AccountId: 011433970860
ContactId: b925fabb-df44-4ca4-8a59-f9233c5b8f11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1026448 ms
Total Talk Time (AGENT): 292875 ms
Total Talk Time (CUSTOMER): 196014 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/b925fabb-df44-4ca4-8a59-f9233c5b8f11_20250213T18:37_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII]. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] I'm doing fine. Um, I have got a broker calling on a claim and I didn't see a quick connect for the accident department, so I don't know if you can take this or not.
[AGENT][NEUTRAL] Hey it's an accident policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] I'll do my best.
[CUSTOMER][NEUTRAL] OK. Um, the policy number that she's calling about, and this has been an ongoing situation, um, it's for [PII].
[CUSTOMER][NEUTRAL] The policy number is 024.
[CUSTOMER][NEUTRAL] 351-54
[AGENT][NEUTRAL] OK, if it would help if I pulled up the right policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You got her pulled up?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, it's her name is [PII]. She's with the ES group and.
[CUSTOMER][NEUTRAL] I, it's, there's a lot in the file I'm sure.
[AGENT][POSITIVE] Oh goodness. OK. It's on [PII] her name's [PII].
[CUSTOMER][NEUTRAL] Mhm, she's with the broker's office.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][POSITIVE] All right. Thank you. Bye.
[AGENT][POSITIVE] You're welcome. Bye.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] This is [PII] in the claims department. How can I help you today?
[CUSTOMER][NEUTRAL] Yeah, I'm just following up on two different claims. Uh, first one is an accident claim under the policy 02435157.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Who, who's the, who's the patient?
[CUSTOMER][NEUTRAL] So, the policyholder is [PII], the patient is [PII], but I believe there may also be one for [PII] as well.
[AGENT][NEUTRAL] OK. And what's that policy number again?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 02435157
[AGENT][NEUTRAL] 0157 OK.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII]'s date of birth is [PII].
[AGENT][POSITIVE] Thank
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] Thank you and you're checking the claim on both [PII] and [PII]?
[CUSTOMER][NEUTRAL] Yeah, I know the one on [PII] was denied, but I don't know if she was gonna, uh, submit any additional information in.
[AGENT][NEUTRAL] Uh, we do not have any additional information. Um, the last thing we received was on [PII].
[CUSTOMER][NEUTRAL] OK, and what did you?
[AGENT][NEUTRAL] It looks like uh it was an EOP but let me, let me see how we denied it.
[CUSTOMER][NEUTRAL] And that was on [PII]?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Let me look to see.
[AGENT][POSITIVE] Exactly what we received.
[AGENT][NEUTRAL] OK, that's just the EOBs.
[AGENT][NEGATIVE] OK, yeah. It looks like the um the offices and the physical therapy were both denied.
[CUSTOMER][NEUTRAL] OK, and those were for [PII].
[AGENT][NEUTRAL] [PII], right.
[CUSTOMER][NEUTRAL] OK, has she submitted anything in for herself for an accident claim?
[AGENT][NEUTRAL] Yeah, let me look at her.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] She did on 128 and that, that one was paid.
[CUSTOMER][NEUTRAL] And how much paid out for that?
[AGENT][NEUTRAL] I, I cannot release that information because she is the one who filed the claim.
[CUSTOMER][NEUTRAL] OK, well, we're the agent.
[AGENT][NEUTRAL] Yes ma'am, but um since you didn't file the claim we cannot release that information.
[CUSTOMER][NEUTRAL] OK. I've never had that before.
[CUSTOMER][NEUTRAL] We have all their information since we submitted in all their information to get the policy set up.
[CUSTOMER][NEUTRAL] Uh, usually if we're the agent we always get that information.
[AGENT][NEUTRAL] Um, I'm, I'm sorry, but yes, ma'am, um, we cannot release that information since the insured.
[CUSTOMER][NEUTRAL] OK, can you get, OK, can you get me over to the critical illness department, please?
[AGENT][NEUTRAL] Um, I also do critical illness.
[CUSTOMER][NEUTRAL] OK, well, it's not gonna help me if you're not gonna give me any information, so I'd rather speak with them.
[AGENT][NEUTRAL] Just 1 2nd.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I don't know, any other insurance.
[CUSTOMER][NEGATIVE] Company that we deal with to get it so I don't understand that.
[CUSTOMER][NEUTRAL] Hello, you've reached the desk of [PII]. My normal working hours are. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], this is [PII].
[AGENT][NEUTRAL] Hey, I have an agent on the phone who was, who was upset with me because I will not release any information because they did not file the claim.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, they don't?
[AGENT][NEUTRAL] I was
[AGENT][NEUTRAL] We can tell them how much we paid.
[AGENT][NEUTRAL] OK. OK. Um.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I thought we'd received something new and I just, I couldn't remember it and I can't find it, so.
[AGENT][NEGATIVE] I was just erring on the side of caution.
[AGENT][NEUTRAL] OK, alright.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm bye.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hey, um, I apologize, um, I can release that information, uh, so let me get, get, get [PII] back pulled up.
[AGENT][NEUTRAL] Uh, here she is.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh, that was paid on [PII] and we paid $1450.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] You're welcome. And you said you had a critical illness?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK, what's that policy number?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] 243-515-5
[CUSTOMER][NEUTRAL] Policyholder is [PII], and it's on her son [PII].
[AGENT][NEUTRAL] OK, I see [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what's his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I'm sorry. That was her date of birth. His date of birth is [PII].
[AGENT][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] OK, OK. Uh, let's see, uh.
[AGENT][NEUTRAL] Uh 4.
[AGENT][NEUTRAL] Yeah, we're needing the medical records from the doctor who first diagnosed him with the critical illness in [PII] and all of those records must include the imaging studies along with the test results of this.
[AGENT][NEUTRAL] Several spinal fluid test, cerebral spinal fluid test.
[CUSTOMER][NEUTRAL] So, medical records from first diagnosis and then what?
[AGENT][NEUTRAL] Um, uh, and those records have to contain all the imaging studies, um, along with the cerebral spinal fluid test that he, if he had one.
[CUSTOMER][NEUTRAL] And was this information sent to her?
[AGENT][NEUTRAL] Yes ma'am, let's see when this information was sent to her.
[CUSTOMER][NEUTRAL] I mean I know that she submitted a couple different times on things so you didn't receive anything that shows that.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Anytime.
[AGENT][NEUTRAL] We received um some medical notes of a visit. Let me see.
[AGENT][NEUTRAL] When this visit was.
[CUSTOMER][NEUTRAL] Because before she submitted the critical illness claim, she actually sent in the note.
[CUSTOMER][NEUTRAL] She submitted the notes prior to filling out the claim.
[AGENT][NEUTRAL] OK, so let me see what note she sent in.
[AGENT][NEUTRAL] She sent in um the she the only notes that she sent in was for data service of 89 but um.
[AGENT][NEUTRAL] The claim form stated that he was diagnosed in July, so we need those medical records diagnosed in that MS.
[CUSTOMER][NEUTRAL] OK, but you didn't receive in the summertime you didn't receive any of that information because I said she sent information in before she actually did the claim form.
[AGENT][NEUTRAL] Um, yes, and this is, um, what we received was a copy of her policy and the medical and the medical notes for [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when did you mail that to her?
[AGENT][NEUTRAL] It was mailed um.
[AGENT][NEUTRAL] I wanna say 121, but let me get back to that.
[AGENT][NEUTRAL] Um, it was mailed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I will get with her thank you.
[AGENT][POSITIVE] You're so very welcome, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Nope, that is everything.
[AGENT][POSITIVE] All right, thank you for calling APL. Have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye.