AccountId: 011433970860
ContactId: 3d37a9f4-7582-4193-846f-9709db36192c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519158 ms
Total Talk Time (AGENT): 208027 ms
Total Talk Time (CUSTOMER): 118811 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/3d37a9f4-7582-4193-846f-9709db36192c_20250528T20:23_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I was calling to check on a couple of claims I had submitted to see the denial reason.
[AGENT][NEUTRAL] OK, so you're the insured and these claims are for yourself that you're wanting to check status on, is that correct?
[CUSTOMER][NEUTRAL] Uh, they're for my children.
[AGENT][POSITIVE] Yes, ma'am. I can help you. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], thank you. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] 1536509
[AGENT][NEUTRAL] I'm sorry, did you say 1536549?
[CUSTOMER][NEUTRAL] 6509.
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] And Miss [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. I will have to verify several pieces of information with you first for security. So first off, if you could please verify the subscriber's name and date of birth and then your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. My date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the phone number that we would have on file for Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII] or [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And you said that the claims you were wanting to check status on are for dependent children, is that correct?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, it'd be for Chase Bagar.
[AGENT][NEUTRAL] And what is his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And was he the only dependent you're needing to check or was there a separate dependent also?
[CUSTOMER][NEUTRAL] Uh, no, I think it was just him at this moment.
[AGENT][NEUTRAL] Just for Chase. OK, alright.
[CUSTOMER][NEUTRAL] Others too like.
[AGENT][NEUTRAL] OK, so one moment.
[AGENT][NEUTRAL] OK, so first off, um, what is the date of service, Ms. [PII], and that you're calling about for Chase?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And do you have the total bill amount for that data service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think it was $388.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] And who is the provider for that data service?
[CUSTOMER][NEUTRAL] Um, it would be Aspire Health.
[CUSTOMER][NEUTRAL] [PII]'s shoe ring or something.
[AGENT][POSITIVE] OK. All right, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She can't.
[CUSTOMER][NEUTRAL] I had to park based on yours.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] You're not in the parking lot, yeah.
[AGENT][NEUTRAL] OK, so yes, ma'am, I did locate this claim. Do you want the claim number? or do you already have that?
[CUSTOMER][NEUTRAL] Uh, no, I have that online.
[AGENT][NEUTRAL] OK, so the remarks according to the denial, which you can also see on your explanation of benefits in the portal.
[AGENT][NEUTRAL] State on each line item this policy provides benefit. This is, it's a paragraph, OK, on this denial, um.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It states this policy provides benefits due to accidental bodily injury, which means physical damage to an insured person or covered person sustained on or after the effective date, and while this policy is in force, which is the direct cause of loss, independent of disease, bodily infirmity, or any other cause. All injuries sustained in any one accident and all complications arising therefrom.
[AGENT][NEUTRAL] And reoccurrence and complication shall be deemed to be a single injury based on the information received, it does not appear that an accidental bodily injury occurred. Therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, that remark, that entire remark that I just read to you, it's on page 2 of your explanation of benefits under that claim number.
[CUSTOMER][NEUTRAL] OK, so I can access that online?
[AGENT][POSITIVE] Yes, ma'am, you can. Mhm.
[AGENT][NEUTRAL] If you have cause that's how you're submitting your claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I didn't know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you click on that claim number, yes ma'am, you should be able to see that explanation of benefits and then that remark on the 2nd page.
[AGENT][NEUTRAL] Ms. [PII], are you still there?
[CUSTOMER][NEUTRAL] Yeah, I'm here. I was looking to see.
[AGENT][NEUTRAL] Oh, OK. I'm sorry. I was just making sure I didn't, that her call had not been lost.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] I was just looking to see what it looks like.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And that way I can just look when I need uh have a question.
[CUSTOMER][NEUTRAL] Oh OK yeah I didn't know I could click on that for some reason so.
[AGENT][NEUTRAL] Yeah, you, mhm.
[CUSTOMER][MIXED] That that is helpful, so I should have clicked on it to begin with.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, well, that's OK. That's all right. Anytime you have a question, please call us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, well I
[AGENT][POSITIVE] OK, well, you're very welcome. So can I help you with anything else toda[PII]?
[CUSTOMER][POSITIVE] Alright, thank
[CUSTOMER][NEUTRAL] Uh, no, that was it. That's all I need to check on.
[AGENT][POSITIVE] OK. Well then, thank you very much for calling APL and I hope you have a very nice evening.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Yes, ma'am. Thank you very much.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Good bye.