AccountId: 011433970860
ContactId: b89c8a7a-0690-44ce-9c71-4c7e8508962e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 597409 ms
Total Talk Time (AGENT): 293668 ms
Total Talk Time (CUSTOMER): 155083 ms
Interruptions: 3
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/b89c8a7a-0690-44ce-9c71-4c7e8508962e_20250527T17:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I just uploaded um a few things on my claim. Can you guys merge the two so when the adjuster looks at it they can look at everything.
[AGENT][NEUTRAL] Oh, you needed to add documents to a claim you've already submitted?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I just uploaded them.
[AGENT][NEUTRAL] OK, it should have gone to the claim did you file it under the same claim number or did it give you that option?
[CUSTOMER][NEUTRAL] No. Mm mm.
[AGENT][NEUTRAL] OK, now we typically if we we typically whenever we ask for more documentation if you can put the.
[AGENT][NEUTRAL] The claim number on there um that's helpful but it should be able to whenever the examiner looks at it go to the policy that it needed more information on um did you want me to check for you?
[CUSTOMER][NEUTRAL] Sure. It's um the, the policy number is 25, the policy's number is 254-5851.
[AGENT][NEUTRAL] OK, I.
[AGENT][NEUTRAL] And what's your name and phone number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK one moment.
[AGENT][NEUTRAL] Let me check on that for you and you said you submitted it the extra information today?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me check.
[AGENT][NEUTRAL] [PII], can I get you to verify your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the address and phone number that we have on file?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Um, let me see here.
[AGENT][NEUTRAL] And were you submitting on your behalf?
[CUSTOMER][NEUTRAL] No, my husband [PII].
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] There we go.
[AGENT][NEUTRAL] I do show us as having received it um it has not been processed yet so I can't see if they.
[AGENT][NEUTRAL] I do show that we received it, but I can't show if we can add the claim number in there um what the the examiner will do is they will look at it.
[AGENT][NEUTRAL] And they will put they they should be able to match it with the claim that got denied recently um and match it with that.
[CUSTOMER][NEUTRAL] OK, have a claims so I've gotten it already.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Has a claims rep received it already?
[CUSTOMER][NEUTRAL] I know what you received, but it's in processing it.
[AGENT][NEUTRAL] Yes, it is in processing um.
[AGENT][NEUTRAL] I would allow anywhere from 7 to 10 business days depending on how much documentation was was needed um because they review every piece of uh every document that's submitted so we just like to say a rule of thumb 7 to 10 business days um it might be less if it was only 1 or 2 pieces of information.
[CUSTOMER][NEUTRAL] OK, but it's been in there for almost a week now and I submitted new documentation.
[CUSTOMER][NEUTRAL] They didn't ask. I just submitted it.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Do you know what the
[AGENT][NEUTRAL] Date of service was and I can check on that.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Of this year.
[AGENT][NEUTRAL] Do you know what it was for or the charge?
[CUSTOMER][NEUTRAL] Um, it was for a knee replacement.
[AGENT][NEUTRAL] Cause I am showing several.
[CUSTOMER][NEUTRAL] It was one I just put in last week.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I am showing several that got.
[AGENT][NEUTRAL] That are finished processing. Let me see if I can figure out which one it is.
[AGENT][NEUTRAL] You said last week.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, if you submitted it last week, I am showing one that was submitted on the [PII]. That one has not been completed yet.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, have they started looking at it?
[AGENT][NEUTRAL] I can't tell if someone's looking at it right now. All I can say is that it's been received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me check on something real quick.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] It looks like it is being worked on.
[AGENT][NEUTRAL] It's just not, it's not completed yet. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, who can we send those can we send the documents to the process of who's working on it?
[AGENT][NEUTRAL] They will do that once they they submit they've gotten all of your information and all of the paperwork now they're just putting it all together and processing it.
[CUSTOMER][NEUTRAL] Right, but I'm talking about the new paper.
[AGENT][NEUTRAL] I can't see on my end who's doing it.
[CUSTOMER][NEUTRAL] OK. Can you send, can you send me the claims?
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Whisper if you're gonna talk. You, you are loud.
[CUSTOMER][NEUTRAL] Ferring
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] with the care team. I have [PII] on the line. She [PII], she submitted some extra documentation and then she was wanting to know um if she needed anything else. I, it was kind of hard to understand her. I told her that it was being worked on and being processed, um, but then she asked if I could send her to claims instead.
[AGENT][NEUTRAL] Because I can't see who's looking at her claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, sure. What was the policy number?
[AGENT][NEUTRAL] The policy number is 254-585-1.
[AGENT][NEUTRAL] I've verified her and she's speaking on behalf of her husband because she's the one who submitted the claim um she's verified everything.
[AGENT][NEUTRAL] She said, I do see that she submitted documents today um towards a claim that she had already been working on. It looks like from what I understand, the claim that she submitted last week, she didn't say she needed any. We asked her for any of this extra information. She just provided more documentation.
[AGENT][NEUTRAL] And she was wanting to know if she needed to do anything further.
[CUSTOMER][NEUTRAL] OK, and what claim number was she referring to?
[AGENT][NEUTRAL] Since they haven't been processed yet, there's not a claim number.
[AGENT][NEGATIVE] It's just the first two on there for part two. They show 0 all the zeros.
[AGENT][NEUTRAL] I have the date of service though.
[CUSTOMER][NEUTRAL] Oh, so she's checking on the claim status for the new claims?
[AGENT][NEUTRAL] Yeah and I yeah and I am showing one for the date of service that she's asking for but I don't know if it's the same one and when I tried to get that information she just wanted to be sent to you instead.
[AGENT][NEUTRAL] Because I did see one for that data service.
[CUSTOMER][NEUTRAL] OK, I just wanna make sure that I know what she's needing.
[CUSTOMER][NEUTRAL] So she just wanted to check with the claim status for the two most recent claims she sent in.
[AGENT][NEUTRAL] Right, she wants to know because she didn't put a claim number on them um she I think she wants to have peace of mind on how they're gonna get because she didn't put a claim number on them.
[CUSTOMER][NEUTRAL] OK, um, and do you have a callback number?
[AGENT][NEUTRAL] If that makes sense, yeah.
[AGENT][NEUTRAL] I do, it's [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Right, are you ready for?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][POSITIVE] Thank you for holding yes.
[AGENT][NEUTRAL] I, I have [PII] on the line for you through in claims. Uh, she'll be able to help you with what you're asking for, OK?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] OK, thank you. Hi, [PII], how are you?
[CUSTOMER][NEUTRAL] Uh, yes, Ms. [PII]. How are you doing? And yes, my name is [PII], and how can I help you today? Hi, [PII]. I um sent in some documents last week to process and my husband had a knee surgery. Um, and then today I uploaded home health records and I didn't know if that's something that's payable on the screen.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK, just take a look at that for you. So you were wanting to know if you have home health care benefits available on your accident policy? Mhm.
[CUSTOMER][NEUTRAL] OK, try to take a look at that for you, uh, bear with me just a moment please.