AccountId: 011433970860
ContactId: e5b3315e-792c-482d-bb7c-0898063865d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335040 ms
Total Talk Time (AGENT): 119650 ms
Total Talk Time (CUSTOMER): 159989 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/e5b3315e-792c-482d-bb7c-0898063865d6_20250211T14:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, good morning. This is [PII] and [PII]. We're calling about, we had a message that our claim is now complete. Which claim does that refer to, please?
[CUSTOMER][NEUTRAL] Yeah, we have, um, actually 2, we had, um, yeah, 4 different claims put in, so 2 of them.
[CUSTOMER][NEUTRAL] A couple of weeks ago and then I just had an accident.
[CUSTOMER][NEUTRAL] Uh, that should be in. Can we look at the status of those, please?
[AGENT][NEUTRAL] Sure, and I'm sorry, you said your name is [PII]?
[CUSTOMER][NEUTRAL] If you don't mind.
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK, and what is uh on the text message that you received, did it have a claim number or do you have a policy number?
[CUSTOMER][NEUTRAL] Uh, there is one, there is one. Hang on. It says your claim is now complete. The reference is 3,561,360.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] No, that should be, well, one of the two first ones we put in. There was one for my husband and then there was one visit for me and then uh
[CUSTOMER][NEUTRAL] There was um a wellness claim for my husband and an accident claim for myself.
[AGENT][NEUTRAL] OK, one moment. And Ms. [PII], verify your date of birth, mail address, and email address, please.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, email is [PII]. And what else did you need the ZIP code? Address is [PII].
[AGENT][NEUTRAL] OK. Give me one moment. Uh, it looks like that claim was for, um,
[AGENT][NEUTRAL] Critical illness?
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] For an ER visit?
[AGENT][NEUTRAL] Yes, ma'am, and it processes treatment received in a hospital ER or emergency room is not covered under the policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The ER visit is not covered?
[AGENT][NEUTRAL] Correct, and this is under the uh critical illness policy that you have, that process is not covered.
[CUSTOMER][NEUTRAL] Well, how critical do I have to get in case not to go to the emergency room? that was covered before.
[AGENT][NEUTRAL] Let me pull up your policy, one moment.
[AGENT][NEUTRAL] Well, under the critical illness policy, under a schedule of benefits, it has a list of what is considered critical illness such as um advanced Alzheimer's, Parkinson's disease, a complete loss of sight, speech, or hearing, um, end-stage renal failure, heart attack, those are considered critical illness as part of the policy. There's not a benefit that pays for ER.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if I have a danger, if I have a danger if I have a dangerously high blood pressure and they're expecting a heart attack and running tests, that's not, that's not critical?
[CUSTOMER][NEUTRAL] I'm just questioning it.
[AGENT][NEUTRAL] Unless if it was an actual heart attack, because it has, I don't know if you have a copy of your policy, but in the policy, it lists all the different um covered critical illnesses and it has a max benefit that's payable. So if you are diagnosed as far as having a heart attack, then that could be covered under the policy under the critical illness plan.
[CUSTOMER][NEUTRAL] OK, so I, I actually.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK. And then my husband had an accident claim where he had a splinter in his eye and went to um urgent care and they removed the splinter. I'm assuming that was a work accident that is covered under work accident policy.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] That is one that is not how we, we haven't received any messages yet on that apparently this is still in the workup, but you could.
[AGENT][NEUTRAL] Well, I show a claim being received on the [PII].
[CUSTOMER][NEUTRAL] Give me
[AGENT][NEUTRAL] And it's in line for processing. They haven't been processed yet. Usually it takes about 7 to 10 business days to process from the time the claim was received.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then I'm assuming my accident I broke my foot is not being processed yet because he turned that in.
[CUSTOMER][NEUTRAL] [PII], the insurance guy turned that in. I broke my foot on the [PII].
[CUSTOMER][NEUTRAL] He probably turned it in on the [PII] or [PII], so that's not, you don't show anything on it yet, correct?
[AGENT][POSITIVE] Correct, because I show we received it on the [PII], so it's in line for processing.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][POSITIVE] OK, so I will receive messages then as far as, yeah. OK. Just check up with you if this is all good and if there's anything else needed. Thank you.
[AGENT][POSITIVE] Uh, yes, ma'am, and thank you for calling APL. Have a great day, Ms. [PII].
[CUSTOMER][NEUTRAL] Sure. You too. Bye.
[AGENT][NEUTRAL] Bye.