AccountId: 011433970860
ContactId: c16768dc-0b1f-4b16-ab28-0046f155663f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 937630 ms
Total Talk Time (AGENT): 184976 ms
Total Talk Time (CUSTOMER): 104113 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/c16768dc-0b1f-4b16-ab28-0046f155663f_20250424T20:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling on behalf of the broker's office to assist an employee in a claim status update.
[AGENT][NEUTRAL] Of course, [PII], I can help you with claim status today.
[CUSTOMER][NEUTRAL] And I have a claim number if that's helpful.
[AGENT][NEUTRAL] OK, and then
[AGENT][NEUTRAL] Oh, you do. OK, what's the claim number?
[CUSTOMER][NEUTRAL] Um, 359-222-28.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And then can I have your name, please?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII].
[AGENT][NEUTRAL] Oh, plenty. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Last name is [PII].
[AGENT][NEUTRAL] OK, and then what's your company's name?
[CUSTOMER][NEUTRAL] Crescent City benefits.
[CUSTOMER][NEUTRAL] And the agent of record on file is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and then what's the group number?
[CUSTOMER][NEUTRAL] The group number is 26967.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, and then it doesn't look like you're listed as a broker.
[CUSTOMER][NEUTRAL] I'm the assistant to the broker.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I have to have you on file to give out any information.
[CUSTOMER][POSITIVE] Um, I call all the time to get information and assist.
[AGENT][NEUTRAL] You do? OK. Um, give me just one moment, OK? I'm sorry, I'm still kind of new. Just a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, sorry about that. Thank you for holding.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, let me.
[AGENT][NEUTRAL] I will look up that claim status for you.
[CUSTOMER][NEUTRAL] So actually I know um it paid out 300 for the X-ray.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, but they didn't pay any office visits.
[CUSTOMER][NEUTRAL] So I don't know if if you can assist with that or if I need to get transferred to a claims examiner.
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] OK, yes, I do see that the 300 for the X-ray.
[AGENT][NEUTRAL] OK, one.
[AGENT][NEUTRAL] Let me look at the benefits really quick and see why.
[AGENT][NEUTRAL] And do you know what kind of office visit it is? Is it a physician's office?
[CUSTOMER][NEUTRAL] Um, it was a doctor's office.
[AGENT][NEUTRAL] the doctors, OK.
[CUSTOMER][NEUTRAL] So she saw a chiropractor?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. [PII], do you mind if I put you on a brief hold and reach out to a colleague?
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hey, [PII], thank you for holding.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so we are digging deeper into this policy to find out why exactly, OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I didn't want to leave you on hold for a long time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that's OK.
[AGENT][NEUTRAL] OK, and what's the employer's first and last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, just one second, my system is loading the information right now.
[AGENT][NEUTRAL] And then while I'm waiting, what's a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Sorry, while you hold, not me. Just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], yes, I'm going to transfer you over to claim support so they can go over this claim in detail.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, just a second, OK? Thank you.
[CUSTOMER][NEUTRAL] OK, mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hi [PII]. This is [PII] from the care team and I have a a special broker on the line. Her name is [PII]. She's from the Danny Reams office.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, [PII] told me to transfer you over so that.
[AGENT][NEUTRAL] Uh, they could, you guys could go over the codes and like in more detail for her claims since she's a special broker.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, well, what's the policy number?
[AGENT][NEUTRAL] I have policy 260.
[AGENT][NEUTRAL] 5156.
[AGENT][NEUTRAL] And this is for the insured, and she gave me a claim number 359.
[AGENT][NEUTRAL] 222 8.
[AGENT][NEUTRAL] And under that claim number, it looks like we paid 300 for an X-ray and she knows that she wants to know why the the office visit is not covered. This is for a chiropractic office.
[CUSTOMER][NEUTRAL] OK, and it's for [PII], right?
[CUSTOMER][NEUTRAL] By the right person?
[AGENT][NEUTRAL] It's, oh, yes, ma'am. That's for the policy, yeah. And this is [PII], but it looks like she hung up. Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sorry.
[CUSTOMER][NEUTRAL] Right [PII].
[CUSTOMER][NEUTRAL] Uh oh, do you have a phone number I'll call her back?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and did she verify the information?
[AGENT][NEUTRAL] She did, yes, she verified.
[CUSTOMER][NEUTRAL] For the patient, it did.
[AGENT][NEUTRAL] Mhm, she did.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I'll give her a call back, uh, [PII] at that number you provided me and see if I can help her, OK?
[AGENT][NEUTRAL] OK. OK.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] You're welcome [PII].
[AGENT][NEUTRAL] OK, thanks. Bye.
[CUSTOMER][POSITIVE] Thank you. Have a good day bye bye.
[AGENT][NEUTRAL] You too bye.