AccountId: 011433970860
ContactId: dc8fec70-63cf-4e6b-8dd4-863c9ac1555b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 454670 ms
Total Talk Time (AGENT): 173802 ms
Total Talk Time (CUSTOMER): 136488 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/dc8fec70-63cf-4e6b-8dd4-863c9ac1555b_20250605T14:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to check the status of my husband's claim.
[AGENT][NEUTRAL] OK, I can help you with claim status. May I please get your name and your callback number?
[CUSTOMER][NEUTRAL] My name is [PII]. My number is [PII].
[AGENT][NEUTRAL] And what is the policy number, please?
[CUSTOMER][NEUTRAL] Oh, I have the claiming. Hold on, I have to log in to get the policy number.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I used to have, you know, it's all. I used to fall so much. No.
[AGENT][NEUTRAL] Yes ma'am, if you give me the claim number I'll go ahead and put that in and see if it'll pull the policy up for us.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, the claim number is 3608862.
[AGENT][NEUTRAL] OK, let me see if I can find that real quick.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, is, um, Mr. [PII] there where I can speak to him and just get a verbal consent that it's OK to talk about the claim?
[CUSTOMER][NEUTRAL] There should be a consent on file for me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For Mr. [PII].
[AGENT][NEUTRAL] Mr. [PII], uh, Mr. [PII]. OK, let me look and see.
[CUSTOMER][NEUTRAL] Mhm, mhm, yes.
[AGENT][NEUTRAL] Yeah, I'm not showing that you're on the third party release. Uh when did you send that in?
[CUSTOMER][NEUTRAL] We filled that one.
[CUSTOMER][NEUTRAL] Um, earlier this year.
[AGENT][NEUTRAL] And was it for the same policy?
[AGENT][NEUTRAL] Um, that this claim is on or.
[CUSTOMER][NEUTRAL] For this, yeah, for the uh
[CUSTOMER][NEUTRAL] Uh-huh, for the, uh, the hospital indemnity.
[AGENT][NEUTRAL] Yes ma'am, let me look and see if I can't find it. It's gonna be just a minute while I pull up the files and see if it's in there.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I sent it on.
[CUSTOMER][NEUTRAL] The it was emailed to you guys on the [PII] on [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I still have a copy of it in our email in my email.
[AGENT][NEUTRAL] Yes ma'am, let me look at it.
[AGENT][NEUTRAL] I'm looking at it. I do see that it was sent in and it was signed um I'm just gonna make sure that I get that over to the correct department so they can add it to the policy for you.
[CUSTOMER][NEUTRAL] Oh, OK. Uh-huh.
[AGENT][NEUTRAL] OK, so let me.
[CUSTOMER][NEUTRAL] It, it should have been on everything, but they said I needed to, do I need to fill out one for each policy?
[AGENT][NEUTRAL] No, ma'am. It should be for every policy, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Because he doesn't call or do any of the business, I always do it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Let me look at.
[CUSTOMER][NEUTRAL] They're doing those men.
[AGENT][NEUTRAL] Yes ma'am, let me look at his claims real quick and is that claim number that you gave me, that's the one that you're inquiring about, is that correct? 3608862.
[CUSTOMER][NEUTRAL] Yes, ma'am. I think that's the only one that's open. Mhm.
[AGENT][NEUTRAL] Yes, OK, let me look at it real quick.
[CUSTOMER][NEUTRAL] I the only one, the latest one.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, I've got the claim pulled up and there's two remarks. Um, one is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] One is that in order to complete the processing of your claim, we need the itemized statements of the services provided listing the diagnosis code.
[CUSTOMER][NEUTRAL] OK, I'll call the hospital for that.
[AGENT][NEUTRAL] And then the other one is calendar year maximum for this benefit has been exhausted, but let me look back on the claim and see.
[AGENT][NEUTRAL] What item, what procedure code was?
[AGENT][NEUTRAL] Listed as exhausted.
[CUSTOMER][NEUTRAL] Yeah, yeah, he had
[CUSTOMER][NEUTRAL] Um, probably the, uh, probably the hospital stay, the whatever it is, the, the maximum one hit.
[AGENT][NEUTRAL] It's
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] So, and then how does the, the surgery, like he's had surgery 3 times, what does that fall under?
[AGENT][NEUTRAL] The surgery
[CUSTOMER][NEUTRAL] Does that just fall in the hospital indemnity? Yeah, does he have to have like, oh, I know he got denied cause he's had 3 surgeries in the last, since the [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh they did the hospital indemnity, but I thought that there was a surgery cause as well.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Right, so looking at the policy, and this is just to verify benefits, it's not a guarantee of payment. Um, he does have an accident surgery benefit in a facility.
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] OK, so only if he had an accident.
[AGENT][NEUTRAL] Right, one per calendar year.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's just the hospital indemnity is what me. So I will call the hospital and see if I can get because we uploaded what they gave us.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, yes, if you can get that itemized statement with the diagnosis code and upload it, it will help complete the claim.
[CUSTOMER][NEUTRAL] Um, but
[CUSTOMER][NEUTRAL] OK, I'll send it in.
[AGENT][NEUTRAL] Alright, is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] No ma'am, that's it thank you so much for your help.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] He was
[CUSTOMER][POSITIVE] Thank you. You as well.
[AGENT][NEUTRAL] Bye-bye, ma'am.