AccountId: 011433970860
ContactId: ce5d113b-5aa2-4733-8827-054882447260
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326309 ms
Total Talk Time (AGENT): 77930 ms
Total Talk Time (CUSTOMER): 197440 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/ce5d113b-5aa2-4733-8827-054882447260_20250411T15:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I recently submitted an accident claim for my daughter.
[CUSTOMER][NEUTRAL] And she went to the emergency room and then the next day was followed up um to see um her ENT the day, day or so afterwards. And I thought I had been submitting the claim for the emergency room visit, but it looks like it got approved for the um.
[CUSTOMER][NEUTRAL] The uh I cannot think of the word. The follow up visit looked like it got approved for the follow up visit because I got paid out 100 for it. So I'm just wondering, should I resubmit another claim for the emergency room visit or did they happen to assess that and just say.
[CUSTOMER][NEUTRAL] This is all that you qualify for because I thought the policy covered a $300 benefit for emergency room and then $100 for any follow up visits. So I'm just trying to see if I need to submit more paperwork or what.
[AGENT][NEUTRAL] OK, um, can I get your policy number, please?
[CUSTOMER][NEUTRAL] Sure, um.
[CUSTOMER][NEUTRAL] Accident, um, 258.
[CUSTOMER][NEUTRAL] 4397.
[AGENT][POSITIVE] Hey can I get a good callback number from you just in case I lose the call?
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what was your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and just a few more pieces of information, uh, your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And lastly your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. OK, and this claim was for let's see.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] For my daughter [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] What date of service was that for?
[CUSTOMER][NEUTRAL] Like what date did the incident happen?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Um, service from date, I think that was, let me make sure that's right.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, it looks like all that we've received is just the physician um visit. So it looks like we're missing the ER.
[CUSTOMER][NEUTRAL] And I have
[AGENT][NEUTRAL] Um, would you be able to submit that again to us?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or upload it.
[CUSTOMER][NEUTRAL] Yeah, so I just wanna make sure that the document I filled the document out correctly because I think maybe the signature is what indicated to you guys that this was coming from the office visit. Let me make sure.
[CUSTOMER][NEUTRAL] That I have it worded correctly because I can just resubmit.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is there
[CUSTOMER][NEUTRAL] A way of me specifying that this is for the ER visit in the document.
[AGENT][NEUTRAL] Um, let me, let me pull up the document we received.
[AGENT][NEUTRAL] OK, so I got your
[CUSTOMER][NEUTRAL] Because I had the attending physician information signed by Doctor [PII], um, and she was the one who saw Cora a couple of days after the ER visit, so maybe that's what triggered.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] The payout for $100 but the information from the document, the original, what do you guys call this accident claim form should be the same for the emergency room, so maybe I just need to get the signature from the emergency room attendant attending doctor to indicate. I'm just wondering if there's another place on this document that I need to indicate that this is emergency room specific.
[AGENT][NEUTRAL] Um, it looks like, let's see, well, OK, so this form, since the, yes, since the attending physician filled it out, that's why it paid out how it did. So do you have like a statement from the ER that you could attach?
[CUSTOMER][NEUTRAL] I have the after visit summary listing the people that saw her. It's just difficult to get a hold of the attending physician from the emergency room because we usually don't deal with the emergency room doctors. I'm sure that I can get that if it's needed, but if I can just include an after summary document with all of the the names of the people that saw her while she's in the emergency room, that would be great. Or are you saying I need that plus the signature of who saw her in the ER?
[AGENT][NEUTRAL] No, you, you should just be able to submit the aftercare summary if it includes all the information that shows she was in the ER, what she was seen for, how they treated her, that should, should be sufficient.
[CUSTOMER][NEUTRAL] It does.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK great so I can upload the same document that I have for the the one that was already paid out and just include it with the after visit summary and I should be good for that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, as long as it has the information that we discussed, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK all right perfect thank you so much that's what I'll do.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] You too thanks bye.