AccountId: 011433970860
ContactId: ce585f04-e641-4f3b-93bb-8aaeddea8663
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451239 ms
Total Talk Time (AGENT): 136636 ms
Total Talk Time (CUSTOMER): 182498 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/ce585f04-e641-4f3b-93bb-8aaeddea8663_20250416T21:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], how are you? I see where um they said my plan has been completed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You see
[CUSTOMER][NEUTRAL] And I'm calling to check on it. I see online where it's mhm it says my claim has been completed.
[AGENT][NEUTRAL] On a claim?
[AGENT][NEUTRAL] OK, do you have the claim number?
[CUSTOMER][NEUTRAL] Um, I don't. I can't give you my policy number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Whenever you're ready.
[CUSTOMER][NEUTRAL] OK, you know what, I can't. I thought I had it, but I, I don't, um, I can give you my name.
[AGENT][NEUTRAL] OK, let's take a look by name. What is the last name?
[CUSTOMER][NEUTRAL] [PII] First name is [PII]
[AGENT][NEUTRAL] Do you reside in the state of [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if I could get [PII], please, your date of birth and full address.
[CUSTOMER][NEUTRAL] So [PII] address [PII]. Hey [PII].
[AGENT][NEUTRAL] And which policy was the claim recently filed under?
[CUSTOMER][NEUTRAL] I had to come here and take this call.
[CUSTOMER][NEUTRAL] Accident.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they said it was completed today.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Was the claim under
[CUSTOMER][NEUTRAL] It's for my husband, [PII].
[AGENT][NEUTRAL] OK, that's what I was gonna I was gonna ask if it was under yours or his name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it looks like the benefit payment was sent today or since the claim is processed, it'll be sent uh today or tomorrow you have direct deposit it looks like it was a benefit amount of $1,625.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, why is that it? What are they paying for?
[AGENT][NEUTRAL] So when I look on the claim, it looks like they're showing.
[AGENT][NEUTRAL] There was
[AGENT][NEUTRAL] Let me pull up the explanation of benefits on it. Give me just one moment please.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] It said 1600, but I wanna know what that's for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Since it was just done, I can't pull the explanation of benefits on it just yet, so I'm gonna need to get somebody on in the lining claims to look at it, [PII], to explain to you what each of these line items are. So give me just one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. You are on hold.
[AGENT][NEUTRAL] Oh yeah, yeah, yeah.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] over in customer care. How are you?
[CUSTOMER][POSITIVE] I'm good how are you [PII]?
[AGENT][NEUTRAL] I am good. Um, I have an insured on the line who has a question about things that have been paid on a claim, and I was hoping you could help him with that.
[CUSTOMER][NEUTRAL] OK, uh, what's that policy number?
[AGENT][NEUTRAL] Uh, policy number is 254-5851.
[AGENT][NEUTRAL] For [PII] and [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there, is it just that one claim that was paid or she's looking at [PII] and herself?
[AGENT][NEUTRAL] No, it's just the one that was paid processed today for [PII]. She's wanting, so I gave her the, yeah, so I gave her the uh benefit payment information. It was just done.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Um, and she's like, well, what exactly are they paying for? Well, because it was just done. I mean, I don't, I'm not familiar with these like codes and uh there's no explanation of benefits, so I'm not sure.
[CUSTOMER][POSITIVE] Yeah, OK, uh, yeah, I can definitely um.
[CUSTOMER][NEUTRAL] Help them with that.
[AGENT][POSITIVE] OK, I appreciate you thank you. Do you want our callback number?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Yeah, just in case.
[AGENT][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, here comes [PII], thanks.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], my claim was completed today and she told me it was for $1600 and I'm trying to find out what is that for?
[CUSTOMER][POSITIVE] OK, um, I would be happy to help you with that. I'm looking at it now. This is for Mr. [PII], correct?
[CUSTOMER][NEUTRAL] Yes. OK, alright, so it looks like we have a hospital admission that took place on [PII].
[CUSTOMER][NEUTRAL] Um, so that benefit for the admission itself is $1250.
[CUSTOMER][NEUTRAL] Um, you do have a consignment benefit, but that is not payable on the same day that the admission was there and since he was only there for one night, um, that benefit was not paid. However, we also saw that he had surgery, so surgery was paid at $300.
[CUSTOMER][NEUTRAL] And anesthesia is 25% of that $300 so we paid anesthesia at $75 so that brings your total to $1625.
[CUSTOMER][NEUTRAL] So what, it, it was knee surgery, so why, what kind of surgery are you that paid 300?
[CUSTOMER][NEUTRAL] Um, let me get the claim pulled up so I can see what it is they have exactly.