AccountId: 011433970860
ContactId: b842f3f8-c4e7-4216-be9e-aebdb65b17b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 989940 ms
Total Talk Time (AGENT): 215929 ms
Total Talk Time (CUSTOMER): 377777 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/b842f3f8-c4e7-4216-be9e-aebdb65b17b3_20250502T14:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII], this is [PII]. I am having trouble getting into um
[CUSTOMER][NEUTRAL] The site um.
[CUSTOMER][NEUTRAL] To be able to send some claim forms.
[AGENT][NEUTRAL] OK, have you created an account before?
[CUSTOMER][NEUTRAL] Uh, it says I have, but I don't know.
[AGENT][NEUTRAL] OK, do you have your policy number?
[CUSTOMER][NEUTRAL] Mm, let me look. I probably have it on these forms. Hold on.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can also look it up by your last name or social.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, my social is [PII].
[AGENT][NEUTRAL] OK, getting that pulled up, one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Which policy are you trying to submit a claim for?
[CUSTOMER][NEGATIVE] Uh, cancer.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK. And what is your date of birth, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] OK, thank you. And just need two more pieces of information. What is your address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then your email address?
[CUSTOMER][NEUTRAL] Well, I have 2.
[CUSTOMER][NEUTRAL] And I don't know
[CUSTOMER][NEUTRAL] She had to send me the information.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The uh she had to send me the information to my work email because I don't have my um.
[AGENT][POSITIVE] Looks like a work.
[CUSTOMER][NEUTRAL] We don't have internet right now at our home, so would I give you that one?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Alright, it's [PII].
[CUSTOMER][NEUTRAL] At Lincoln Prep.school.
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] OK, let me look and see if we've got an account already established.
[AGENT][NEUTRAL] OK, yes, it looks like you've got an account set up.
[AGENT][NEUTRAL] Um, your username is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Because it, I don't know my password, I guess.
[AGENT][NEUTRAL] Uh, you'll have to reset it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, were you able to get it reset?
[CUSTOMER][NEUTRAL] Doing that now.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Uh oh, I just read the bottom hold on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] Get loaded.
[AGENT][POSITIVE] Oh, awesome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Now how do I upload the file?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] See, I've mailed stuff in before.
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] Um, I'm looking, hold on one moment, so it should be you have your dashboard, um, and then it should say.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] There should be like a dashboard and it'll say upload claims.
[AGENT][NEUTRAL] Or upload documents.
[AGENT][NEUTRAL] Under file a claim.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yeah, upload files.
[AGENT][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so I click that.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what? Let's see.
[AGENT][NEUTRAL] You have your files on your.
[CUSTOMER][NEUTRAL] File a claim.
[AGENT][NEUTRAL] Yeah, file a claim.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] OK, I've got to use, I don't, I can't.
[CUSTOMER][NEUTRAL] I don't know exactly, um.
[CUSTOMER][NEGATIVE] I can't send it through this computer. I've got to go to another computer.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So how do I do that? Just upload documents?
[AGENT][NEUTRAL] Log log into whatever computer you have the documents on. So you'll log into your account on that computer and then you'll go to that upload documents, and then click upload files, and then grab those files off your computer, the ones that you want to send to us.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm, I'm kind of computer illiterate my um.
[CUSTOMER][NEUTRAL] Supervisor is gonna help me do this, but.
[CUSTOMER][NEUTRAL] Do I just put them like on a um.
[CUSTOMER][NEUTRAL] Jump drive or something? I, I don't understand. She'll help me do it, I know, but so you just upload documents. I'm gonna click it and see.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Yeah, usually,
[CUSTOMER][NEGATIVE] OK, it's not doing.
[AGENT][NEUTRAL] Usually like, um, if you have access to a printer, you can scan the documents to your computer and then it'll put that file on your computer, and then from there you can grab the file from your computer and upload it.
[CUSTOMER][NEUTRAL] OK, and send it to y'all?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. I'm gonna try.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I, I've mailed it before.
[AGENT][POSITIVE] If y'all have any issues.
[AGENT][POSITIVE] Yeah, you and you can absolutely mail it you can mail it, but it is faster if you wanna do it through the computer, um, and if y'all have any, if you have any issues when you're doing it, please just give us a call back and we'll walk you through every step.
[CUSTOMER][NEUTRAL] Ma'am?
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that sounds wonderful.
[CUSTOMER][POSITIVE] Wonderful, wonderful. OK.
[CUSTOMER][POSITIVE] I think I've got it all together. Well, I appreciate it, [PII].
[AGENT][POSITIVE] Absolutely. Here to help and glad to help and I hope you have a great day. And is there anything else I can help with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] I sent in.
[CUSTOMER][NEUTRAL] They, um,
[CUSTOMER][NEUTRAL] Intensive care forms a while back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I guess.
[CUSTOMER][NEUTRAL] I guess they were denied. I'm not sure but.
[CUSTOMER][NEUTRAL] Um, he was in intensive care.
[CUSTOMER][NEUTRAL] But I don't know if they coded it right on I just sent a hospital bill.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that, but like on one spot it says room surgical services.
[CUSTOMER][NEUTRAL] But it was intensive care or uh.
[CUSTOMER][NEUTRAL] You know, he was in there quite a while in intensive care in several places it says surgical services, but I don't know if the code is incorrect or what, but all these claims were denied.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I was looking the other day and y'all have a new.
[CUSTOMER][NEUTRAL] Uh, form for that, right? A critical illness form?
[AGENT][NEUTRAL] Um, yeah, let me look up that policy. And you said that was your intensive care policy, right?
[CUSTOMER][NEUTRAL] Yes, it was on my husband.
[AGENT][NEUTRAL] OK, let's get that pulled up. Hold on one moment.
[AGENT][NEUTRAL] OK, let's see, and that was for [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] happened.
[AGENT][NEUTRAL] Is it from, let's see.
[AGENT][NEUTRAL] From [PII].
[AGENT][NEUTRAL] Is that right?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][NEUTRAL] OK, let's see um.
[CUSTOMER][NEGATIVE] I mean I've had this policy for years and years and I was surprised that it denied that one.
[AGENT][NEUTRAL] Well, it stated that it was due to not being at the highest level of care in the intensive care unit, but let me pull up what we received and see what's going on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I think it it looks like because the bill didn't say ICU. It just said moderate.
[AGENT][NEUTRAL] MDM
[AGENT][NEUTRAL] Um, it didn't indicate anywhere on here that he was ICU.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, see, that's what I'm asking. It says room critical care services on one on one charge and then on another charge it says uh surgical, you know, room and it that I don't know that they coded it wrong or what, but he was in intensive care. See on this one it says on 63 it says critical care services.
[CUSTOMER][NEUTRAL] I, I don't know, do I need to get like his records from the to.
[CUSTOMER][NEUTRAL] From the hospital? I mean, I thought the bill was enough.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, if you could get some type of records that show he was in the intensive care unit.
[AGENT][NEUTRAL] Because that's what we're looking for.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, but this says critical care services, that's not the same thing.
[AGENT][NEUTRAL] No, um, we need to see that it shows intensive care.
[AGENT][NEUTRAL] Um, so yes, I would, I would check with medical records and see if you can get the records because that should indicate if he was in intensive care.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He was, trust me, but I have another question. have to fill out these new critical illness claim forms?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, you don't have to fill those out again. Yeah, you can just send the medical records, yeah.
[CUSTOMER][NEUTRAL] Or can I just send
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEGATIVE] I tried to get them and um I don't know if they sent them to my husband's email. I can't get his email like I said we're we're in a mess we don't have uh internet and he's sick right now, um.
[CUSTOMER][NEGATIVE] He's having heart issues now.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEGATIVE] He's gonna have to have on his heart. He's got congestive heart failure. He's had cancer. It's just terrible, but I will try to get those records and resubmit those.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] OK, that sounds good.
[CUSTOMER][NEUTRAL] And I will try to get
[CUSTOMER][NEUTRAL] I can send just what cancer things I have now. It's not the whole um treatment. It's just the first, you know, couple of years and then, I mean, he's still going back and forth to [PII] now.
[CUSTOMER][NEUTRAL] So I can send what I've got now right? until I fill out.
[CUSTOMER][NEUTRAL] The rest of them.
[AGENT][POSITIVE] Yes, absolutely, yeah, you can do that.
[CUSTOMER][NEUTRAL] OK. OK. OK.
[CUSTOMER][POSITIVE] Well, thank you, [PII]. I appreciate it.
[AGENT][POSITIVE] Well thank you, Ms. [PII], and I hope you have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Great day
[CUSTOMER][NEUTRAL] Bye bye.