Act 01Insurance broker · Inbound · Hinglish
Guides a panicked son at the hospital desk after a cashless denial
A son calls from a hospital TPA desk: cashless is denied for his admitted father over 'undisclosed hypertension'. The service AI verifies the policy, reads the denial note and the proposal form, opens a grievance, finds the employer group policy also covers the hospital, explains the reimbursement fallback, refuses to help change medical records, and gets a licensed claims specialist on the phone within the hour. No selling.
Demo business, not a client Suraksha Setu Insurance Brokers, Gurugram is an invented business. Scripted call, audio not recorded yet. The business is invented, and the AI says it is an AI at the start of the call.
Act 02Transcript, audio coming
Read it line by line
The audio for this call is not recorded yet. Read the full script, with an English translation under every Hindi line, and see what the AI did at each turn.
InboundHinglish
Guides a panicked son at the hospital desk after a cashless denial
Insurance broker · Suraksha Setu Insurance Brokers, Gurugram (invented)
A son calls from a hospital TPA desk: cashless is denied for his admitted father over 'undisclosed hypertension'. The service AI verifies the policy, reads the denial note and the proposal form, opens a grievance, finds the employer group policy also covers the hospital, explains the reimbursement fallback, refuses to help change medical records, and gets a licensed claims specialist on the phone within the hour. No selling.
Transcript, audio coming. The voice recording for this call is not made yet. The script below is final, and the audio player replaces this note when it lands.
What it did
- Policy verified: ₹10 lakh floater, 14 months, no PED declared
- Denial reason read: undisclosed hypertension
- Sale record checked. Grievance GR-7709 opened
- Found: employer group policy, hospital in its network
- Reimbursement fallback and document list sent
- Refused to help alter medical records
- Licensed claims specialist call within 1 hour
- No renewal pitch. Service only
Planned voice: Sarvam Bulbul, simran_enhi_customer (caller: shubh_hi_customer). Scripted: not a recording, not a real customer.
- AI employeeनमस्ते, Suraksha Setu Insurance Brokers, claims help desk। मैं यहाँ की AI assistant हूँ, और ये call record हो रही है। बताइए, क्या हुआ?Hello, Suraksha Setu Insurance Brokers, claims help desk. I am the AI assistant here, and this call is recorded. Tell me, what happened?
- Callerमेरे पापा hospital में admit हैं, कल रात chest pain हुआ था। TPA desk बोल रहा है cashless reject हो गया! अब ये लोग दो लाख advance माँग रहे हैं। आप लोगों ने policy बेची थी, अब बताओ मैं क्या करूँ?My father is admitted in hospital; he had chest pain last night. The TPA desk says cashless is rejected! Now they want ₹2 lakh advance. You people sold the policy, now tell me what do I do?
- AI employeeमैं समझ रही हूँ, ये बहुत तनाव वाला वक़्त है। हम मिलकर अभी step by step रास्ता निकालते हैं। Policy number बता दीजिए, या आपका registered mobile।I understand, this is a very stressful moment. Let us work out the way step by step right now. Please give me the policy number, or your registered mobile.
- CallerPolicy number SS एच एफ आठ आठ दो एक चार। जल्दी कीजिए please।Policy number SS-HF-88214. Please hurry.
- AI employeeVerify हो गया, Mr Anand। Family floater, दस लाख का cover, चौदह महीने पुरानी policy। Proposal form में कोई pre-existing disease declare नहीं है। Insurer का denial note आ गया है, reason लिखा है: hypertension, pre-existing, declare नहीं किया गया।Verified, Mr Anand. Family floater, ₹10 lakh cover, a 14-month-old policy. No pre-existing disease is declared in the proposal form. The insurer's denial note is in; the reason says: hypertension, pre-existing, not declared.
- CallerBP? पापा तो दो साल से BP की गोली ले रहे हैं, लेकिन policy लेते समय किसी ने पूछा ही नहीं! आपके agent ने बस form भर दिया।BP? Father has been on BP tablets for two years, but nobody asked when we took the policy! Your agent just filled in the form.
- AI employeeये बहुत गंभीर बात है। मेरे पास उस sale call की recording का record है, और उसमें health questions वाला हिस्सा नहीं दिख रहा। मैं इस पर फ़ैसला नहीं दे सकती, लेकिन मैंने insurer के साथ grievance खोल दी है, number है GR-सात सात शून्य नौ, और हमारी internal review भी शुरू कर दी है।This is a very serious point. I have the record of that sale call, and the health questions section does not appear in it. I cannot give a verdict on this, but I have opened a grievance with the insurer, number GR-7709, and started our internal review too.
- CallerGrievance-शिवेंस बाद में! अभी पैसे कहाँ से लाऊँ? Hospital बोल रहा है advance दो वरना...Grievances later! Where do I get the money right now? The hospital says pay the advance or else...
- AI employeeसही है, पहले आज की बात। आपकी file में एक और cover दिख रहा है, आपकी company की group health policy, जिसमें आपके पापा dependent के तौर पर listed हैं। Network list में ये hospital उस policy के network में है।Right, today first. Your file shows another cover, your company's group health policy, with your father listed as a dependent. Per the network list, this hospital is in that policy's network.
- Callerअरे हाँ! Office वाली policy। मुझे तो याद ही नहीं था।Oh yes! The office policy. I had completely forgotten.
- AI employeeTPA desk पर जाकर बताइए कि cashless group policy पर लेना है। उन्हें आपका employee ID और company का health card चाहिए होगा, जो आपके HR portal पर मिलेगा। मैं group policy का number और TPA का नाम अभी WhatsApp पर भेज रही हूँ।Go to the TPA desk and tell them you want cashless on the group policy. They will need your employee ID and the company health card, which you will find on your HR portal. I am sending the group policy number and the TPA's name on WhatsApp now.
- Callerऔर अगर वो भी reject हो गया तो?And if that also gets rejected?
- AI employeeतो दूसरा रास्ता है reimbursement, यानी अभी hospital को pay करें और discharge के बाद claim डालें। उसके लिए आज से ये चीज़ें संभालकर रखिए: सारे original bills, discharge summary, सारी test reports, और पापा की पुरानी BP prescriptions भी। ये पूरी list मैं WhatsApp कर रही हूँ।Then the other route is reimbursement: pay the hospital now and file the claim after discharge. From today keep these safe: all original bills, the discharge summary, all test reports, and your father's old BP prescriptions too. I am WhatsApping the full list.
- Callerसुनिए, एक बात बताइए। अगर मैं doctor से बोल दूँ कि file में BP वाली history ना लिखें, तो claim निकल जाएगा ना?Listen, tell me one thing. If I ask the doctor not to write the BP history in the file, the claim will go through, right?
- AI employeeनहीं, ये मैं बिलकुल नहीं कहूँगी, और please ऐसा मत कीजिए। Medical records में कुछ भी बदलवाना गलत है, और इससे claim पूरी तरह reject हो सकता है, ऊपर से कानूनी परेशानी अलग। सही रास्ता सच बताना है, और grievance में ये रखना कि health questions पूछे ही नहीं गए।No, I will absolutely not say that, and please do not do it. Getting medical records changed is wrong, and it can get the claim fully rejected, plus legal trouble on top. The right way is to tell the truth and put in the grievance that the health questions were never asked.
- Callerहाँ हाँ, ठीक है, मैं बस घबराया हुआ हूँ।Yes, yes, okay, I am just panicking.
- AI employeeबिलकुल समझती हूँ। आप अकेले नहीं हैं इसमें। मैं हमारे licensed claims specialist Mr Prakash को अभी आपका case दे रही हूँ। वो एक घंटे के अंदर आपको call करेंगे, और ज़रूरत हो तो TPA desk से सीधे बात भी करेंगे।I completely understand. You are not alone in this. I am handing your case to our licensed claims specialist, Mr Prakash, right now. He will call you within an hour and, if needed, speak to the TPA desk directly.
- Callerएक घंटा? और ये grievance का जवाब कब तक आएगा?An hour? And when will the grievance get a reply?
- AI employeeInsurer को IRDAI के नियम में तय समय के अंदर grievance का जवाब देना होता है। Exact timeline और आगे के steps Mr Prakash आपको लिखित में भेजेंगे, ताकि मैं अंदाज़े से कोई तारीख ना बोलूँ। Grievance का हर update आपको WhatsApp पर मिलेगा।The insurer has to reply to a grievance within the time set in IRDAI rules. Mr Prakash will send you the exact timeline and next steps in writing, so I am not guessing a date. You will get every grievance update on WhatsApp.
- Callerठीक है। पापा के ठीक होने के बाद इस policy का क्या? Renewal करूँ या नहीं?Okay. After Father recovers, what about this policy? Should I renew or not?
- AI employeeअभी उसकी चिंता मत कीजिए। Renewal अभी चार महीने दूर है, और वो फ़ैसला grievance के नतीजे के बाद, आराम से, किसी licensed advisor के साथ करना चाहिए। अभी सारा ध्यान पापा और cashless पर रखिए।Do not worry about that now. Renewal is four months away, and that decision should be made calmly after the grievance outcome, with a licensed advisor. Keep all your focus on your father and the cashless for now.
- Callerठीक है। मैं TPA desk जा रहा हूँ।Okay. I am going to the TPA desk.
- AI employeeजाइए। Recap: TPA desk पर group policy से cashless माँगिए, employee ID और health card के साथ, details WhatsApp पर हैं। Reimbursement की document list भी भेज दी है। Grievance GR-सात सात शून्य नौ खुल गई। Mr Prakash एक घंटे में call करेंगे। पापा के जल्दी ठीक होने की दुआ करती हूँ।Go ahead. Recap: ask the TPA desk for cashless on the group policy, with your employee ID and health card; details are on WhatsApp. I have also sent the reimbursement document list. Grievance GR-7709 is open. Mr Prakash will call within an hour. Wishing your father a quick recovery.
Act 03The rules on this call
Honest from the first line
- It says it is an AI assistant in its first line, and that the call is recorded.
- It uses only the facts the business gave it. Anything else goes to a person, with a time.
- No guarantees, no invented offers, no pressure. Prices only from the business’s own list.
- The business is invented and both voices are AI. No real customer is on the call.
Your calls next
Hear it answer your number
We build a demo on your own questions, prices and hours, then you call it yourself before you decide.