AccountId: 011433970860
ContactId: 2ce16994-bc4f-4aae-9269-e88662903dfd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 225899 ms
Total Talk Time (AGENT): 85715 ms
Total Talk Time (CUSTOMER): 89326 ms
Interruptions: 3
Overall Sentiment: AGENT=2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/2ce16994-bc4f-4aae-9269-e88662903dfd_20250306T22:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling for claim status. My name is [PII].
[AGENT][NEUTRAL] Sure, I can check on a claim for you. [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] I have let me get it.
[CUSTOMER][NEUTRAL] It's 01988261.
[AGENT][NEUTRAL] OK, and then uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] It's for let me get that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK perfect thank you for verifying that and then what was the date of service for this claim?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and then do you have that bill amount?
[CUSTOMER][NEUTRAL] And the total charge, mhm it's $127.
[AGENT][POSITIVE] OK, got it thank you one moment.
[CUSTOMER][NEUTRAL] I have a reference number if you need it. Um, I'm actually following up from a previous call that was made on [PII].
[AGENT][NEUTRAL] Regarding this claim?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, no I shouldn't need that reference number. Give me just a moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] I believe I found it, of course.
[CUSTOMER][POSITIVE] Alright thanks.
[AGENT][NEUTRAL] OK. So yes, I did find this claim. Uh, we were unable to pay a benefit as the policy provides no benefits for the treatment of conditions other than a sickness or an injury as defined by the policy. Um, so did you submit an appeal?
[CUSTOMER][NEUTRAL] Let me look 1 2nd.
[CUSTOMER][NEUTRAL] I think I just looked at the notes and I confused this with another account so I apologize let me see.
[AGENT][NEUTRAL] Oh, no, no, you're fine.
[CUSTOMER][NEUTRAL] Is this OK so was this one denied because um preventive visits are not, are not covered? It's not a covered benefit?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there is the claim number 3521194?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] All right, so yeah, I think I already called on this one. I'm so sorry so um nothing has changed since is that correct? Nothing else has changed.
[AGENT][POSITIVE] OK, no, no, you're perfectly fine.
[AGENT][NEGATIVE] Right, um, there's no payable benefits for this claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] You know, I think what I was following up on was a copy of that EOB. I think that's what I'm needing let me.
[AGENT][NEUTRAL] Oh sure I can send that to you um do you have a fax number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah it's um.
[CUSTOMER][NEUTRAL] 949
[CUSTOMER][NEUTRAL] 7,644,790.
[AGENT][NEUTRAL] OK, I'm gonna read that back, make sure I heard that correctly, that was [PII]?
[CUSTOMER][POSITIVE] That's correct mhm.
[AGENT][POSITIVE] OK, I will get that sent to you. You should get it here within 10-15 minutes. Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is there a reference number for the call?
[AGENT][NEUTRAL] It would just be my first name, last initial, and today's date, uh so my name is spelled [PII]
[CUSTOMER][POSITIVE] All right perfect thank you so much.
[AGENT][POSITIVE] Of course, thanks for calling APL have a great rest of your day.
[CUSTOMER][NEUTRAL] Mhm you too bye bye.
[AGENT][POSITIVE] Thank you bye bye.