AccountId: 011433970860
ContactId: ed214dc3-bef3-468e-adea-a4b18a0195dd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 588099 ms
Total Talk Time (AGENT): 298370 ms
Total Talk Time (CUSTOMER): 83963 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/ed214dc3-bef3-468e-adea-a4b18a0195dd_20250430T19:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, uh, my name is [PII], and I recently sent a claim in and they said I didn't pull it out right, and I, but I sent a attachment from the results that I got.
[AGENT][NEUTRAL] OK, um, well, I can help you with your claim, and [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you. And the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] 02249039
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII]. My address is [PII] and my email is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I'm taking a look at the claim so I can see um what's going on here. Hold on one moment, I'm just waiting for everything to come up.
[CUSTOMER][POSITIVE] You're welcome. OK.
[AGENT][NEUTRAL] And what are you asking?
[AGENT][NEUTRAL] OK, so on the wellness claim form, they're saying, we received the claim, we received your documents, but sections A through E are not completed. Um, let me go to the top of this. Hold on one second.
[CUSTOMER][NEUTRAL] A to E.
[AGENT][NEUTRAL] Mhm. That's the um.
[AGENT][NEUTRAL] That's the statement of the insured. I'm looking at it now. Hold on one second.
[AGENT][NEUTRAL] So section D.
[AGENT][NEUTRAL] OK, hold on. She's missing, he's missing.
[AGENT][NEUTRAL] And Ms. [PII], do you mind if I place you on just a brief hold? I'm just looking at the documents received and um what the claim form is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh I gotta think oh what am I looking for? Wellness?
[AGENT][NEUTRAL] Oh wellness, here we go. What does he look like?
[AGENT][NEUTRAL] CD
[AGENT][NEUTRAL] Ain't no E.
[AGENT][NEUTRAL] What are they talking about?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] So now we're gonna do a side by side. Come on claims.
[AGENT][POSITIVE] Y'all know this is caring. It will be World War 345.
[AGENT][NEGATIVE] Statement of insured isn't even A through E, it's A and B. There is no E, I mean.
[AGENT][NEUTRAL] today
[AGENT][NEUTRAL] Statement of insured sections A through F. OK, so where is the rest?
[AGENT][NEUTRAL] D A B C D D E, it goes D F.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So what is she supposed to be signing?
[AGENT][NEUTRAL] Or finishing. It wasn't that on here. Oh, where did this come from?
[AGENT][NEUTRAL] And it's a G, right?
[AGENT][NEUTRAL] OK, now, I'm getting confused a little bit here.
[AGENT][NEUTRAL] What do we do?
[AGENT][NEUTRAL] What did the note. Can I read the note?
[AGENT][NEUTRAL] What about it?
[AGENT][NEUTRAL] See.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it skips to F.
[AGENT][NEUTRAL] Um, is there anything on it's just verbage on here though, and then G.
[AGENT][NEGATIVE] I don't get it.
[AGENT][NEGATIVE] I don't get it. She filled out everything.
[AGENT][NEUTRAL] I don't know what's missing.
[AGENT][NEUTRAL] To even
[AGENT][POSITIVE] Let's do it again.
[AGENT][NEUTRAL] Wellness claim for wellness claim for?
[AGENT][NEUTRAL] Section A
[AGENT][NEUTRAL] Section B.
[AGENT][NEUTRAL] Section C.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Checked it.
[AGENT][NEUTRAL] Section D is right here. She's not dated it.
[AGENT][NEUTRAL] There is no E. So what?
[AGENT][NEUTRAL] I don't know what that's talking about.
[AGENT][NEGATIVE] I'm sending this back.
[AGENT][NEUTRAL] F
[AGENT][NEUTRAL] NG signed and dated. I have no idea. I can't, I don't know.
[AGENT][NEUTRAL] OK, I'm sorry, Ms. [PII].
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. I was just looking at the actual claim form and the form that you sent in. I'm gonna send this back to claims because everything I see, everything signed and dated and filled out. I'm not really sure what what's missing because I went through the original claim form, it's only 4 pages. I went through it twice and all the pages that
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] are to be signed and dated, you did that. So I
[AGENT][NEUTRAL] I don't know, but I'm gonna send it back.
[CUSTOMER][NEUTRAL] Yeah, and then like, yeah, because, because on the other on the um on on section D, I put that for the eye exam for that one that they had wanted me also to write in the mammogram but then I sent the paper.
[AGENT][NEUTRAL] But even if that was the case, then they that that they would have put that for the denial reason, the denial reason is saying the claim form is not completed, but I, I don't see anything missing.
[CUSTOMER][NEUTRAL] I don't either because I spent, I, I.
[AGENT][NEUTRAL] And they're really
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] I didn't see a section E like I saw C, D, and then the next page 3 is F. So there is no, there is no E and there's nothing for you to sign on on section F, it's just like verbiage. But the next page was G and you signed and dated that. So I'm gonna send this back to claims. I apologize for this inconvenience. If there's something that I'm missing, they'll let me know.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] But I don't see anything missing here.
[CUSTOMER][NEUTRAL] I don't either. That's why, but yeah, please resend it and, and just let them. I mean, I don't know what else I'm supposed to do.
[AGENT][NEUTRAL] And I went through each page and made sure I saw everything dated and signed and I, I do.
[AGENT][NEUTRAL] So, I'll just send this back to them and ask them to reprocess or research it. Um, if it doesn't need to be reprocessed and this is correct, I'll have them reach out to you with an explanation. If it's not correct, and they're gonna go ahead and reprocess, then you'll, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You'll get a new explanation of benefits with the completed claim.
[CUSTOMER][POSITIVE] Oh, OK. All right. Thank you.
[AGENT][POSITIVE] You're welcome. Again, I'm sorry for that inconvenience, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL. I hope you have a good evening.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.