AccountId: 011433970860
ContactId: b9785df8-3e16-412b-abe6-b03909e1592d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1204819 ms
Total Talk Time (AGENT): 572247 ms
Total Talk Time (CUSTOMER): 341643 ms
Interruptions: 7
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/b9785df8-3e16-412b-abe6-b03909e1592d_20250114T18:33_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII], this [PII]. I'm calling to see have y'all received my claim.
[AGENT][NEUTRAL] OK, so you're calling to see if we've received a claim that you submitted, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, I can help you. I can check that for you and I'm so sorry, could you please give me your name again?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, Ms. [PII], thank you. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And do you have your policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEGATIVE] I did have my card. I don't even know what's going with that. No, ma'am, I, I don't know what I done with my card.
[AGENT][NEUTRAL] OK, is the policy, are you the subscriber, Ms. [PII] on this policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what is your social security number and I can try and look it up that way.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Oh, I have, I have my policy.
[AGENT][NEUTRAL] That's OK. Um
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] It's OK. I believe I've located it.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and Ms. [PII], I will need to verify several pieces of information with you first and also any information that I do provide for you will be a verification of benefits and not a guarantee of payments. So first off, if you will please verify your date of birth for me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And also your home mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have for you is the same as the one that you gave me, so that is your best contact number. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you and lastly your email address, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service, Ms. [PII], for the claim that you've submitted?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm sorry. I'm way ahead of myself, ain't.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] So, [PII]?
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yeah, so, yeah, uh, [PII].
[AGENT][NEUTRAL] OK, so [PII] and [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do not see that we've received anything for those two dates of service.
[AGENT][NEUTRAL] You did say [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] OK. Let me check [PII].
[AGENT][NEUTRAL] You gave me two different, OK, just one moment.
[CUSTOMER][NEUTRAL] Well, that's it, it started on the.
[AGENT][NEUTRAL] Is it [PII]?
[AGENT][NEUTRAL] Is it [PII]? Is that the year?
[AGENT][NEUTRAL] Of a
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK so I don't see a claim. I see that um give me a moment to look at something, please.
[AGENT][POSITIVE] Thank you for your understanding, Miss [PII], while I'm pulling up a document to look at.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So, Ms. [PII], um, I'm gonna see if I, I, do you mind letting me place you on a brief hold? I'm so sorry. Do you mind holding for me? I'm having
[CUSTOMER][NEUTRAL] Let me ask you something. Are you looking at that? I called yesterday about my claim. They claimed that it was complete and I called.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they said that they paid out.
[CUSTOMER][NEUTRAL] In [PII] for something that happened in [PII].
[CUSTOMER][NEUTRAL] [PII]. I said, how is that possible?
[AGENT][NEUTRAL] Yes, ma'am. So what I'm gonna do is I'm gonna connect you over to one of our claims examiners to further look at this claim with you because I'm seeing.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] A different
[AGENT][NEUTRAL] Let me, let me look at your, you've had multiple policies, but this accident was in [PII], not [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so yes ma'am, give me just a moment and when I do transfer you, Ms. [PII], you will not have to re-verify any of your information. I will give them your policy number, let them know the reason for your call, and they can take a look at these documents.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, to better answer that question.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For you as far as
[AGENT][NEUTRAL] What I'm seeing in my system. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so, um, is there anything else there, Ms. [PII] that I can help you with before I connect you?
[CUSTOMER][NEUTRAL] Mm, no, I just called, wait, let me ask you this, can you fax your policy over?
[AGENT][NEUTRAL] OK, sure, let me.
[CUSTOMER][NEUTRAL] Or do you have to mail it?
[AGENT][NEUTRAL] I'm sorry, the, you mean a claim?
[CUSTOMER][NEUTRAL] I mean the claim, claim I'm talking about.
[AGENT][NEUTRAL] No, ma'am, and you're set up in the online service center in the portal where you can log in.
[AGENT][NEUTRAL] And have access to all of.
[CUSTOMER][NEGATIVE] And I can't get into that.
[AGENT][NEUTRAL] Do you need me? I can provide you your username that you set up now I don't have access to your password so if you don't remember your password, you would just have to do, you know, select the forgot password and create a new one, but I can provide you, yes ma'am, give me just a moment to locate that for you.
[CUSTOMER][NEUTRAL] OK, well, uh,
[AGENT][NEUTRAL] OK, so I show that your username.
[AGENT][NEUTRAL] Is [PII] altogether and the [PII] is the only capitalized letter.
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] So it's, yes, ma'am. And again, the [PII] is the only thing that is capitalized.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's all it is.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm. Yes, ma'am, it is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now have you ever received uh the user guide for the portal that explains it gives you directions on how you can add in, for example, direct deposit information you it also gives you the information on how to upload documents to us through the portal.
[CUSTOMER][NEUTRAL] I don't think so.
[AGENT][NEUTRAL] OK, I can email that to you.
[CUSTOMER][NEUTRAL] Oh, I've got it.
[CUSTOMER][NEUTRAL] OK, please sir.
[AGENT][NEUTRAL] Yes, ma'am, let's see, give me just one second. I'll go ahead and do that real quick before I transfer you.
[CUSTOMER][NEUTRAL] If I have it, I don't forgot how to do it.
[AGENT][NEUTRAL] That's OK. I'll send this to you and.
[AGENT][NEUTRAL] OK, just a second.
[AGENT][NEUTRAL] OK, so I just sent you that email, Ms. [PII], and, and it's going to come, the email is going to be coming from [PII].
[AGENT][NEUTRAL] And I did put APL online service center.
[AGENT][NEUTRAL] In the um in the subject line for you so that you can recognize that as not being junk mail or spam mail.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Absolutely, certainly. And you said that you did locate your policy number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Just so you can, OK, and you'll also be able to see that as well, Ms. [PII] in the portal when you sign in as well.
[AGENT][NEUTRAL] Um, so, is there anything else that I could help you with before I connect you?
[CUSTOMER][NEUTRAL] Yeah, one more question when I.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] When I signed in, they said I first I got was uh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Getting ready to sign in, uh.
[CUSTOMER][NEUTRAL] What, what do I use that ID number?
[AGENT][NEUTRAL] No ma'am, when you, OK, so to sign in, yes ma'am, but you've already created your profile, so you shouldn't have to enter that again.
[CUSTOMER][NEUTRAL] Use the social security number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, OK then.
[AGENT][NEGATIVE] You should have just been able to click um.
[AGENT][NEUTRAL] Let me pull this, let me pull this side up, just one sec.
[CUSTOMER][POSITIVE] I think I was kind of creative.
[AGENT][NEUTRAL] OK, so where you would just, yeah, you would just, um, where it says log in.
[AGENT][NEUTRAL] Make sure that's the tab that's selected on that first screen and then you would enter the legions there and then your password, but if you for if you don't remember what your password was, you should see right below where it says submit, it says forgot or.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Reset password, you would click there if you have to reset it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, yes, ma'am.
[CUSTOMER][NEUTRAL] Well, that's about it then.
[CUSTOMER][NEUTRAL] Yeah I don't have any other questions.
[AGENT][POSITIVE] OK, well then I will get you connected over to claims and again thank you for calling APL. I hope that you have a very nice afternoon.
[CUSTOMER][POSITIVE] You too and thank you for your help.
[AGENT][POSITIVE] Absolutely. You're very welcome. So, it was my pleasure. So one moment, please.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Ferring.
[CUSTOMER][NEUTRAL] Thank you for calling American Public Live. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. How are you?
[CUSTOMER][POSITIVE] Good how are you?
[AGENT][NEUTRAL] I'm fine, thank you, but I have an insured on the line that um I think this claim was just processed incorrectly, but instead of creating a hub ticket, she had called to see if we received the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But it looks like we put the wrong date.
[AGENT][NEUTRAL] In and we told her that we had already paid the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But anyhow, um, it's on policy 188.
[AGENT][NEUTRAL] 8560 for Miss [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's the most recent received claim is 355-0282.
[CUSTOMER][NEUTRAL] OK, and.
[AGENT][NEUTRAL] But the data service that's on that EOB that I looked at has the year is 23.
[CUSTOMER][NEUTRAL] Let me pull it up.
[AGENT][NEUTRAL] All of her claims information has 24, which is what she says is correct, but the denial remark says that we have paid the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 55 or 24.
[CUSTOMER][NEUTRAL] OK, do we have a claim out here for 55 or 23 that did go to the provider?
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] No, I didn't see that.
[AGENT][NEUTRAL] Mhm. Uh.
[CUSTOMER][NEUTRAL] OK, let's see. OK.
[AGENT][NEUTRAL] And let's say this policy, yeah, let's see, hold on.
[AGENT][NEUTRAL] Yes, so that, I mean, I don't know if the bill amount is not the same. I mean, the.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The, you know, the codes look the same, but as far as
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, let me look I'm just.
[AGENT][NEUTRAL] But that again is for 23. She says the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the informa and I did look at the documents that she submitted.
[CUSTOMER][NEUTRAL] What what date or what page of her documents so you know it takes forever to get through this stuff so I can just look.
[AGENT][NEUTRAL] Sure does.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Home base is not the swiftest.
[CUSTOMER][NEUTRAL] Cause I'm looking at like a collision report.
[AGENT][NEUTRAL] For say what the, but what is it says.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] Let me pull it up by the mail number because the claim number is.
[AGENT][NEUTRAL] Per the information I was looking at.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] that she submitted on that.
[AGENT][NEUTRAL] Claim number
[AGENT][NEUTRAL] Most recently processed. Oh, hold on. I have too many screens. There's no way we have to do things. I've got too many.
[CUSTOMER][NEUTRAL] The 282? OK, let me pull by the.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] 282-108-25105 let me pull it up.
[AGENT][NEUTRAL] Yes, yes. OK.
[AGENT][NEUTRAL] Right, that claim number, the documents that are attached to it in on base.
[CUSTOMER][NEUTRAL] About the mail number.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Has the data services 24.
[CUSTOMER][NEUTRAL] OK, so where, where are you seeing it because it looks this what I'm looking at I pulled by the mail number.
[AGENT][NEUTRAL] Which, but this.
[AGENT][NEUTRAL] I don't know about that male number.
[CUSTOMER][NEUTRAL] Yeah, it's the same cause sometimes it's, it's different.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] It's like 219 pages.
[CUSTOMER][NEUTRAL] Um, let me see. Yes, 19 pages. Uh, now I see she has dates in the hospital [PII] to [PII]. Is that what you're looking at, date of accident?
[AGENT][NEUTRAL] Yeah, the client sheet
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the police, right, but this.
[CUSTOMER][NEUTRAL] And then like the um the.
[CUSTOMER][NEGATIVE] The traffic report or the police. OK, so we really should have denied this.
[AGENT][NEUTRAL] But I don't know, again, what we processed it was for, for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And saying we pay the provider and I don't.
[CUSTOMER][NEUTRAL] Let me highlight it.
[AGENT][NEUTRAL] I mean this, you know, it's not even for the same amount as that facility claim that is in there for the same for [PII].
[CUSTOMER][NEUTRAL] Yeah, I mean, it's not even enough information to say pay to the provider. I mean, it's just the.
[AGENT][NEUTRAL] And the bill amount, I mean, anyway, so I.
[CUSTOMER][NEGATIVE] Yeah, she just sent, it should have been denied for, yeah, I mean I guess I can just tell her it's gonna be reprocessed because it really should have been denied for correct information she only sent it.
[AGENT][NEUTRAL] That's why I'm transferring her.
[CUSTOMER][NEUTRAL] Uh, traffic report like there's no, I don't see an EOB.
[AGENT][NEGATIVE] Arm base is terrible.
[CUSTOMER][NEUTRAL] I don't show we got an ELB. I show she sent the claim and then she sent like the police report of the accident, but it's not a medical bill.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] It's a collision report.
[CUSTOMER][NEGATIVE] Which we would have denied for the ELB, the itemized bill and the uh.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, the you'll be the itemized bill and the diagnosis code like, yeah, so you can send her over. It was just.
[AGENT][NEGATIVE] And the dates wrong. Mhm.
[CUSTOMER][NEGATIVE] Yeah, it's not, yeah, the dates wrong and I, yeah, even she shouldn't even look at, even if it was the same date, it still should have been denied for information cause this is not, there's nothing that on what she sent that matches.
[AGENT][NEGATIVE] There's a lot of stuff wrong.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, 40.
[CUSTOMER][NEUTRAL] The claim we paid, so yeah, I don't know.
[AGENT][NEUTRAL] OK. I don't know either. I don't know, but it blew, it blew my hair back. But anyway.
[CUSTOMER][NEUTRAL] OK, yeah, you can, uh, where is she getting that charge for?
[AGENT][POSITIVE] OK. But she's fully verified and she's very nice, Miss, she's very nice, [PII], and the phone number in line, which is also the one I believe that's on the screen. Let me pull that up. Yes, that would be the number to call her back on.
[CUSTOMER][NEUTRAL] OK, OK, you can send her over.
[AGENT][POSITIVE] OK, thank you so much. Have a great afternoon, OK? All right. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. You too.
[CUSTOMER][NEUTRAL] Bye.