AccountId: 011433970860
ContactId: 1a338d8b-6582-4771-a0ef-b7e458bb762c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214000 ms
Total Talk Time (AGENT): 72528 ms
Total Talk Time (CUSTOMER): 79290 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/1a338d8b-6582-4771-a0ef-b7e458bb762c_20250214T19:44_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII], and I filed a claim and I got um.
[CUSTOMER][NEGATIVE] Denied on
[CUSTOMER][NEUTRAL] And so I wanted to see what I got had to do to maybe appeal it because.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I did it twice, but I could tell you the I know you need the the what claim it is whatever but.
[AGENT][NEUTRAL] Yes, what's your policy number?
[CUSTOMER][NEUTRAL] Policense number is 021.
[CUSTOMER][NEUTRAL] 558-59
[AGENT][NEUTRAL] OK thank you let me one moment.
[AGENT][NEUTRAL] OK, and verify your date of birth, mail address and email address, please.
[CUSTOMER][NEUTRAL] Uh, it's, um,
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What else?
[AGENT][NEUTRAL] Uh, mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, area code is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And who is the claim for?
[CUSTOMER][NEUTRAL] Uh, my son's name is [PII].
[AGENT][NEUTRAL] No one.
[AGENT][NEUTRAL] OK, and do you have a claim number or the date of service?
[CUSTOMER][NEUTRAL] Claim number is 356.
[CUSTOMER][NEUTRAL] 356 5
[AGENT][NEUTRAL] OK, let me look at the client. Give me one moment.
[AGENT][NEUTRAL] OK. It looks like it was processed. His office visits aren't covered. Outpatient hospital facility.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, um, cause like when I called to redo it, the, the lady I spoke with said, you know, that we did an overnight stay and it was past 18 hours consecutively.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So she asked me to get this, this bill that I uploaded, but with the codes, but that's my, that's my issue is like, you know, I, I bought this insurance in case we had an overnight stay or something like that, and I don't know how to prove to you guys that it, that we were overnight consecutively past 18 hours, you know.
[AGENT][NEUTRAL] Um, usually you can request from the hospital admit and discharge summary. It will show when he was admitted and discharged from the hospital.
[CUSTOMER][NEUTRAL] Yeah, let me write that down.
[CUSTOMER][NEUTRAL] So admit
[AGENT][NEUTRAL] Discharge summary.
[CUSTOMER][NEUTRAL] And discharge summary.
[AGENT][NEUTRAL] Yes, sir. It will show the date and time you were admitted and discharged from the hospital.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So I need to get that and probably file a new claim.
[AGENT][NEUTRAL] Uh, yes, sir. And if you want to submit an appeal, you can submit a letter stating the reason for the appeal and attach that information to it so it can be reviewed.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I'll try again next week.
[AGENT][NEUTRAL] OK. And is there anything else I can assist you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, uh thank you for calling APL and you have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Good bye.