AccountId: 011433970860
ContactId: d64bceb5-5465-431e-8bd8-e5a0f0b45c9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 683099 ms
Total Talk Time (AGENT): 365592 ms
Total Talk Time (CUSTOMER): 256044 ms
Interruptions: 8
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/d64bceb5-5465-431e-8bd8-e5a0f0b45c9a_20250509T17:08_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII]. I, um, received a letter, uh, that said you've received a claim on my policy and review has started, but I'm not sure what this is in relation to.
[AGENT][NEUTRAL] OK, Mr. [PII], so you're the insured and there's a claim that we're working on for you and you've received something in the mail.
[CUSTOMER][NEUTRAL] Yeah, I don't have it.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] OK, yeah, so I
[CUSTOMER][NEUTRAL] But I'm not sure what it is um.
[AGENT][NEUTRAL] OK, sure. Well, I can take a look at that for you and see if I can help you with this. So, what is a good callback number for you please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Thank you, and your policy number?
[CUSTOMER][NEUTRAL] Um, it's not on my letter, so I'm not really sure.
[CUSTOMER][NEUTRAL] I can go try to look it up. I can't log into the APL site. I can't set up a user profile, so I'm not sure, but I can give you all the rest of my information.
[AGENT][NEUTRAL] So the, OK, well, I can help you, so there must be, there must be some information that's either not matching what you're trying to enter to create a profile for security reasons that would.
[AGENT][NEUTRAL] Gonna throw up a red flag. um, what is your full social and I can see if I can look up your information that way.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I'm not with that company anymore who had this insurance, maybe that's why I can't log in, but I don't know.
[AGENT][NEUTRAL] That would definitely, yes, that would also be a reason. OK. So first off, um, I will need to verify some information with you for security and any information that is provided, Mr. [PII] would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address please.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. And that'll be all of the well, you can go ahead.
[AGENT][NEUTRAL] And verify your email, please.
[CUSTOMER][NEUTRAL] Uh, let's see, uh, probably [PII], or I don't even know if you have my email address, um, [PII] would be another option.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, thank you. That one. OK, so give me just, and does it say in what regards, I mean, you had multiple different policies when you had coverage with us. Does it indicate, what's the date on it?
[CUSTOMER][NEUTRAL] OK. Is that the one? OK, cool.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, [PII], it says your policy holder holder, we've received a claim on your policy and a review of the claim has started.
[CUSTOMER][NEUTRAL] In some cases, additional information must be requested from you or your providers uh of medical services for the claim to be processed. We'll contact you if more information is needed, but what I'm trying to do is get uh.
[CUSTOMER][NEUTRAL] Idea of what this is about, so.
[AGENT][NEUTRAL] OK, and that is from APL and it doesn't reference any other type of number on there, is that correct?
[CUSTOMER][NEUTRAL] That's right, just sincerely claims department and this phone number.
[AGENT][NEUTRAL] OK, so give me a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you, uh, let me just see what I can locate here.
[AGENT][NEUTRAL] OK, so what I'm going to do is because I, I don't know which policy this is on.
[AGENT][NEUTRAL] Based on, I don't.
[CUSTOMER][NEUTRAL] OK. If you did medical, that's one clue, but yeah.
[AGENT][NEUTRAL] OK, so um with APL, I was looking.
[AGENT][NEUTRAL] OK, so the policy that I initially went into is your dental policy. You didn't even have a medical policy with APL.
[AGENT][NEUTRAL] So that's probably why you got that letter that someone filed a medical claim with us.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But since you did not have a medical
[CUSTOMER][NEUTRAL] I mean, I'm going through some medical stuff.
[AGENT][NEUTRAL] I'm sorry, say that again, Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah, but I have my own insurance. I
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I am going through some medical stuff, but I have my own insurance and I also um
[CUSTOMER][NEUTRAL] You know, through, uh, an accident, some being, it's a third party building through Pip, so I don't know, I've never used the APL stuff, um, so I don't know why this is.
[CUSTOMER][NEUTRAL] here, so
[AGENT][NEUTRAL] Mm and uh let me just look at one more thing because.
[AGENT][NEUTRAL] Mhm. I'm just cross-referencing each of your policies to see if I can.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] See a copy of that letter, but I don't see that now I would be happy to connect you over to a different division within the company to see if they could pull.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Locate that letter for you.
[AGENT][POSITIVE] To tell you what it's in regards to. If you would like for me to do that, I'll be happy to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, sure, I'd love to solve this. That'd be great.
[AGENT][NEUTRAL] OK. All right. Well, is there anything else that I could help you with today before I do?
[CUSTOMER][POSITIVE] Uh, nope, that's everything. Thanks for looking into it, [PII]. I appreciate it.
[AGENT][POSITIVE] OK, Mr. [PII]. Absolutely, you're very welcome. So if that is all I can help you with, thank you again for calling APL and I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] Thank you. You too. Thank you.
[AGENT][POSITIVE] Yes, sir. You're welcome. So one moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. How are you?
[CUSTOMER][POSITIVE] I'm good. How are you, [PII]?
[AGENT][POSITIVE] I'm very thankful it's Friday.
[CUSTOMER][NEUTRAL] I hear that.
[AGENT][NEUTRAL] So I have a gentleman on the line he says he has received a letter from APL. It doesn't have any kind of policy number it just says that we've received a claim, um, may need more information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He had been, he was a big person and he had 4 policies.
[AGENT][NEUTRAL] Uh, there's nothing in Onase that I can find about this letter that he's read to me.
[AGENT][NEUTRAL] On any of the policies, but, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] I don't know.
[AGENT][NEUTRAL] It just says from our claims department.
[CUSTOMER][NEUTRAL] Give me weird, uh, give me like one of the policy numbers.
[AGENT][NEUTRAL] And he didn't even have an HR policy. OK. I mean, he had a group accident, a dental.
[CUSTOMER][NEUTRAL] Oh, that's weird. OK.
[AGENT][NEUTRAL] Doing
[AGENT][NEUTRAL] Do you want
[CUSTOMER][NEUTRAL] Give me the accident policy.
[AGENT][NEUTRAL] OK, it is 259-417-4.
[AGENT][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Now there's no phone number mhm there's no phone number in line for him and with it being big, you know, we can't add that, but I can give it to you.
[CUSTOMER][NEUTRAL] Data
[AGENT][NEUTRAL] But yeah.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] Uh, so his callback number if anything happens, is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But he says it doesn't reference a policy number. I mean, it's, it's like a really generic letter.
[AGENT][NEUTRAL] That's from APL and it's from claims department.
[CUSTOMER][NEUTRAL] Yeah, clearly.
[CUSTOMER][NEUTRAL] And it just says something about receiving a claim?
[AGENT][NEUTRAL] Mhm, he'll read it to you. It's not that long, but and that we've received a claim. Further information may be required.
[AGENT][NEUTRAL] But it
[CUSTOMER][NEUTRAL] Well, he didn't have any claims on his accident.
[AGENT][NEUTRAL] Mm, no.
[CUSTOMER][NEUTRAL] He doesn't have any on his critical illness.
[CUSTOMER][NEUTRAL] Or on his group life.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] He does have claims on his dental.
[AGENT][NEUTRAL] But on my dental.
[AGENT][NEUTRAL] Yeah, but that's
[AGENT][NEUTRAL] I saw that.
[AGENT][NEUTRAL] But the letter is dated.
[CUSTOMER][NEUTRAL] But it's a refund letter.
[AGENT][NEUTRAL] Yeah, that's not, yeah. I went to the bar.
[CUSTOMER][NEUTRAL] And that, that went to the insured.
[AGENT][NEUTRAL] But that's not what he's talking about. Mm mm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] I went to the insured.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, it went to the provider, sorry.
[AGENT][NEUTRAL] Well, this shows as I say, prior, yeah.
[CUSTOMER][NEGATIVE] Yeah, that was my bad.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I meant to say insured our provider. Look, there I am again saying insured. I'll get it right eventually.
[AGENT][NEUTRAL] Uh,
[AGENT][POSITIVE] He's real nice too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, I mean, I, I'll take the call. I don't know what the heck to tell him, especially if it doesn't have.
[AGENT][NEGATIVE] I don't know what's, yeah, I don't, I don't know. Maybe when he read the letter to you make, yeah, I mean, I don't know how it would have been sent or why it's not on base. This kind of thing is very frustrating. No notes, you, I mean it's just, yup.
[CUSTOMER][NEUTRAL] Anything you know.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] For sure because there's not like a.
[AGENT][NEGATIVE] And my crystal ball's not been working for a long time.
[CUSTOMER][NEUTRAL] The only, do you know when it was dated?
[AGENT][NEUTRAL] He said, and I think it was like maybe the [PII].
[AGENT][NEUTRAL] But don't, don't make, you'll need to verify that with him, uh, cause I didn't jot that down, yeah, but it didn't match even that refund letter, I mean that refund on that claim on the dental policy didn't match that.
[CUSTOMER][NEUTRAL] Of April.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, yeah, I'll take it and see what it says but like you said I have, I really and truly don't know.
[CUSTOMER][NEGATIVE] What the heck?
[CUSTOMER][NEUTRAL] We'll do about it. I mean if it's.
[AGENT][NEGATIVE] I just told him that, you know, cause he says that references a medical claim, but I told him, you know, he, we went through the policies that he formerly had with us, and I explained to him he did not have a limited benefit plan with APO and told him what type of policies he had. He just don't understand why he got the letter. I don't want to say me either.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] I mean, me either, my guy. Me either. I mean, the only quote unquote limited benefit would be the accident, but
[AGENT][POSITIVE] Again, I'm glad it's Friday.
[AGENT][NEUTRAL] But there's nothing under, and that's the policy I'm making my note under. I initially pulled up his general, but I'm gonna make the I'm making my note under his accident.
[CUSTOMER][NEUTRAL] No, but there's, OK.
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][NEUTRAL] OK [PII]okey.
[CUSTOMER][NEUTRAL] All right, well I'll talk to him, see if, see if I can figure anything out, but it's not sounding likely.
[AGENT][POSITIVE] OK, girl. Hm, that sounded likely. Well, look, if I don't talk to you again, thank you for taking the call. But if I don't talk to you again, I hope you have a wonderful Mother's Day weekend, [PII].
[CUSTOMER][POSITIVE] Yes, ma'am, you too.
[AGENT][POSITIVE] Thank you so much. All right. Well, here comes Mr. [PII] then. All right. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK