her or you let me know, um.
[CUSTOMER][NEUTRAL] No, I can. That should be fine.
[AGENT][NEUTRAL] OK, we're we'll look at it and make sure that all.
[CUSTOMER][NEUTRAL] The what? I'm sorry you kinda cut out.
[AGENT][NEUTRAL] Of the dates have been captured and what any.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Yeah, I'm sorry you kinda cut out there.
[AGENT][NEUTRAL] I look, girl, I told you.
[CUSTOMER][NEUTRAL] Yeah, no it's it's like you said, that was, that's OK.
[AGENT][NEUTRAL] OK, yeah, it.
[CUSTOMER][NEUTRAL] I'll just let her know that she's, she did everything she was supposed to and we'll just go ahead and get that um processed.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, I will go back and look at everything and make sure that no dates were missed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. OK, well I sure appreciate your help, [PII]. I hope your day gets better.
[AGENT][POSITIVE] Yes, ma'am, you too.
[CUSTOMER][POSITIVE] Thanks. Bye.
[AGENT][NEUTRAL] Uh-huh uh-huh, bye bye.