AccountId: 011433970860
ContactId: 011ea5f9-3f77-4c72-b00d-5f6a4866ebdb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1125709 ms
Total Talk Time (AGENT): 365406 ms
Total Talk Time (CUSTOMER): 93038 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/011ea5f9-3f77-4c72-b00d-5f6a4866ebdb_20250404T12:52_UTC.wav
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[AGENT][NEUTRAL] We.
[CUSTOMER][NEUTRAL] She went amino cabrera er to Jamando for [PII].
[AGENT][NEUTRAL] One of the on the other.
[CUSTOMER][NEUTRAL] Uh, see [PII] put on claim and then seguti pero [PII] and [PII] nega le porque esita.
[AGENT][NEUTRAL] In the.
[CUSTOMER][NEUTRAL] Benicinco era nveres.
[AGENT][NEUTRAL] the.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I hope to sinco sent a sare.
[CUSTOMER][NEUTRAL] No, no, Benticinco Sea nveres.
[AGENT][NEUTRAL] Which is even.
[CUSTOMER][NEUTRAL] Hey
[AGENT][NEUTRAL] What you.
[CUSTOMER][NEUTRAL] [PII] numera [PII] chose [PII] [PII].
[AGENT][NEGATIVE] Ingratimasita socio de la polia.
[CUSTOMER][NEUTRAL] I do rea um [PII].
[AGENT][NEUTRAL] Which is grasses for verification notification on the galamo a CSSC.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And el de la Carta uh the claim number. She's a similar paper performing there.
[CUSTOMER][NEUTRAL] Claim number 2 Cinco Oticuatro nuevedo.
[AGENT][NEUTRAL] In it.
[AGENT][NEUTRAL] and so on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, la lau derelemenion key is to los beneficios noun.
[AGENT][NEUTRAL] For incorridas or preexistencia is the condition is.
[AGENT][NEUTRAL] And.
[AGENT][NEUTRAL] The continua male.
[AGENT][NEUTRAL] The una clausula the preexistencia.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] When my moment.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um, cancer cue.
[AGENT][NEUTRAL] OK let me go and test it.
[CUSTOMER][NEUTRAL] Currently no agent staffed. Goodbye.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, check my say very safe.
[AGENT][NEUTRAL] [PII], oh.
[AGENT][POSITIVE] Good morning, [PII] how are you doing?
[AGENT][NEUTRAL] Hello? Can you hear me?
[AGENT][NEUTRAL] Oh yeah, I hear you now.
[AGENT][POSITIVE] I'm sorry, good morning. How are you doing today?
[AGENT][POSITIVE] I'm very good thank you [PII]. I'm calling you because I have uh an insurer on the phone who would like to order um.
[AGENT][NEUTRAL] More details about the denial of the center um this is for policy 257-096-3.
[AGENT][NEUTRAL] It seems like we denied the claim due to uh the pre-existent or the treatment was she doing the pre-existent um clause. What time? I'm sorry.
[AGENT][NEUTRAL] And I was wondering if you can help me explain this to the member because I was trying to see um if I get any information on the certificate, but the certificate only as preexisting as pre-existence, you know.
[AGENT][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, you know, I have to translate this to to.
[AGENT][NEUTRAL] To the member, you know, in in a way that he can understand what pre-existing means and what was the reason.
[AGENT][NEUTRAL] The claim was denied due to that.
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, great.
[AGENT][NEUTRAL] Let me ask you something. So the purcha cost, it will be.
[AGENT][NEUTRAL] Implemented doesn't matter.
[AGENT][NEUTRAL] Like, for example, I'm sorry, say this person, this person has some type of cancer, right? That he was, he was diagnosed prior to the policy if I could take.
[AGENT][NEGATIVE] But this, this person continue with this cancer, so this means this, this type of cancer will never be payable. He has to have another type of cancer.
[AGENT][NEUTRAL] To be considered under the benefits after the policy was effective.
[AGENT][NEUTRAL] Or the, the first condition could be treatable after a certain amount of time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To have the
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, OK.
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] When
[AGENT][POSITIVE] Got it, yeah.
[AGENT][NEUTRAL] Preexisting
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then he gets to keep on claims that's fine, but.
[AGENT][NEUTRAL] But that
[AGENT][NEUTRAL] But that will only, uh, will be in regards of this type of cancer that he has, right? Like, like I said, for example, if he got another cancer.
[AGENT][NEUTRAL] Right now.
[AGENT][NEGATIVE] Like right now, like, like 2 days ago, he, he found out he got another type of cancer. He can receive treatment for that cancer or he has to wait also another 12 months to start receiving benefits for that or not.
[AGENT][NEUTRAL] Cause that would not be considered preexisting. I understand that.
[AGENT][NEUTRAL] Like I said, you know, I know that for this particular reason, the one that we denied already, he'll not be payable until um until [PII].
[AGENT][NEUTRAL] No, no, no, no, no, he doesn't say that. It, it, it's, it's just, it's just a question that I got. If he got if he got a um diagnosed with a different type of cancer right now at this moment, that type of cancer will be treatable, right? I mean, will be payable under the policy cause he's already passed it, uh.
[AGENT][NEUTRAL] The effective date.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] like
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] That cancer
[AGENT][NEUTRAL] That was not preexisting.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Totally.
[AGENT][POSITIVE] Totally. All right. Well, uh, [PII], thank you very much for everything. I appreciate you. You have a great day.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] and cerca del porque reform the video uh er.
[CUSTOMER][NEUTRAL] Egan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It on a condition preexistent significaque is supposed of for diagnostic on cancer.
[AGENT][NEUTRAL] El Dia qui nom de losi lapoli and peso er effective but still the primero de vireos mil venti.
[AGENT][NEUTRAL] Poss cars and gas.
[CUSTOMER][NEUTRAL] Oh, pero la polia.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And don't say poa ra no curenel.
[CUSTOMER][NEUTRAL] Elain.
[AGENT][NEUTRAL] As the diagnostic Ovio aviao.
[AGENT][NEUTRAL] Ador parts medios and to via uncortura.
[AGENT][NEUTRAL] In respect of cancer.
[CUSTOMER][NEGATIVE] Yeah, the problem que forgasutravajo and principio de noviembre and no savia quetena condition.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Plan,
[CUSTOMER][NEUTRAL] Er propolisa effectiva after savi condition.
[AGENT][NEUTRAL] It's like to see the police.
[CUSTOMER][NEUTRAL] OK, and just now I said.
[AGENT][NEUTRAL] There's a.
[CUSTOMER][NEUTRAL] OK, Gracia.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] I just told.
[AGENT][NEGATIVE] Get down.
[CUSTOMER][NEUTRAL] 81.