AccountId: 011433970860
ContactId: b49032f6-b23d-457a-9321-1517bd5239b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1082380 ms
Total Talk Time (AGENT): 255499 ms
Total Talk Time (CUSTOMER): 340694 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/b49032f6-b23d-457a-9321-1517bd5239b0_20250609T19:20_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yes, ma'am, uh, this is [PII]. Uh, my policy number is 2088763.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] And Ms. [PII], for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII]. Email is uh [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Thank you. And a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Uh, the same number [PII].
[AGENT][POSITIVE] Thank you. And how may I assist you today, Ms. [PII]?
[CUSTOMER][NEGATIVE] OK. I called last week because I was not able to get into my account and they told me I had to re-register because y'all got new software update. And uh we, they were having trouble. My my latest claim I filed was not showing up anywhere and she told me that it would take a while for that to update.
[AGENT][NEUTRAL] Mm mhm.
[CUSTOMER][NEUTRAL] Um, I got a text on Saturday saying this latest claim had been processed and for me to go view it online, but it doesn't give, I mean, it shows it paid 0, so I'm trying to figure out if it really paid 0 or if it really hasn't processed yet.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. Um, let me check and see what happened to that claim, OK? So let me pull the documents and the claim details.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] And have you tried to get into the website to view it or are you still having troubles getting there?
[CUSTOMER][NEGATIVE] Oh, I'm, no, it shows, no, I'm, I've, I had to re-register. I'm in the website, but it says on this claim 361-024-9 says processed amount paid 0 OK it says it was completed on [PII] and I can't imagine it didn't pay any of that claim at all.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, and did they give you an option for you to view the EOB or no?
[CUSTOMER][NEUTRAL] Uh, down, um.
[CUSTOMER][NEUTRAL] OK, download.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, it just says, yeah, it just doesn't.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Duplicate of previous.
[CUSTOMER][NEUTRAL] I don't know why it says that duplicate.
[AGENT][NEUTRAL] OK, let me look at the.
[CUSTOMER][NEUTRAL] Because I, this is my first.
[CUSTOMER][NEGATIVE] This is my fir it might be a duplicate because they had to reenter it into their new system, but it is not a.
[CUSTOMER][NEUTRAL] Duplicate because I filed it back. Oh.
[CUSTOMER][NEUTRAL] I don't know, April, and they were waiting on hospital bills to get it. And so those didn't come through till May. I mean, I was really waited a couple of months to get the hospital bills. So this, I don't know why it's saying it's a duplicate.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and let me see, um, let me check and see why this pain is like.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And the itemized seal you said was from [PII].
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Mm yeah.
[AGENT][NEUTRAL] OK. So in this case, what I have to do is um I can go ahead and um send a request over to an examiner to give you a call back and check and see why is it a duplicate um or I can try to get somebody on the line.
[CUSTOMER][NEGATIVE] Well, I would rather, this has been going on almost 3 months. It's really irritating. I mean, it took forever to get the hospital bill. And then in the meantime, y'all got the hospital bill, updated your software, and so maybe it's a problem on your end where you think I'm filing a duplicate claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Maybe they had to reenter it in the system some way. I mean, it's not duplicate. It's never been processed before.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, and I'm trying to see if I can view the documents to see if it's the same one or it's different ones or.
[AGENT][NEUTRAL] What's going on.
[CUSTOMER][NEUTRAL] So, this is what it's showing here, the hospital stay, intensive care, ambulance, all that.
[AGENT][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Um, I submitted all that several months ago and they said, well, you have to have the hospital bill before we'll pay for an ambulance to the hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so anyway, it took till May to get all that. They faxed it over about 2 or 3 weeks ago. And then I guess y'all had a software update.
[CUSTOMER][NEGATIVE] So nothing's ever been processed on this.
[AGENT][NEUTRAL] Yeah, the, the soft, yeah, yeah, the software update and the documents that you send in after it doesn't collage or anything with each other, so, um, it will not, mm, you know.
[AGENT][NEUTRAL] Collage or just ruin the claim, so it's, it's not they just went ahead and look into it and it looks like it was the same information but if you feel that that's not correct, I can always send a request for a an examiner to call you back after reviewing all the documents.
[CUSTOMER][NEGATIVE] Yeah, is there somewhat, yeah, I need to I need to talk to them as soon as I can because I guess I'm just, it's the first time I've ever filed a claim on this insurance in 15 years and it's a little disheartening that
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I can't get and I've got to file another one, but I was gonna make sure this one got.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I mean, I don't even know how they could say it was a duplicate. Yeah. So I would rather hold and try to get someone.
[AGENT][NEUTRAL] OK, yeah, let me, let me go, OK, OK, yeah, let me try that first, OK, one moment.
[CUSTOMER][POSITIVE] Thank you. OK.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Currently no agent staff. Goodbye.
[CUSTOMER][NEUTRAL] I know agent staff. Goodbye.
[CUSTOMER][NEUTRAL] I know agent staff.
[AGENT][NEUTRAL] Thank you for holding. I'm still waiting. Um, do you wanna continue waiting?
[CUSTOMER][NEUTRAL] Well, I guess I need some options. I mean, I know they take my number, but do they really call you back or is it one of those things you wait for a week?
[AGENT][NEUTRAL] They do.
[AGENT][NEUTRAL] No, they do. We have to report it. um I think somebody became available. Let me see if I can catch her, OK? One moment.
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[AGENT][NEUTRAL] Hi [PII], how are you?
[CUSTOMER][POSITIVE] Good thanks how are you?
[AGENT][NEUTRAL] I'm good. This is so. Um, I have a member on the line that she set up said that we processed the claim and denied as a duplicate and she said this is not a duplicate that somebody needs to be looking into documents correctly. I don't know if you can assist her, and then she has to speak to somebody. She didn't want to call back.
[CUSTOMER][NEUTRAL] OK, alright, what's the policy number?
[AGENT][NEUTRAL] It's 208-876-3.
[AGENT][NEUTRAL] It's a lot of documents, so I don't know if you can, you probably will have to call her back.
[AGENT][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] And is that for her [PII]?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] Uh yes, I'm [PII].
[CUSTOMER][NEUTRAL] And she's the one that called or she's the one on the line?
[AGENT][NEUTRAL] Yeah, she's the one in the line, mhm.
[CUSTOMER][NEUTRAL] OK, and that's her callback number [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] and it's claim 361.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] 249.
[CUSTOMER][NEUTRAL] And she's saying we denied it as duplicate?
[AGENT][NEUTRAL] Yes, we denied it as duplicate and then that is not duplicate, that is a different claim.
[AGENT][NEUTRAL] She said the item I feel of the surgery, I guess, and that's what we were asking to process the remaining of the claim. So she's a little confused saying why we process as a duplicate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me pull that up.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Everything's been verified correct?
[AGENT][POSITIVE] Yes, everything has been verified, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I'm pulling up the um documents now so you can.
[AGENT][NEUTRAL] And when you're ready.
[AGENT][NEUTRAL] Yeah, I know, and it's a lot of documents. I know. I try to pull I'm like, oh, that's 31 [PII], OK.
[CUSTOMER][NEGATIVE] So she's saying we asked for something and then we denied it as duplicate.
[AGENT][NEUTRAL] Yes, she said we asked for the uh surgical bills so we can pay any ambulance or any charges for the um for the um for the ambulance and stuff like that. And that's what she said, she said and um that we still, um, we went ahead and denied it as a duplicate. So basically she's, she says upset because we denied it as a duplicate and she thought that that's what we needed to process the remaining of the claim that we did not pay.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Did I explain myself correctly?
[CUSTOMER][POSITIVE] All right. I think I got it.
[AGENT][POSITIVE] OK, I'm so sorry. OK, here she comes. Oh, good afternoon, [PII].
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you for holding and being patient for you, Miss [PII]. I got Miss um Miss [PII]. I, I do apologize. I got Ms [PII] on the line.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hi Ms. [PII], my name is [PII]. I'm on the claim support team, so I understand that we um had requested some information and you submitted it and we denied it as a duplicate. Is that right?
[CUSTOMER][NEUTRAL] Yes, um, I don't know why. I mean, it, I mean, they got the stuff I think it was [PII] or the [PII], and I thought, OK, this probably has a, is it one of their computer new software glitches or something because I called last week and she goes, it's just not showing up yet. So I said, OK. I said, I don't understand.
[CUSTOMER][NEUTRAL] Why it's not even showing up there that I filed the claim. And she said, well, it's in there, you just can't see it on the computer. And I said, OK. So then Saturday, I got an email saying it's been processed. So then I go in there today to look at it and it says it's a duplicate. And I'm like, OK, well, I don't know.
[CUSTOMER][NEUTRAL] I don't know why they say it's a duplicate.