AccountId: 011433970860
ContactId: f8ada37e-6193-4d11-a5f3-df68c98bc5ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 794820 ms
Total Talk Time (AGENT): 245456 ms
Total Talk Time (CUSTOMER): 423943 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/f8ada37e-6193-4d11-a5f3-df68c98bc5ce_20250529T15:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII]. How are you today?
[AGENT][POSITIVE] Oh, I'm good how are you?
[CUSTOMER][NEUTRAL] Oh, I'm alright. Can you please pull up a policy and just answer two questions for me? I don't plan on transferring this insured.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Um, the policy is 234-042-1.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the first question is on the most recently received claim that we processed for her, the last one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That was issued via check. Can you tell me why it wasn't direct deposit?
[CUSTOMER][NEUTRAL] Why would it is
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Direct deposit to.
[AGENT][NEUTRAL] 18
[CUSTOMER][NEUTRAL] And I don't know what that see if you look on CUDAT where it has active Y and N, there's a number 2 on my screen. I've never seen that.
[AGENT][NEUTRAL] Yeah. Somebody probably, they probably put uh
[CUSTOMER][NEUTRAL] I don't know what that is.
[AGENT][NEUTRAL] A 2 in there instead of a Y.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] we probably need to.
[CUSTOMER][NEUTRAL] Is that something you could change?
[AGENT][NEGATIVE] No, I can't. It's gonna be, uh, I don't even know who put the direct deposit information in.
[CUSTOMER][NEUTRAL] I mean,
[AGENT][NEUTRAL] I wonder does it say who did it changed the address.
[CUSTOMER][NEUTRAL] Mm, uh, no, I'm sure not. Well, it wouldn't be a change of address.
[AGENT][NEUTRAL] O
[AGENT][NEUTRAL] No, I'm saying usually they, if they put uh.
[CUSTOMER][NEUTRAL] I mean,
[AGENT][NEUTRAL] You said they, you know, updated, uh, claims stated, uh, DD direct deposit is in process to be released today.
[AGENT][NEUTRAL] Uh, so that additional notes the premium.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I don't know, so that would probably be something that customer service I guess would have to change because we claims can't do that we can't do it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, let's see, hold on one second.
[CUSTOMER][NEUTRAL] OK, verify.
[AGENT][NEUTRAL] I want to know
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, so I'll, I'll send a request over to customer service.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] About that, cause, you know, and then the next thing.
[AGENT][NEUTRAL] Yeah, but that's the reason, probably the reason.
[CUSTOMER][NEUTRAL] OK, and the next thing is, is, so there are benefits for crutches on this policy, but she didn't submit that so she's wanting to verify what she has to send us for that.
[AGENT][NEUTRAL] Benefits for what now?
[CUSTOMER][NEUTRAL] And it was the doctor at crutches.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when she's at the hospital being seen, she says that the doctor was putting her on crutches for 10 number of times.
[CUSTOMER][NEUTRAL] What does she need to send to us?
[AGENT][NEUTRAL] Did she have to pay
[CUSTOMER][NEUTRAL] For that benefit to be.
[AGENT][NEUTRAL] Did she have to pay for them or did she go what did you know did they charge her for the crutches?
[CUSTOMER][NEUTRAL] Oh, well, I'm a, uh, I don't know that [PII]. I did not specifically ask her that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me pull up her claim and see if I.
[CUSTOMER][NEUTRAL] I mean the claim form says you know that we would have to have a prescription for an appliance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I mean that's what the claim form says anyway.
[CUSTOMER][NEUTRAL] I've never been asked that question.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Appliance benefit provide a prescription.
[CUSTOMER][NEUTRAL] But again, this was
[AGENT][NEUTRAL] So usually they pres prescribe her, if they do a prescription, she would need to go to the uh like uh you know, kinda like we got here.
[CUSTOMER][NEUTRAL] When she's stay at the hospital.
[CUSTOMER][NEUTRAL] Right, but she was at the hospital so they.
[AGENT][NEUTRAL] And they just gave him to her there.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Let me, do you mind letting me put you on hold? I was trying to, I thought this would be pretty easy because I didn't wanna transfer her.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] I was just gonna try to answer a question. Let me ask her that instead of just releasing her to you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, give me just a second, OK?
[AGENT][POSITIVE] OK, no problem.
[CUSTOMER][POSITIVE] Thanks, [PII]. Uh, one moment.
[CUSTOMER][NEUTRAL] Hey, [PII]. All right. So she was given the crutches at the facility.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When she was there. They gave them to her when she was there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Did she know if she was did they bill her for the crutches?
[AGENT][NEUTRAL] I'm sorry, cause that's what, you know, if she was, if they gave her a bill if they send her something, you know, where she has to pay out of pocket.
[CUSTOMER][NEGATIVE] Uh no.
[AGENT][NEUTRAL] Oh, she was, I would say send that in.
[AGENT][NEUTRAL] Uh, or something showing that she was issued the crutches.
[AGENT][NEUTRAL] Uh, we need something from that facility.
[CUSTOMER][NEUTRAL] OK, so that would just
[CUSTOMER][NEUTRAL] So just like her notes, what an itemized bill, I mean,
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] You wanna send it to me?
[CUSTOMER][NEUTRAL] Girl, I thought this was gonna be so simple, [PII], and that was never my intention. I was like, I was just gonna say, oh no, tell her to send this and that'll be fine. So, OK, well, let me just um join her in because I did not tell her that I was transferring her so instead of putting you on hold again, I'm just gonna bring us all together and then I'll leave the call but her callback number is the one [PII] that you see up on the screen.
[AGENT][NEUTRAL] Mm. You're fine. You're fine.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If something happens during this connection here, OK, and actually I may stay on the call to just hear this since I have not had one like this before if that's OK.
[AGENT][POSITIVE] OK, alrighty, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I won't see any. OK, so give me one second.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah fine. Hi, this is [PII] and I also have one of our examiners on the line, [PII] and [PII] is going to help you um with answering your questions regarding what you would need to provide us for this benefit so before I just turn it over to [PII], is there anything else that I can help you with? Well, yes, um, you guys issued me a check I believe but I already have direct deposit signed up.
[CUSTOMER][NEUTRAL] So I'm not sure why you that.
[CUSTOMER][NEUTRAL] That is correct, and I'm going to send a request to have that looked at um as to why it was done because I could also see that this was this last claim was processed on a check instead of direct deposit that was strange. Did you already send out the check?
[CUSTOMER][NEUTRAL] Yes ma'am, that check would have already been sent out because I believe on this. Yes ma'am, it was actually um processed, I believe on the [PII], which means that would have, yes, so it would have mailed on yesterday.
[CUSTOMER][NEUTRAL] OK, that's fine. I mean I can use the check, but I just don't normally want, you know what I mean? I didn't know why I did that, but. Yes ma'am, and I'm not 100% sure. I think I know why, but they just need to look at it and correct one piece of information I think that was typed in incorrectly, but we'll get that taken care of for you. OK, no problem, thank you I appreciate it.
[CUSTOMER][POSITIVE] Well you're welcome and thank you again for calling APL. I hope you have a very nice day and [PII], are you able to hear Miss [PII] and Ms [PII], can you hear [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, alright then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hi, good morning. This is [PII]. How are you?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Good morning. Good, how are you, hon?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm doing well, thanks for asking. OK, uh, so I had a couple of questions and, and instead of her keep going back and forth between us, you know, she just, uh, sent you to me. OK, so for the, for the crutches.
[CUSTOMER][POSITIVE] Sure honey.
[CUSTOMER][POSITIVE] That's probably a good idea.
[AGENT][NEUTRAL] OK. So for the crutches that you have, uh, when they gave them to you at the, at the facility, uh, did they give you anything, uh, like any documentation, uh, you know, stating that uh why you needed the crutches? OK, so that's what we're needing. We needed, um, we need something, some documentation from them, like a prescription for the crutches so that we would know, uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] You know, that, that you were actually prescribed those crutches and that, you know, they are needed. They were prescribed by the physician.
[AGENT][NEUTRAL] So is there any way you can go back to the?
[CUSTOMER][NEUTRAL] OK, so I had backed the form.
[CUSTOMER][NEUTRAL] I had faxed a um a report from
[CUSTOMER][NEUTRAL] I'll tell you what it says and you can tell me if that would be acceptable or not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second. It's from, um, it's just from the hospital portal like their report.
[AGENT][NEUTRAL] Is that the information from Mount Nitney Health, is that correct?
[CUSTOMER][POSITIVE] Yes, yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so it does say that.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Uh, let's see. It doesn't list anything about the crutches.
[CUSTOMER][NEUTRAL] I, I just faxed it this morning.
[AGENT][NEUTRAL] Or you just faxed it this morning.
[CUSTOMER][NEUTRAL] You probably don't see it. Yeah.
[AGENT][NEUTRAL] OK. Yeah, I do not see it.
[CUSTOMER][NEUTRAL] There were other notes that were in the portal that I was able to pull that off of. So I just did that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right. Well, is there any way.
[CUSTOMER][NEUTRAL] Um, I'll tell you what,
[CUSTOMER][NEUTRAL] Well, honey.
[AGENT][NEUTRAL] Is there any way that I can watch for this documentation to come over and then I'll review it and then I can give you a call back to let you know if that's something that we can use or not?
[CUSTOMER][NEUTRAL] I could, yeah, you could do that or I could, I mean, I'm looking at it right now. I could tell you what it says.
[AGENT][NEUTRAL] OK, yeah, but we still gonna have to review it anyway once it gets here.
[CUSTOMER][POSITIVE] Oh, of course, yes, I did. I just wanted to know if I needed to get anything else. If I did, then I would start working on, you know what I mean? I'd
[AGENT][NEUTRAL] OK, you can go ahead and tell me what it is.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Probably have to call 1000 people for that, but
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Being it's being stupid with me. I apologize.
[AGENT][NEUTRAL] That's OK. OK, you can go ahead and tell me what it says.
[CUSTOMER][NEUTRAL] OK, I'm trying to get to here, sorry.
[AGENT][NEUTRAL] OK, you're fine.
[CUSTOMER][NEGATIVE] Is being stupid for me today.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][POSITIVE] One second, sweetie. I appreciate your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, no problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I did fax it, but I'll tell you what it says anyway. If not, if you don't think it'll work, I'll get you, I'll go work on trying to get something else.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It just says,
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I discussed with the patient that we would put an ace strap on her foot to help with swelling and that she could continue to wrap the ice and elevated home to help with symptom control, patient requested crutches to help with minimum weight bearing until it was tolerated. The patient was ordered a set of crutches. Patient was encouraged to follow up with orthopedic and her symptoms not resolved over the next several days.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that sounds like we should be able to use it, but I'm gonna wait until it gets here and then I'm gonna review it.
[CUSTOMER][NEUTRAL] OK, I guess
[AGENT][POSITIVE] And, uh, then I will give you a call back.
[CUSTOMER][NEUTRAL] OK. I mean, there's more. I just read you, I just read you the stuff that, uh, that actually pertaining to that, but there's more. I faxed two pieces of paper.
[AGENT][NEUTRAL] Yes, OK.
[AGENT][POSITIVE] OK, yes ma'am. I'm gonna watch for it and as soon as I uh review it, I'll give you a call back and let you know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you. I appreciate it.
[AGENT][NEUTRAL] OK, did you have any other questions for me on today?
[CUSTOMER][POSITIVE] You have a good day.
[AGENT][POSITIVE] All right. You too.
[CUSTOMER][POSITIVE] No, I didn't. Thank you so much. All right. Mhm. Bye-bye.
[AGENT][POSITIVE] All right have a great one bye bye.
[CUSTOMER][NEUTRAL] You too bye bye.