AccountId: 011433970860
ContactId: f7891e18-d4f4-4aef-a720-75ebeea71552
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 538250 ms
Total Talk Time (AGENT): 257695 ms
Total Talk Time (CUSTOMER): 164931 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/f7891e18-d4f4-4aef-a720-75ebeea71552_20250113T18:22_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes. I need, um, about 2 claims.
[CUSTOMER][NEUTRAL] And I was needing some help with it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can help you with your claims. Can I please get your name and your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my number is [PII].
[AGENT][NEUTRAL] OK. Thank you, Ms. [PII]. What is your policy number?
[CUSTOMER][NEUTRAL] Uh, let's see, it will tell me, OK, yeah, 170.
[CUSTOMER][NEUTRAL] 2608
[AGENT][NEUTRAL] OK, let me pull in your policy real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[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] [PII] [PII] and my email is [PII].
[AGENT][POSITIVE] Thank you I appreciate you verifying all that information for me, Ms. [PII], and then was the claim for yourself?
[CUSTOMER][NEUTRAL] One of them was, but one of them was for my son.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] You just had in you just wanted uh the status of the claim?
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yeah, pretty much, but I noticed uh that claim I filed for my son, see, I did it one time before and I did it wrong.
[AGENT][NEUTRAL] OK. Let me
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But then I done it again the other day and I apparently done it wrong too because I, I see the service date is wrong.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] It's supposed to be [PII].
[AGENT][NEUTRAL] OK, so which son did you file the claim for?
[CUSTOMER][NEUTRAL] Uh, [PII], the 2nd.
[AGENT][NEUTRAL] [PII]. OK, I'm gonna write that down so I can go back and look.
[AGENT][NEUTRAL] OK, so on your claim, I'm pulling it up. I'm gonna tell you what it says for it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is for uh.
[AGENT][NEUTRAL] for Prisma Health, easily Family? OK.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Yeah, he punched his
[CUSTOMER][NEGATIVE] sadly step in the eyeball.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] No, actually, it's not for prisma health, just for um
[AGENT][NEUTRAL] That's, I'm, I'm looking at yours first.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on yours, um, it is saying this policy provides benefits for actual charges incurred as a result of a covered accident. Please submit fully itemized bills with the diagnosis and procedure codes for further consideration. So you can get that information from the physician.
[AGENT][NEUTRAL] And just tell them that you need a detailed itemized statement.
[AGENT][NEUTRAL] That includes your procedure codes and diagnosis codes.
[CUSTOMER][NEUTRAL] Yeah, that's just crazy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, includes what now?
[AGENT][NEUTRAL] Your procedure codes.
[AGENT][NEUTRAL] And diagnosis.
[CUSTOMER][NEUTRAL] And um that's.
[AGENT][POSITIVE] Yes, ma'am. And you can submit that in and then that, that was for yours and let me look at [PII]'s um for you real quick.
[AGENT][NEUTRAL] His is the same thing we need the um detailed itemized statement with the diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] OK, I'm just probably gonna cancel it because y'all, I'm gonna cancel my whole insurance policies.
[CUSTOMER][NEGATIVE] Cause I, every time I, I've never made a claim, I've had job for about 15 years and it just seems to be so much trouble to do it.
[AGENT][NEUTRAL] OK. Um, one thing I will suggest to you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, if, if you choose not to cancel it, when you go to the um facility, the physician's office.
[AGENT][NEUTRAL] Hand them your insurance card and let me give you the payer ID number that you can give to them and they can file your claim for you electronically.
[CUSTOMER][NEUTRAL] I don't, I don't even, I've never had an insurance card through you guys.
[AGENT][POSITIVE] OK, I can order you one.
[AGENT][POSITIVE] I'll get one ordered for you um to be mailed to the address that you provided for me.
[CUSTOMER][NEGATIVE] No, I mean, I've had job for you a lot of years, never claimed anything and this is just becoming.
[AGENT][NEUTRAL] I'm doing that
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] A pain in the rear.
[CUSTOMER][NEUTRAL] There's no other way to say it.
[AGENT][NEUTRAL] OK. And I'm sorry. I'm very sorry. I know that that's a lot of information that has to be sent in when you file it for yourself and it can get frustrating. I do understand, um.
[AGENT][NEUTRAL] And I'm, I'm very sorry that you, that you're feeling like it's, it's a bit overwhelming. I'm, I apologize, but we have to have every single piece of paper in in order to be able to file the claim for payment.
[CUSTOMER][NEUTRAL] Well, I mean, who gets, who gets your procedure codes and diagnosis on a regular bill?
[CUSTOMER][NEUTRAL] Nobody.
[AGENT][NEUTRAL] For the itemized statement.
[CUSTOMER][NEGATIVE] They just want the money and that's it.
[CUSTOMER][NEUTRAL] On any of it.
[CUSTOMER][NEUTRAL] Maybe when you get released from the hospital.
[AGENT][NEUTRAL] Yeah, that
[AGENT][NEUTRAL] The itemized statement is actually.
[CUSTOMER][NEUTRAL] But then I don't even remember that.
[AGENT][NEUTRAL] The itemized statement is actually.
[AGENT][NEUTRAL] A bill from the hospital.
[AGENT][NEUTRAL] That shows everything that was paid and everything that was charged.
[CUSTOMER][NEUTRAL] Well, I sent you I sent you the bills then you should have had it.
[AGENT][NEUTRAL] Yes, ma'am, I understand, um, but the, the itemized statement is different.
[CUSTOMER][NEUTRAL] Yeah, see that's what I'm talking about.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Now where do I send this or because I can't, I don't know how to go back and add this to my policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, um, what, well, if you'd like to fax it in you can do that. I can give you the fax number.
[CUSTOMER][NEUTRAL] OK. That'll be fine.
[AGENT][NEUTRAL] That's, yes, ma'am. That's 1877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] And then on
[AGENT][NEUTRAL] For [PII]'s um claim number let me give you this claim number that you could put on that fax for a reference.
[CUSTOMER][NEUTRAL] I have, I think I have their claim numbers. Hold on, it was [PII]'s and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0SC 90804
[AGENT][NEUTRAL] That's your online service center confirmation number.
[CUSTOMER][NEUTRAL] the moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me give you the claim number for him.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 355-0719.
[CUSTOMER][NEUTRAL] OK, what's the claim number for me?
[AGENT][NEUTRAL] The claim number for you is let me pull you in real quick.
[AGENT][NEUTRAL] Your claim number is 355.
[AGENT][NEUTRAL] Let me make sure this is correct. 355-071-6.
[CUSTOMER][NEUTRAL] OK, so that's all I need is those includes procedure codes and diagnosis?
[AGENT][POSITIVE] Yes ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK, I'll try it.
[AGENT][NEUTRAL] OK, Ms. [PII].
[AGENT][POSITIVE] I hope you have a blessed day. You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] OK.