AccountId: 011433970860
ContactId: 14216ce0-be87-49d9-8387-6ba36c48f6ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 348579 ms
Total Talk Time (AGENT): 105262 ms
Total Talk Time (CUSTOMER): 86911 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/14216ce0-be87-49d9-8387-6ba36c48f6ca_20250623T17:07_UTC.wav
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[AGENT][NEUTRAL] How may I assist you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling about a claim that I have.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And what is your policy number?
[CUSTOMER][NEUTRAL] Hold on one second please.
[CUSTOMER][NEUTRAL] 018
[CUSTOMER][NEUTRAL] 325
[CUSTOMER][NEUTRAL] 20
[CUSTOMER][NEUTRAL] M L 8
[AGENT][NEUTRAL] Can I have your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your email address and your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And are you calling about a claim for yourself or for someone else?
[CUSTOMER][NEUTRAL] For myself.
[AGENT][NEUTRAL] Do you have a data service or a claim number?
[CUSTOMER][NEUTRAL] Day of service, um, [PII].
[AGENT][NEUTRAL] February, what date in February? What day in February? Do you have a date? Like February is the month, but what was the date?
[CUSTOMER][NEUTRAL] Um, I, I think it's the only.
[CUSTOMER][NEUTRAL] Yeah, I think it's the only one in [PII] maybe or [PII].
[AGENT][NEUTRAL] There's multiple claims for the data service. Are you calling about the one that was recently denied?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Shows that the policy.
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] The, I keep getting uh the um.
[CUSTOMER][NEUTRAL] You know, misinformation saying that the claim is denied due to the insurance.
[CUSTOMER][NEUTRAL] Um, like not being covered, but this same service.
[CUSTOMER][NEUTRAL] It's happened, I mean, it's been covered in the past, so.
[CUSTOMER][NEGATIVE] I don't, I don't understand why it was covered in the past and it's not covered now.
[AGENT][NEUTRAL] Cause it's, it's not a sickness.
[CUSTOMER][POSITIVE] It's covered under my policy.
[CUSTOMER][NEUTRAL] But it's the same code that has been used in the past and it's been covered.
[CUSTOMER][NEUTRAL] It my policy covers that.
[AGENT][NEUTRAL] Mm. Family history of, um, that's not covered under the policy. That's not a sickness. That's a family history. So that means that you're getting, receiving a screening, a screening for family history, not your own personal reason.
[AGENT][NEUTRAL] And if it has been passed.
[CUSTOMER][NEUTRAL] It is my, I mean it's, it's the same code. I mean, I don't know.
[AGENT][NEUTRAL] Right, but is it, if it has been paid in the past, then it means that somebody wasn't paying attention to.
[CUSTOMER][NEUTRAL] It's the same diagnostic code.
[AGENT][NEUTRAL] The um the ICD code, unfortunately, however, I'm gonna look at this. May I place you on a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Thank you, let me check the history to see what procedure code was paid in history. Hold one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding. Upon looking at the history, there is no payment made for the procedure code of Z80.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] 23.
[AGENT][NEGATIVE] They were denied for the same reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, in [PII] there wasn't a payment made.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] The policy has been active since [PII] [PII], and for that procedure code of Z80.3, there's no, there's been no payment made on the claim regarding that procedure, the diagnosis code, unfortunately.
[CUSTOMER][NEUTRAL] OK, alright, I'll go ahead.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] Thanks for calling APL [PII]. Have a great day. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.