AccountId: 011433970860
ContactId: fd7d159a-bec3-4c27-8fdc-7a97eef92745
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268230 ms
Total Talk Time (AGENT): 133058 ms
Total Talk Time (CUSTOMER): 93146 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/fd7d159a-bec3-4c27-8fdc-7a97eef92745_20250313T20:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks. I'm sorry, good afternoon. Thanks for calling ATO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on the care team. I just did the same thing on my other call. How are you doing?
[AGENT][NEUTRAL] Look, you see how I'm doing, girl. I don't know who I am, morning or evening.
[CUSTOMER][POSITIVE] Just ready to go, that's what it is.
[AGENT][NEUTRAL] Exactly. How are you?
[CUSTOMER][POSITIVE] I'm doing good. Um, can you, can you help me with this claim?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so it's policy number 2152602.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just for part 4.
[AGENT][NEUTRAL] Alright, 4.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's um claim number 357-538-9?
[AGENT][NEUTRAL] OK, let's see what we denied it for.
[AGENT][NEUTRAL] Not accident related due to an accident. Did they say it was due to an accident?
[CUSTOMER][NEUTRAL] It sounds like she hurt herself on track, but the note doesn't, it doesn't say that's what it says possibly.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can see it OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK looks like they're sending her um a form, a claim form to complete.
[AGENT][NEUTRAL] And so if it was an accident, uh, we probably just gonna need something.
[CUSTOMER][NEUTRAL] Explaining what happened.
[AGENT][NEUTRAL] Explaining what happened and so that's the form that they're gonna send to uh to them.
[AGENT][NEUTRAL] And looks like they're also gonna send um the uh authorization form so um.
[AGENT][NEUTRAL] With along with the name of her, the providers, the doctors and everything so when they send that back in, I'm not sure if they're gonna try to request medical records or not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To see if they can get the information but just let her know that uh.
[AGENT][NEUTRAL] That we're needing a diagnosis. It something showing that it was, it was diagnosed as an accident and that we're also mailing uh some forms out to her for her to complete and send back in to us.
[CUSTOMER][NEUTRAL] OK, so let me ask you this because I explained, I went through the um reasoning, you know, the diag diagnosis code, [PII], the remark code with him. I told him all of that. He said, well, I already sent that in. I just sent in the notes from the doctor. So I pulled it up in on base. That's where I see the stuff about her track, a possible tract injury.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The Marcos, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But it said possible tract injury but not a serious injury, so it didn't say she wasn't injured, but I don't, so it's highlighted, but he's like, is that not good enough? And I'm like, I don't know. I'm trying to examine it. So.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on, let me, let me see if it's coming up here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it just says leg pain.
[AGENT][NEUTRAL] And see, I guess because it happened a month ago and it says possible track injury, it doesn't say that it was a track injury.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I guess they're trying to just figure out if it is related to something that she got try yeah.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK. Well, I just wanted to make sure because he asked me that and I'm like, um, I mean, it explains it to me, but that that that's not clear. So, OK.
[AGENT][NEUTRAL] Well, but if it is possible, I mean, if I say we're going out to eat if I say, well, I possibly have enough money for both of us to eat.
[CUSTOMER][NEUTRAL] Right, mhm.
[AGENT][NEUTRAL] So I mixed one of us might not eat that day. So.
[AGENT][NEUTRAL] So, uh, yeah, tell him that's just what it is, uh, because it says possible it doesn't say that it's a definite, that it was a definite, definite track injury. Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Possible.
[CUSTOMER][NEUTRAL] Right, it's nothing confirmed it was a true accident.
[AGENT][NEUTRAL] Right, and so, but let him know that we are sending him some information to sign so uh that they're probably gonna request the records.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Well, thank you very much.
[AGENT][POSITIVE] No problem. Have a great rest of your day.
[CUSTOMER][NEUTRAL] All right, you too. Bye-bye.
[AGENT][NEUTRAL] Alright bye bye.