AccountId: 011433970860
ContactId: e48f9f2e-ecdc-443b-a3b6-410c1737ef2c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 724609 ms
Total Talk Time (AGENT): 321880 ms
Total Talk Time (CUSTOMER): 222550 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/e48f9f2e-ecdc-443b-a3b6-410c1737ef2c_20250219T14:04_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Hi, [PII], how are you today? I, I sent in, um, I'm not doing good after getting this, but I sent in a claim um for my husband. Um, he has to have knee surgery. He had an accident.
[AGENT][NEUTRAL] I'm fine and you?
[CUSTOMER][NEGATIVE] And um y'all only gave me $50 and he has to have a whole surgery.
[AGENT][NEUTRAL] OK, so you're wanting to check the status on a claim that you filed with us. Is that correct?
[CUSTOMER][NEUTRAL] Well, I see the status in here and they're saying $50.
[AGENT][NEUTRAL] Mhm. OK. So how can I help you today?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] I'm calling to find out why is it only $50 and he has to have a surgery on his knees, a knee replacement.
[AGENT][NEUTRAL] OK, yes, ma'am. Well, I can take a look at that for you. Who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] OK, thank you. And Miss [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is your policy number please, Ms. Ms?
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Tell you in a second.
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] It's uh 254.
[CUSTOMER][NEUTRAL] 5851
[AGENT][NEUTRAL] OK, thank you very much. So give me a moment, [PII], to get your information pulled up. Once I get everything pulled up, I will need to verify several things with you first for security purposes, OK? So just a moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'll send this email any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is, I will first off, what is your date of birth and then also your husband's date of birth?
[CUSTOMER][NEUTRAL] [PII] is my date of birth and my husband's 3-22-64. I also have a claim number.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yes, ma'am. We'll get to that in just a moment. What is your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have for you is the same as the one you gave me, so that is the best number that we should have, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. And lastly your email address please, Ms. [PII].
[CUSTOMER][NEUTRAL] Emails [PII].
[AGENT][POSITIVE] OK, thank you so much. So just a moment.
[AGENT][NEUTRAL] OK, and when you said that you did have a claim number, is that correct?
[CUSTOMER][NEUTRAL] Yes, it's 254-585-1.
[AGENT][NEUTRAL] OK, thank you. So give me just a moment to get that information pulled up.
[AGENT][NEUTRAL] OK, so on this particular claim this was for a screening benefit.
[CUSTOMER][NEUTRAL] OK. No. All right.
[AGENT][NEUTRAL] That was the $50 benefit was paid.
[CUSTOMER][MIXED] OK, but it wasn't a screening benefit.
[CUSTOMER][NEUTRAL] Wait, maybe that one was, hold on, let me get this other one up.
[AGENT][NEUTRAL] It shows that this was for an accident screening.
[CUSTOMER][NEUTRAL] OK, so here's, here's the other one, it's 356 5465.
[AGENT][NEUTRAL] OK, thank you, give me one moment to get that information pulled up.
[AGENT][NEUTRAL] This is for a data service of 23.
[AGENT][NEUTRAL] OK, so on this, on this particular claim number, the 2nd claim number you gave me, Ms. [PII], the remarks on the explanation of benefits state receipt of your claim is acknowledged. However, in order to provide further consideration for this loss under this policy, we will need supporting documentation to evidence the accident and when it occurred.
[AGENT][NEUTRAL] Supporting documentation may include but is not limited to office notes, hospital admission and discharge summaries and or diagnostic testing results.
[AGENT][NEUTRAL] The other
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Comment. The other remark on here states medical records requested.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So, are they gonna get them from the doctor or do I need to?
[AGENT][NEUTRAL] Let me look at some of the notes. If you'll give me just one moment, please.
[AGENT][NEUTRAL] OK, so what I can do is I can transfer you over to one of the examiners who reviews this type of claim, Ms. [PII], because I am not sure if the medical records, that's what it states. I'm not able to fully verify if that has actually been um submitted for request of the records, but they would be able to clarify that with you. When I transfer you. Yes, ma'am, you will not have to re-verify any information. I will give them that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, well, you're welcome. So is there anything else that I could help you with today uh before I do transfer you?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] No, that's it. Thank you so much.
[AGENT][POSITIVE] You're welcome, Ms. [PII] and thank you again for calling APL. I hope you have a very, a very nice day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Good morning. Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. Good morning.
[CUSTOMER][NEUTRAL] Hi [PII], how are you?
[AGENT][NEUTRAL] Oh, I'm OK.
[AGENT][NEUTRAL] It's Wednesday. Glad of that, but I'm OK. So I have a, uh, an insured on the line who I've gone over her claim. Her husband, it's for her husband. She's the insured, but it's the most recently received and processed claim for her husband. Um, the policy number, Roxy is 254.
[AGENT][NEUTRAL] 5851 and again the claim is for part two.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's claim number 356-547-3.
[AGENT][NEUTRAL] And it states on one of the remarks, again, I went over both of them, but the medical records requested, but I don't see a note on this policy regarding that.
[AGENT][NEGATIVE] So she's wanting to verify if we've requested them or if that's something that she's supposed to do, and I can't answer that. She's upset.
[CUSTOMER][NEUTRAL] OK, 6 64 73, right?
[AGENT][NEUTRAL] Yes, uh-huh, yes.
[CUSTOMER][NEUTRAL] Sometimes it could be in the EOB andT notes um.
[CUSTOMER][NEUTRAL] You know where they add.
[CUSTOMER][NEUTRAL] Let me see if they included it.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh, EOB and T, is that what you said?
[CUSTOMER][NEUTRAL] Yeah, if, if there's something sometimes they add notes in that EOBNT screen if there's uh.
[AGENT][NEUTRAL] And on that screen.
[AGENT][NEUTRAL] Do I have to go to that from [PII]? Well, I can't, sometimes I don't know, maybe I'm not doing it right. So you go to [PII] and then go to EOBNT?
[CUSTOMER][NEUTRAL] I'm looking now.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I'm not sure how to access it that way. I just know it from, um, and there's, I don't see any notes, um, I looked in, I'm looking in there now, usually it's from that claim screen and you wouldn't know that if you're not processing claims, so.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it looks like we're asking for evidence of an accident, so, um.
[AGENT][NEUTRAL] Mhm. And then the second remark states medical records request.
[CUSTOMER][NEUTRAL] Usually that would mean that we reached out as long as we had our authorization and it looks like we did um but you're right I don't see any.
[CUSTOMER][NEUTRAL] Indication that we.
[CUSTOMER][NEGATIVE] And there wasn't anything in the notes.
[AGENT][NEUTRAL] I didn't see anything.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So I'm looking at it now so.
[AGENT][NEUTRAL] And just so you know [PII], um, the phone number for Miss [PII] is the same as the one that's in line.
[CUSTOMER][NEUTRAL] OK, and is that that one listed there that's [PII].
[AGENT][NEUTRAL] Yes, it is. The uh-huh [PII]. Mhm.
[CUSTOMER][NEUTRAL] And she's all been verified correct?
[AGENT][NEUTRAL] She has fully been verified, yes, and she's already on the list so we didn't talk about that.
[CUSTOMER][NEUTRAL] Yeah I don't see where the notes were requested either, but usually when we use when we use that code, that means that we're reaching out for medical records so um.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I'm looking over the documents if you wanna go ahead and transfer, and I'll do my best to assist her. It looks like we don't have an accidental diagnosis code, so that's why we're reaching out, um, because it is an accident policy. It does require accidental bodily injury, so, um, that's what we have to verify.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. And I did read, like I said, I did read that remark, but she's needing to verify who's supposed to be getting these records and I just
[AGENT][NEUTRAL] I don't know what to tell her because she's.
[AGENT][NEGATIVE] You know, she got, she was upset when she got that, you know.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, well I'll do my best to assist her.
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] I know you will, you always do, and I always appreciate you. OK, [PII]. Well, thank you so much. Are you ready for Ms. [PII]?
[CUSTOMER][NEUTRAL] I am mhm.
[AGENT][POSITIVE] OK. Thank you. Have a great day if I don't talk to you again.
[CUSTOMER][POSITIVE] You too, [PII] thank you.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye.