AccountId: 011433970860
ContactId: fadba80f-adf2-4bb1-a84d-4bc8c04d7786
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1176150 ms
Total Talk Time (AGENT): 294446 ms
Total Talk Time (CUSTOMER): 294223 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/fadba80f-adf2-4bb1-a84d-4bc8c04d7786_20250219T16:25_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII], it's [PII]. I have got [PII] from NAS on the line. Um, she has some questions about Mr. [PII]. His policy number is 02570659.
[AGENT][NEUTRAL] Really.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mr. [PII] is deceased, um, and the policy is currently lapsed, but it was just effective 121. So I think we probably need premium before we can do anything, but she does have some questions on this accident policy.
[AGENT][POSITIVE] OK. All right, you can put her in. Thank you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Alright, uh-huh. Bye.
[AGENT][NEUTRAL] Right
[AGENT][POSITIVE] Good morning, Ms. [PII]. This is [PII] in the care team department and how may I assist you today?
[CUSTOMER][NEUTRAL] How are you?
[AGENT][POSITIVE] I'm good, thank you.
[CUSTOMER][NEUTRAL] I'm good. Hey, I have a question on the accident policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the accident claim form requests a, uh, signed document by the physician, and the broker is asking if the death certificate is enough since the um decedent never left the hospital.
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] Bear with me just a second. And um can you verify some information for me um really quick, um, can you verify his date of birth?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And this is for [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me have a callback number just in case we get disconnected, Ms. [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Hold on because I don't call myself. [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, um, let me go ahead and, and, um, contact the claims department and see if that's enough, um, and you said you're not sending the signature of the doctor, but you are trying to send the death certificate, correct?
[CUSTOMER][NEUTRAL] Right, um, the, the broker, it had, yes, the broker is indicating that the, that the APLS and claim form asks for the attending physician's statement and signature.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But he never made it out of the hospital. He was hit and run by a car, um, so they want to know if the death certificate, which provides that he was a pedestrian, he was, um, you know, struck by a vehicle, etc. and it's obviously signed by the state registrar if that would suffice.
[AGENT][NEUTRAL] OK, OK, let me go ahead and route this information over to claims department and see what they answer. I'm gonna put you on a brief hold and I'm just gonna go ahead and send this, um, this information over to them and see what they can, um, tell me about that, OK? One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[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][POSITIVE] Thank you for holding and being patient for me, Miss [PII]. I do apologize for the long wait. Um, I'm still waiting for that answer. Um, I went ahead and send it to the, um, supervisor, um, chat to see if they can answer that for me. I do apologize, it's taking this long.
[CUSTOMER][NEUTRAL] Well, you know what, while you're looking into that, can you also send them a message, um, so when I spoke to [PII], she told me that he had not paid his premium for December and January, but when I look at the two invoices, it looks like they took a credit, so I don't know, um, because she told me it had to be paid before they could file the claim, but I'm looking at the I'm looking at the January invoice.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it shows passed away 1/14, so I guess it looks like I'm assuming it was the group that took the credit.
[CUSTOMER][NEUTRAL] I don't know if it was you guys that took the credit, but because they termed him.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] They didn't pay for him in January. It went retro back to 12:31, and in December, they in the invoice they also took credit. Can you have that looked into too?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I, I see the notes on that and yes, um, that will be group billing, that will not be claims, um, that will be group billing, but um, yeah, it looks like there the credit has been given back for this policy, which it means that this policy.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] Not been receiving any payments um and uh so yeah, it needs to just go back to the group and see if they, they can go ahead and send the payment or just send back that credit explaining why they're sending that back, um, but yeah, that, that is what I see in the notes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so do you also see in the notes, does it look like it was the the group that took the credit?
[AGENT][NEUTRAL] Mm, OK, give me just a second, one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, they have some questions, Ms. [PII]. Did he pass, um, on the scene or was it on the way to the hospital?
[CUSTOMER][NEUTRAL] No, he passed at the hospital because his accident was.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, his uh, hold on, I have the death certificate right here. His accident.
[CUSTOMER][NEUTRAL] OK, his date of death was [PII], and it says the accident occurred.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Cause of death and approximate delayed complications of blood injuries. So delayed complications of the, the date of the injury was [PII]. So he died a month later.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He never came out of the hospital.
[AGENT][NEUTRAL] Got you, got you. OK, um, so she said that the physician's statement is not required, um, but we, uh, we're gonna need the death certificate but just for records, but uh we cannot use that as claim. But what we're gonna need is itemized billing.
[AGENT][NEUTRAL] And transportation billing, um.
[AGENT][NEUTRAL] So they need the bills. That's basically what she's letting me know, um.
[AGENT][NEUTRAL] And she said
[CUSTOMER][NEUTRAL] So, OK, but if, so, but if they get a physician statement then would that suffice in place of the bill?
[CUSTOMER][NEUTRAL] Cause I think we're asking a family to do too much in the middle of their loss. What what's the easiest?
[CUSTOMER][NEUTRAL] If you don't accept the death certificate, then what's the easiest?
[AGENT][NEUTRAL] OK, it depends because this particular policy is an accident policy. So, we need to count for all benefits that are payable under the policy.
[AGENT][NEUTRAL] Um, so if there's anything else that we can pay besides the loss of life, we need to, to go ahead and get itemized billing so we know exactly what to pay. Um, so basically that's what they're asking for itemized bill is because if there's any other benefits, then we can go ahead and send those out, um, and then um she said that we need gonna need a loss of life claim form. Um, let me see where I get that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have that form, the loss of life claim form?
[CUSTOMER][NEUTRAL] I don't.
[AGENT][NEUTRAL] You don't. OK. Let me see if I can get a copy of that and send it.
[CUSTOMER][NEUTRAL] Will it be
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Do you have an email address, Ms. [PII]?
[CUSTOMER][NEUTRAL] I do. You can send it to [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and again, that was, um, can you spell Conspes again?
[CUSTOMER][NEUTRAL] [PII] wait, [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me see if I can get a copy of that. Um.
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Let me see. Accident claim form, occupation to disclose, change your request. I'm looking on your website. Continuation of health, dental, I don't see loss of life. Let's see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I don't think lots of money there. I, I can check, but I don't know if they already put that in that one in.
[CUSTOMER][NEUTRAL] Long
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][POSITIVE] 12 book for lots of life. Terms of use product for good. Yeah, I don't see one on your, on your website under the claim forms.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh let's see.
[AGENT][NEUTRAL] Oh yeah, it's gonna be on the 2nd page and it's gonna be the 2nd um after the hospital indemnity.
[CUSTOMER][NEUTRAL] We get it 5
[AGENT][NEUTRAL] It's the loss of life claim form.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Filed by product, let me see.
[CUSTOMER][NEUTRAL] After a hospital indemnity.
[CUSTOMER][NEUTRAL] OK. Did you filter by anything?
[AGENT][NEUTRAL] No, I went to um [PII]. I went to claims and forms.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][POSITIVE] I found it. Yeah, I found it.
[AGENT][NEUTRAL] Scroll to the bottom and go to page 2. OK.
[CUSTOMER][POSITIVE] Yeah, I found that I found that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I found it. I think this the one who is this, hold on, is this the one he.
[CUSTOMER][NEUTRAL] Instruct no, this is a different one OK alright so he needs to submit this as well?
[AGENT][NEUTRAL] Yes, yes, mhm, so that one needs to be submitted.
[CUSTOMER][NEUTRAL] In addition.
[AGENT][NEUTRAL] And then the accident claim form needs to be submitted.
[CUSTOMER][POSITIVE] OK, perfect. Thank you very much. What was your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII], last initial [PII] is [PII], for the premium, just go back, go back to the group and see if they're gonna go ahead and send that back to us for the payment of this policy or what's gonna happen because yeah the credit was based on the notes the credit was sent back to them, OK?
[CUSTOMER][POSITIVE] All right. Thank you. Have a great day.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Thank you for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK