AccountId: 011433970860
ContactId: c4b80dab-5b4d-47d6-9589-1b87db4b70c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 852559 ms
Total Talk Time (AGENT): 161441 ms
Total Talk Time (CUSTOMER): 268015 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/c4b80dab-5b4d-47d6-9589-1b87db4b70c9_20250515T13:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. Who am I speaking with?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII] in customer care. How are you doing this morning?
[AGENT][NEUTRAL] Good and yourself?
[CUSTOMER][POSITIVE] I'm good thanks um I have an insured on the line a little frustrated about a denied claim, and he'd like to speak to somebody about it. I was hoping you could help.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, policy number is gonna be 21820887.
[CUSTOMER][NEUTRAL] Should come up for [PII] that's who we're speaking to is [PII]. The claim is for [PII] though.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the claim number is gonna be 360.
[CUSTOMER][NEUTRAL] 1209.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So I did advise him that it was asking for the critical illness like claim form. He got super frustrated saying that he spoke to somebody and they told him that wasn't needed. I did apologize.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and then I said, you know, I gave him the other denial stating, you know, hey, we need it looks like an itemized bill.
[CUSTOMER][NEUTRAL] Uh, with diagnosis, and he's like, I gave you a bill. Well, I see the bill, but I just see CPT codes and I don't see a diagnosis unless I'm missing something, but he thinks it's an error on our side.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Uh, he
[CUSTOMER][NEUTRAL] Because he said he uploaded, I guess the same thing on his.
[CUSTOMER][NEUTRAL] Indemnity policy.
[AGENT][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Oh no, he's been told we need the claim form, so OK, let me pull the.
[AGENT][NEUTRAL] Clean
[AGENT][NEUTRAL] It's weird that there's no diagnosis code that has all the itemized.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] I didn't see anything like when I scrolled, yeah, when I scrolled through it, so.
[AGENT][NEUTRAL] Uh, yeah, me neither.
[AGENT][POSITIVE] OK, well, I'm ready when you are have everything pulled up.
[CUSTOMER][POSITIVE] OK, here he comes, thank you.
[AGENT][POSITIVE] Alright, no problem.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hi, this is [PII] uh in the uh claims department. How can I help you?
[CUSTOMER][NEUTRAL] All right, mister y'all, uh, I filed a claim with y'all.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The claim number is 3601209.
[CUSTOMER][NEUTRAL] Critical illness.
[AGENT][POSITIVE] OK, yes sir, I have it up.
[CUSTOMER][NEGATIVE] And y'all are telling me that you're only paying $50.
[CUSTOMER][NEGATIVE] And my wife had a heart attack. She uh went into uh
[CUSTOMER][NEUTRAL] The ambulance, they had to do CPR on it, then they had to shock her. Then we took her in and had a, uh, stent put in in the right artery.
[CUSTOMER][NEUTRAL] I sent you all the forms. I sent all of it in.
[CUSTOMER][NEUTRAL] You should be paying $7500 and.
[CUSTOMER][NEUTRAL] What I'm seeing is not there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And you're saying that they're saying they pay $50 and then they're saying and then that and then the lady that I just was on the phone with told me that you, I needed to fill in my form, but the first person I when I sent this in when I called it in, well I didn't call it, but I when I uploaded all the forms and everything, it showed received and the lady that I was talking to on the phone said she saw it she has it. I asked her if I needed to fill in.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Anything else or do anything else she said no we have all the information this is what we've got everything we need.
[CUSTOMER][NEUTRAL] Here I am.
[AGENT][NEUTRAL] OK, uh, give me one second. Let me look at your hospital indemnity because it paid and has the diagnosis code on there, so give me one second.
[AGENT][NEUTRAL] Let me see if it just didn't cross over.
[CUSTOMER][NEUTRAL] And both of them were received on the same day, [PII].
[AGENT][NEUTRAL] Yes sir I'm looking.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK there it is. OK, let me go back over here.
[CUSTOMER][NEUTRAL] And I had sent itemized lists of everything.
[CUSTOMER][NEUTRAL] about uh
[AGENT][NEUTRAL] Yes, I I saw that.
[AGENT][NEUTRAL] All
[CUSTOMER][POSITIVE] It is pretty clear.
[AGENT][NEUTRAL] OK, there's the diagnosis codes. OK, so I'm gonna send it back for that, um, but I do need you to fill out the critical illness claim form.
[AGENT][NEUTRAL] So is there uh an email that I can send it to you for?
[CUSTOMER][NEUTRAL] Yes, you did have that on file also.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, that's what we have. OK, uh, give me a couple of minutes and I'll have the critical illness sent over to you and you just need to fill that out and send it back to us.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Can you tell me
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Can you tell me what happened?
[AGENT][NEUTRAL] Um, the diagnosis, the
[CUSTOMER][NEUTRAL] What happened? I mean, I took it out.
[AGENT][NEUTRAL] Well, with critical illness, unfortunately, with that, that policy, the critical illness claim form does have to be uh filled out. So my apologies for whoever you spoke to earlier that said no, uh, it absolutely does for claims. And then the um
[AGENT][NEUTRAL] Diagnosis code was hidden towards the end of the claim and the examiner just overlooked it.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] Oh, and my problem is I filled it out. I had to fill it out on an iPad.
[CUSTOMER][NEUTRAL] Because I don't have a computer in the house at present, it's down.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and I sent that via that, but she said she got it and they received it all.
[AGENT][NEUTRAL] Uh, for the hospital indemnity, yes. For the critical illness, no.
[CUSTOMER][NEUTRAL] For both of
[CUSTOMER][NEUTRAL] For both of them and look at your date of received on it. They said they received it all on that date.
[AGENT][NEUTRAL] I understand that but for.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Right, but for critical illness, we have to have the claim form. It has to be filled out.
[CUSTOMER][NEUTRAL] So all I need to do is fill out the claim form and get it to you.
[AGENT][POSITIVE] That is correct, yes sir.
[CUSTOMER][NEUTRAL] And you're gonna send it to my email.
[AGENT][POSITIVE] That is correct, yes sir.
[CUSTOMER][NEUTRAL] And I can just reply to your email.
[AGENT][POSITIVE] Yes sir, absolutely.
[CUSTOMER][NEGATIVE] Alright, well, I'm gonna try to do that on my iPad. If not, I'm gonna have to go find a damn computer.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Well, it's just a pain in the butt for for something that should have been pretty nervous because you have the first one and you have all that on the first one. I mean, you can copy it from one to the other, I think.
[AGENT][NEUTRAL] Hey
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Um, they're different claim forms unfortunately.
[CUSTOMER][POSITIVE] Very good.
[AGENT][NEUTRAL] OK, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Sorry, sorry to sound grumpy, but
[CUSTOMER][NEUTRAL] I am
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I said I'm sorry to sound grumpy, but I am grumpy because I'm trying to work and do this at the same time.
[AGENT][POSITIVE] Oh no, you, you, you're not grumpy sir at all. I mean I completely understand your frustration and I apologize for the, you know, the inconvenience and the miscommunication, but I'll go ahead and get it taken care of. I just need that.
[AGENT][NEUTRAL] Unfortunately I just need that claim form but I'll send it out to you right now.
[CUSTOMER][NEUTRAL] And what's your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII] and what do
[CUSTOMER][NEUTRAL] If I have any questions, I want to get the same person. I don't wanna be going in circles.
[AGENT][POSITIVE] Yes, absolutely, um, you can call and just ask for me. It's [PII] and my last initial is [PII], and they'll be able to transfer you to me.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm the only [PII] here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] I thank you.
[AGENT][POSITIVE] No problem at all, give me about 5 minutes and I'll have that right over to you.
[CUSTOMER][POSITIVE] Thank you, ma'am bye bye.
[AGENT][POSITIVE] No problem bye bye.