AccountId: 011433970860
ContactId: f289d142-8b46-47e4-bc06-30242cb9d665
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 875250 ms
Total Talk Time (AGENT): 253080 ms
Total Talk Time (CUSTOMER): 268905 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/f289d142-8b46-47e4-bc06-30242cb9d665_20250328T17:44_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I was uh calling to.
[CUSTOMER][NEUTRAL] Ask about a claim.
[AGENT][NEUTRAL] OK, I can help you with the claim. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Please
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII] and my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, Ms. [PII] is the claim for yourself?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it's for my uh.
[CUSTOMER][NEUTRAL] Late husband.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] He's deceased. [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] And he um
[CUSTOMER][NEUTRAL] I was I was sent back I'd sent in a claim and then.
[CUSTOMER][NEUTRAL] You, uh, your company sent me.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I guess an explanation of benefits.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] They said that
[CUSTOMER][NEUTRAL] I needed additional give him a send a additional information.
[AGENT][NEUTRAL] OK. OK, I can, I can help you with that, Miss [PII]. Can you please give me your policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] I had it here.
[CUSTOMER][NEUTRAL] It's 9895867.
[CUSTOMER][NEGATIVE] Not sure. I don't think that's the right number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hang on, I think I have a different number here.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I can look it up with your social if you want to give me that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK. Thank you, Ms. [PII]. All right, let me go and see if I can find it by the social real quick.
[CUSTOMER][NEUTRAL] I thought that number was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII], I believe I have it pulled up now. Um, can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] So can you please
[CUSTOMER][NEUTRAL] Mine or his?
[AGENT][NEUTRAL] Yours.
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][POSITIVE] Thank you, ma'am. And then what is your
[CUSTOMER][NEUTRAL] I do have a policy number.
[AGENT][NEUTRAL] OK, what is that, ma'am?
[CUSTOMER][NEUTRAL] It, it's 85707.
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Uh, it's probably.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The phone number would have been [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And the and the address.
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] OK, and did you know his email address, ma'am?
[CUSTOMER][NEUTRAL] I did not
[AGENT][NEUTRAL] OK, that's fine. All right. Let me go and look up the claim real quick.
[AGENT][NEUTRAL] OK, do you have the
[CUSTOMER][NEUTRAL] Now one of these.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] Do you have the claim number on the um letter that you received?
[CUSTOMER][NEUTRAL] The explanation of benefits.
[AGENT][NEUTRAL] Oh, OK. That
[CUSTOMER][NEUTRAL] Is is that what you're talking?
[AGENT][NEUTRAL] Is that what you received from us?
[CUSTOMER][NEUTRAL] That well yes and it just tells me.
[CUSTOMER][NEGATIVE] Why, it tells me that they're not gonna pay that.
[CUSTOMER][NEGATIVE] That the American Public life insurance is not gonna pay on this.
[AGENT][NEUTRAL] OK, so there's two remarks on the claim. Do you see a claim number 356608?
[CUSTOMER][NEUTRAL] 356-608 um.
[AGENT][NEUTRAL] 508.
[CUSTOMER][NEUTRAL] Oh yes, uh 356-508, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. OK, so there's 2 reasons. There's two different things going on here. Um, for the surgery, in order to give consideration to your claim, we will need a fully itemized surgery bill that includes the procedure code and diagnosis code.
[AGENT][NEUTRAL] So that's the additional information that they need.
[CUSTOMER][NEUTRAL] So what did I?
[AGENT][NEUTRAL] And you can get that
[CUSTOMER][NEUTRAL] OK, so what did I send then?
[AGENT][NEUTRAL] Uh, I can't see what you said.
[CUSTOMER][NEUTRAL] Because I thought I think all of that.
[AGENT][NEUTRAL] I, I can't see what you sent, ma'am, because I, I can't get to that information, but after the claims examiners reviewed the information that you sent in, this is their request is in order to give consideration to your claim, we will need a fully itemized surgery bill that includes the procedure codes and diagnosis code and you can get that from the facility that did the surgery.
[CUSTOMER][NEUTRAL] Mhm I've already called and talked to him and um.
[CUSTOMER][POSITIVE] They said that I, they sent everything I needed. And I said, I told them about the codes and they said everything is on there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's what I sent, that's what I sent in and they said that we'll, we'll resend you.
[CUSTOMER][NEUTRAL] That information and you can turn around and resend it to them.
[CUSTOMER][NEUTRAL] Um, because, and I kept copies of everything.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, and then another thing it said that.
[CUSTOMER][NEUTRAL] It needed the uh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It needed the
[CUSTOMER][NEUTRAL] Spouse and the bene the name of the beneficiary on there well.
[CUSTOMER][NEUTRAL] As far as I know I'm the only beneficiary that's named.
[AGENT][NEUTRAL] Right, I understand that. OK, so for the claim itself that itemized surgery bill is what we need and then also we have another remark that the lab and diagnostic tests are not covered.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] So under this policy, those are not covered. So those will not be paid because they're not covered under the policy.
[CUSTOMER][NEGATIVE] Uh, so even though what they, it was cancerous, it's still not covered.
[AGENT][NEUTRAL] Right, the policy does not cover the those tests that were sent in.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, hopefully they are turning around and sending me all that.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Let's see here, OK.
[CUSTOMER][POSITIVE] All right. I think that's all I needed.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like the last time I talked to someone, uh, they said that.
[CUSTOMER][NEUTRAL] I could give the uh.
[CUSTOMER][NEUTRAL] The lady I call.
[CUSTOMER][NEUTRAL] That takes care of all the, the claim.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And I did
[CUSTOMER][NEUTRAL] I did give her a call. I, I didn't get in touch with her.
[CUSTOMER][NEUTRAL] Like she called me back but.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I hadn't been able to get in touch with her since then. Do you have her name and.
[CUSTOMER][NEUTRAL] Phone number that I could get from you?
[AGENT][NEUTRAL] Uh, I do not know who um was your claims examiner. I, I can't see that information, but what I can do while we're on the phone together, I can send in a request for somebody to return your call to go over the claim with you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'm.
[CUSTOMER][NEUTRAL] OK, that, that was.
[AGENT][NEUTRAL] Yes ma'am, I'm gonna put you on a quick hold while I get that request sent in, OK? And I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, Ms. [PII]. I've got that request sent in for you to get a call back from a claims examiner and you should be receiving a phone call within 24 hours. Uh, now we are closed on.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, Saturdays and Sundays, so it may be Monday. I just didn't want you to be alarmed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do you know, um, you, you don't know the name of the person that would be calling?
[AGENT][NEUTRAL] No, ma'am. I do not.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, they may have to.
[CUSTOMER][NEUTRAL] Leave a message if they don't.
[CUSTOMER][NEUTRAL] If they don't call back, um.
[CUSTOMER][NEUTRAL] Today they may have to leave a message because I work nights.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And I'll lay. I, I usually sleep in the daytime for
[AGENT][NEUTRAL] OK. Let me
[CUSTOMER][NEUTRAL] Uh, 3 or 4 hours.
[AGENT][NEUTRAL] Let me put a note on there, um, insured works nights.
[CUSTOMER][NEUTRAL] But uh I mean, like I said, they, they
[AGENT][NEGATIVE] If no answer.
[AGENT][NEUTRAL] OK, I have a note on there insured works nights.
[AGENT][NEUTRAL] If no if no answer leave message.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That should work out fine.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, Ms. [PII], is there anything else? You're so welcome.
[CUSTOMER][POSITIVE] All right. Well, thank you.
[AGENT][POSITIVE] Is there anything else I can help you? OK, well you take care, miss you have a wonderful weekend thanks for calling APL bye bye.
[CUSTOMER][POSITIVE] OK. All right. Thank you.
[CUSTOMER][NEUTRAL] Yeah. OK.
[CUSTOMER][NEUTRAL] You as well. OK.