AccountId: 011433970860
ContactId: f89ff044-902a-44c6-8576-5f10d392ee45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 617080 ms
Total Talk Time (AGENT): 214331 ms
Total Talk Time (CUSTOMER): 165586 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/f89ff044-902a-44c6-8576-5f10d392ee45_20250317T14:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I filed a claim and um I received an email that I can't seem to find right now, but, um, it, it's, um, you want my member my member certificate number?
[AGENT][POSITIVE] Yes please.
[CUSTOMER][NEUTRAL] So look, uh, it's 02497961.
[AGENT][NEUTRAL] OK and then what is your name please?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK, Ms. [PII], let me look this up and I can help you with your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], can you please um give me your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] OK, um, the address is [PII]. Um, the phone number is [PII] and what else, and the email is [PII].
[AGENT][NEUTRAL] Thank you I appreciate you verifying your policy for me now if our phone gets disconnected, is that, um, phone number you gave me a good one to call you back on?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Oh thank you. Alright, let's look and see um and your claim, do you have the claim number?
[CUSTOMER][NEUTRAL] No, I do not.
[AGENT][NEUTRAL] OK, is the claim for yourself?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I see one claim here that was reported on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I do show that the claim was paid.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, $250.
[AGENT][NEUTRAL] With check number 203-2339.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] OK, and I'm just curious, um, when I look up the shoulder, which is what I, I broke.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's it it had like $1000 payout on your um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On your schedule of benefits.
[AGENT][NEUTRAL] The meal.
[AGENT][NEUTRAL] Right, let me look and see if there's any remarks on the claim, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is remarks that's on the payment for your claim.
[AGENT][NEUTRAL] Um, we, we will pay the major diagnostic exam benefit amount shown in the schedule of benefits for each day a covered person undergoes a major diagnostic exam for the purpose of diagnosing an injury.
[AGENT][NEUTRAL] The major diagnostic exam must occur within the number of days after the covered accident occurs as specific in the policy certificate. This this benefit is payable once per covered accident and up to the number of days for the planned year for each covered person as defined in the policy certificate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If more than one major diagnostic exam or X-ray.
[AGENT][NEUTRAL] As applicable under this certificate occurs on the same day, only the single highest applicable benefit is payable. This payment represents the maximum payable amount under this benefit. With this payment, this benefit is exhausted for this covered accident and date of service.
[CUSTOMER][NEUTRAL] I don't understand what that means. I mean, I had an MRI um I had X-rays. I'm going for physical therapy, um, so I thought that like all that would.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Kind of help.
[AGENT][NEUTRAL] Right, and it did.
[CUSTOMER][NEUTRAL] You know, I am, and I didn't, uh, OK, and I didn't know that um.
[AGENT][NEUTRAL] And it, it
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, how come on the, on the, the benefits it says it says like 10,040 or something, so it's somewhere.
[AGENT][NEUTRAL] So you had more than one diagnostic exam in one day so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, I didn't. I, I had, I had X-rays one day and then a month later it took a month for me to make an appointment to get an appointment for an MRI, and it was the MRI that showed that I had the fracture.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so what I'm gonna do is I'm going to um.
[AGENT][NEUTRAL] Send in a request for somebody from the claims department to call you back and go over your claim with you so they can explain to you how they they paid for you OK? that way we can get you some answers um it's gonna be a.
[CUSTOMER][POSITIVE] That would be fabulous.
[CUSTOMER][POSITIVE] That would be fabulous.
[CUSTOMER][NEUTRAL] Yeah, and, and you have the number, right?
[AGENT][NEUTRAL] Right, so it's gonna be a brief hold while I request that call back for you so I'm gonna put you on a quick hold. I'm gonna request it while we're on the phone together and then I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright great thank you.
[AGENT][POSITIVE] You're so welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] No
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you Ms. [PII] for holding for me. I got that request in now for somebody to give you a call back to go over how the pay the claim was paid, and you should be getting a call within the next 24 hours from somebody in the claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that's at my, uh, my cell number that I gave you, right? The [PII] number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK great thank you very much for all your help.
[CUSTOMER][NEUTRAL] Favor
[AGENT][POSITIVE] You're very welcome. Is there anything else I can help you before we go?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] No, that's it. I appreciate all your help.
[AGENT][POSITIVE] You're welcome you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you you too bye bye.