AccountId: 011433970860
ContactId: 21f9b1dc-3bc3-4913-8c8b-7b19471837f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 443359 ms
Total Talk Time (AGENT): 110166 ms
Total Talk Time (CUSTOMER): 73952 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/21f9b1dc-3bc3-4913-8c8b-7b19471837f7_20250306T21:33_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I want to call about a claim I put in trying to get some information about it.
[AGENT][NEUTRAL] OK, I can help you. What's your name?
[CUSTOMER][NEUTRAL] Area [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Area.
[AGENT][NEUTRAL] [PII], OK, and what's the policy number?
[CUSTOMER][NEUTRAL] 252-744-41
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] A verify your date of birth and your mailing address for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the claim is for you, right?
[CUSTOMER][NEUTRAL] It's for my husband.
[AGENT][NEUTRAL] Your spouse, OK, what's his name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it looks like there was a claim process today on [PII].
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Still looking.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] I'm still looking.
[CUSTOMER][NEUTRAL] That's the one that was processed for today?
[AGENT][NEUTRAL] Yeah, it was processed on today.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, no payment was made on it, so I was just reading the notes to get clarification.
[CUSTOMER][NEUTRAL] Of course, it's always a deny.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so it says the remark says we do not cover preexisting conditions for the first.
[AGENT][NEUTRAL] 2 years after coverage becomes effective.
[AGENT][NEUTRAL] So the policy was effective September.
[AGENT][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] Yeah, I'm gonna have to get some clarification on this. Give me just a second, [PII], OK?
[CUSTOMER][NEUTRAL] Cause you just processed the claim two weeks ago.
[AGENT][NEUTRAL] Mhm. Give me one second.
[CUSTOMER][NEUTRAL] But the same thing.
[AGENT][NEUTRAL] Yeah. Yeah. Give me a second. Yeah, give me 1 2nd.
[CUSTOMER][NEUTRAL] Oh my God.
[AGENT][NEUTRAL] Sit tight for me, OK? Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] I'm gonna place you on a brief hold, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII] how are you?
[CUSTOMER][POSITIVE] I'm doing good how are you, [PII]?
[AGENT][POSITIVE] I have a, I'm doing good. Um.
[AGENT][NEUTRAL] I have an insured on the phone regarding policy number 252.
[AGENT][NEUTRAL] 7441.
[CUSTOMER][NEUTRAL] 252-744-1, OK.
[AGENT][NEUTRAL] The claim is for part two [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's regarding the claim that was processed today, uh, the 357-2318.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not understanding the line one that denial reason that DHO 42.
[CUSTOMER][NEUTRAL] Um, let's see what it says.
[AGENT][NEGATIVE] It might be the wrong code.
[CUSTOMER][NEUTRAL] 2 year pre we do not cover pre-existing conditions for the 1st 2 years of the coverage becomes effective.
[AGENT][NEUTRAL] Wonder if that was supposed to be 242 for lab.
[CUSTOMER][NEUTRAL] Possibly um you can send her on over and I'll contact the um.
[AGENT][POSITIVE] OK. OK. OK. All [PII]. Thank you. And this is Mrs?
[CUSTOMER][NEUTRAL] The examiner to see.
[AGENT][NEUTRAL] On the phone. It's, it's [PII]. Mhm.
[CUSTOMER][NEUTRAL] Ms [PII].
[CUSTOMER][POSITIVE] OK alright thank you.
[AGENT][POSITIVE] OK. Thank you.