AccountId: 011433970860
ContactId: 11137fe2-4ea5-4651-bc00-bcf87f202932
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 184830 ms
Total Talk Time (AGENT): 92019 ms
Total Talk Time (CUSTOMER): 64122 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/11137fe2-4ea5-4651-bc00-bcf87f202932_20250221T19:34_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling because I, um, filed a claim and I see that it was processed, but the amount paid will be zero and I wanted to understand what happened or why.
[AGENT][POSITIVE] OK, well, I can definitely help you with the claim status. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, my name is [PII], and the phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] 0106 6842.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII] [PII] and what else did you need oh the email um [PII].
[AGENT][NEUTRAL] Alright, and thank you so much for verifying. And all the information provided is a verification of benefits, not a guarantee of payment. So,
[AGENT][NEUTRAL] [PII], [PII]. OK, so it looks like both of these were denied because, so you have a max of 4 doctor office visits per calendar year, and they've been for that calendar year, they were exhausted by the time this claim came in.
[AGENT][NEUTRAL] You had to use the 4.
[CUSTOMER][NEGATIVE] See, see, I don't understand, like I don't even have a paper that tells me what the benefits is or anything, so I have no idea what I'm entitled to or not. Is there any way you can send me something?
[AGENT][NEUTRAL] Yes, hold on, let me see if it's available. I can email it to you. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I just want to make sure that there's a digital copy available before I make a promise. Hold on one second. Yeah, it's here. So I can email you a copy of your policy certificate. It'll, it breaks down all the coverage and the dollar amount that will be paid for the different services. That's what you're looking for?
[CUSTOMER][NEGATIVE] Yes, please, cause I never have any idea. It's like, you know, I'm just guessing and hoping I got reimbursed for something.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, I will go ahead and email this to you right now. Um, hold on, just, I know we just verified it, but just because I'm sending the email, I just want to make sure.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'll go ahead and send this over to you now. Um, so you should be receiving that in a few moments. And was there any other questions that you had in reference to your claim?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] All right. Well, thank you so much for calling APL and I hope you have a great weekend.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Alright bye.