AccountId: 011433970860
ContactId: c3553b41-d08a-4b63-8870-d1483c007c21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 783460 ms
Total Talk Time (AGENT): 372698 ms
Total Talk Time (CUSTOMER): 332714 ms
Interruptions: 8
Overall Sentiment: AGENT=1.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/c3553b41-d08a-4b63-8870-d1483c007c21_20250513T19:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, I, I just got a question um.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, my name is [PII]. I had, um, I hurt my, I had accident insurance with y'all and I hurt, I fractured my ankle back on the [PII]. Um, I, they, we filed a claim. They sent me a, what do you need, what do you need some information first before I can keep going.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, if you don't mind, yes, um, if I could get a good call back number from you in case we're disconnected please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then do you have your policy number?
[CUSTOMER][NEUTRAL] Well I guess my policy number is 02507767.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Alrighty, yes, OK, so I'm just gonna verify some information really quick. Uh, [PII], can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. The last thing I need is the email address we've got on file for you and looks like that is a Gmail account.
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[AGENT][POSITIVE] Perfect thank you so much for verifying all of that. OK, so we did you just have questions on the most recent claim that you submitted, is that right?
[CUSTOMER][NEUTRAL] Well yeah I mean it's, it's, it's for the same. OK, I got an explanation where they didn't pay me anything um and I, and I what I was, I was sending the receipt for the follow up for 425 and it says that they need the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We need the enclosed claim form completed by the insured to give detailed description. First of all, I didn't get no claim for enclosed. Um, second of all, why? Because it's the same claim. It's the same thing. It's the same claim. It's just for one of, for the next follow-up visit. So why do I, why do they have to do another phone?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, I see what you're saying. I'm sorry, I wanted to make sure we were on the same page. um, OK, let me take a look at this previous time. Give me just a moment.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, yeah, that looks like that's the denial for all across the board for this claim because I do have several dates of service [PII], [PII], uh, [PII], and [PII], and that's what they're all saying is that we need that claim form completed, OK.
[CUSTOMER][NEUTRAL] I've already been paid for some of it.
[CUSTOMER][NEUTRAL] All I was doing is for the [PII]. It was another visit.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so this most recent claim that you submitted, we're just looking at the items from the [PII], that's right?
[CUSTOMER][NEUTRAL] Yeah, yeah, and it's for the, it's for the
[AGENT][NEUTRAL] OK, OK, because I do show we've gotten, I, I see, OK, well, Ms. [PII], if you would give me just a moment, um, it could very well be something that they might need a separate claim form, um, but if you'll give me a moment, I'm just gonna put you on a brief hold and reach out to our claim specialist just to get some clarification on that because I see what you're saying like, obviously it was the same accident, um, it's just for something further regarding that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's just a follow-up treatment?
[AGENT][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And an X-ray, I mean, but that's all it is for the same claim.
[AGENT][NEUTRAL] OK, OK, if you don't mind, give me just a moment let me get clarification just wanna make sure I give you the correct information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, Ms. [PII], this is [PII] on the care team. How are you today?
[CUSTOMER][POSITIVE] I'm good how are you [PII]?
[AGENT][NEUTRAL] Doing all right so far, thank you. Uh I've got a member on the line. I'm sorry she's a little bit irate so I think you're gonna have to talk to her. I'm sorry ahead of time. Um, I, I don't think it's anything that major, um, so she's calling about an accident claim.
[CUSTOMER][NEUTRAL] Oh boy.
[AGENT][NEUTRAL] And she had submitted the original claim I guess she submitted more information regarding follow ups and it's just stating that we need the claim form completed and she's arguing that she had already completed the claim form and so she doesn't know why we need that.
[CUSTOMER][NEUTRAL] OK, um, what's that policy number?
[AGENT][NEUTRAL] It is 02507767.
[AGENT][NEUTRAL] And to add to the confusion, um, the most recent claim has several dates of service, um, but she's stating that she's only wanting it for.
[CUSTOMER][NEUTRAL] OK, let's
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Which I, I looked back at the other one and I don't even see that one listed, so that's what I'm, I don't know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I guess she means from the, like the claim form was from the actual accident, like the initial accident.
[CUSTOMER][POSITIVE] Got you. OK, I'll see what I can.
[CUSTOMER][NEUTRAL] I'll see what I can find. Let's see here.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And it's Miss [PII], correct?
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so.
[CUSTOMER][NEGATIVE] My system's so slow. I'm sorry.
[AGENT][NEUTRAL] No, no, no, you're fine.
[CUSTOMER][NEUTRAL] I'd love to blame it on the weather, but I don't even know if it is the weather.
[AGENT][NEGATIVE] I ran out of things to blame. That's just I'm like, man, I'm out of it today, but I'm like, when have I been in it in the last 10 years like.
[AGENT][NEUTRAL] I can't keep saying that.
[CUSTOMER][POSITIVE] Valid point, valid point.
[AGENT][NEUTRAL] I mean, I will keep saying it but.
[CUSTOMER][NEUTRAL] Uh, I feel that.
[CUSTOMER][NEUTRAL] Right, you know.
[CUSTOMER][NEUTRAL] OK, so the accident occurred is 3:21 fell while walking on the steps at an event venue and fractured her left ankle.
[CUSTOMER][NEUTRAL] And we're saying claim form with disk of accident we need the enclosed claim form completed by the insured given a detailed.
[CUSTOMER][NEUTRAL] Yeah, we have that because this is 3:21.
[CUSTOMER][NEUTRAL] Oh my God. Why, why Jesus.
[AGENT][NEUTRAL] OK, well, OK, I'm glad you said that though because I, it made sense where she was coming from, but I didn't know if we would need a sep I wouldn't think we'd need a separate claim form if it was for the same initial accident. OK, OK.
[CUSTOMER][NEGATIVE] Not for follow ups.
[CUSTOMER][NEUTRAL] Yeah, so we have a claim form that was submitted in April. It says that the date her accident occurred was [PII] and then we have the initial ER X-rays, her fracture, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then we have accident follow ups beginning 324, 47 more X-rays like all of it's all done. The thing is that they didn't.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] She doesn't have to. I can let her know. I mean, let me, yeah, it's signed, it's dated.
[CUSTOMER][NEGATIVE] That she even got the provider, no, her employer to fill out their portion and the provider.
[CUSTOMER][NEUTRAL] So like she, she did more than most accident claims yeah she's good if you want to let her know that this is gonna be um.
[AGENT][POSITIVE] So she's good. OK.
[AGENT][NEUTRAL] I can tell her that we'll just reprocess it.
[CUSTOMER][NEGATIVE] Yeah, yeah, just tell her that we'll go back through and reprocess um, it looks like so on the one that was denied.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We're needing a claim form, but it looks like we've already paid initial ER.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So like I, I don't know if she feels she needs.
[AGENT][NEUTRAL] I think like those others, the most recent she did state that the 25th was all she cared about because I was like there's a lot of dates of service so I think she might have just accidentally resent maybe the same information or something.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Everything? OK, so, so 4:25 is the only thing she's needing, is that what she said?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, that's what she said, yeah.
[CUSTOMER][NEUTRAL] OK, OK, alright, tell, um, I mean I can talk to her or you let me know um.
[AGENT][NEUTRAL] No, I can. That should be fine.
[CUSTOMER][NEUTRAL] OK, we're we'll look at it and make sure that all.
[AGENT][NEUTRAL] The what? I'm sorry you kinda cut out.
[CUSTOMER][NEUTRAL] Of the dates have been captured and what.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yeah, I'm sorry you kinda cut out there.
[CUSTOMER][NEUTRAL] I look, girl, I told you.
[AGENT][NEUTRAL] Yeah, no, it's, it's like you said, valid, that's OK.
[AGENT][NEUTRAL] I'll just let her know that she's, she did everything she was supposed to and we'll just go ahead and get that um processed.
[CUSTOMER][NEUTRAL] OK, yeah, it's.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I will go back and look at everything and make sure that no dates were missed.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got it. OK, well I sure appreciate your help, [PII]. I hope your day gets better.
[CUSTOMER][POSITIVE] Yes, ma'am. You too.
[AGENT][POSITIVE] Thanks. Bye.
[CUSTOMER][NEUTRAL] Uh uh-huh, bye-bye.
[AGENT][POSITIVE] Alrighty, [PII], I'm so sorry about that wait are you still with me?
[CUSTOMER][NEUTRAL] Uh-huh. Yes, ma'am.
[AGENT][POSITIVE] OK, alright, I appreciate your patience. Sorry that takes so long, um, so, uh, we were right, um, you did everything you were supposed to do you absolutely did not have to fill out anything additional um I think that was just kind of a hiccup on our end, um, but I did get in touch with, you know, of course, uh one of our claim specialists, and she's going to go ahead and get that continued processing so keep your you do this on the website.
[AGENT][NEUTRAL] Do you use our portal?
[CUSTOMER][NEGATIVE] Excuse me, you're breaking up.
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Do I have a, OK, I hear, I can hear you now. Uh, you said that, you said access to your portal.
[AGENT][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Do you use our portal?
[CUSTOMER][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] Yeah, I mean that I went in and that's what I, I put the receipt in. I mean the statement on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK yeah perfect so you can keep an eye on that. Give it, um, I would give it a few days, um, let's see, today is Tuesday. I say Friday at the latest, um, you should get that updated information, um, you or you're more than welcome to give us a call as well and we can kind of let you know what's going on with it, but I apologize for the inconvenience and the confusion but you've done beautifully you've given us all the information, so that is very much appreciated.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, yeah, cause I was like, what are they talking about? You know what I'm like.
[AGENT][NEUTRAL] Yeah, that's what I'm my role I see kind of surface level, right, I see surface level, but that's what I was like, is there something I'm just not seeing, so I always want to get a second opinion from someone who does this. So she was like, no, no, she's good.
[CUSTOMER][NEUTRAL] I was like, I, I, I was told that all I had to do.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. So it was just a somehow mistake got confused, uh, I guess they thought it was a different claim.
[AGENT][POSITIVE] Yes, absolutely, absolutely. I think it might have been because we did have those other dates in with this other one, but not your fault. It's always better to give more than less. So we'll get that, uh, remedied though. Don't worry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for your, for your help and your time today. OK, alright.
[AGENT][POSITIVE] You are very welcome absolutely did you have any other questions for me?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, so I have to go back again. I have to go back again. So I just upload the the statement back on there again? I mean, OK, yeah.
[AGENT][NEUTRAL] All right. Yeah.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] No, no, you are perfectly fine. You don't have to do anything you've given us everything all they're going to do is just kind of take that junk off of there, reprocess it, um, so that you've given us all that we need. So I would just keep an eye on it here in the next couple of days or so, um, or again if you wanna give us a call to check you're more than welcome to do that as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much. Alright, alright.
[AGENT][POSITIVE] All righty. Yes, ma'am. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] All right. You too, bye-bye.