AccountId: 011433970860
ContactId: 4279a5ac-f8b2-4cfb-b8bd-d5b7e5ca5ff8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 242500 ms
Total Talk Time (AGENT): 129368 ms
Total Talk Time (CUSTOMER): 80802 ms
Interruptions: 3
Overall Sentiment: AGENT=1.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/4279a5ac-f8b2-4cfb-b8bd-d5b7e5ca5ff8_20250417T21:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, ma'am, I wanted to know the um status on the claim.
[AGENT][NEUTRAL] Yeah, I can check on a claim for you. What was your name?
[CUSTOMER][NEUTRAL] The idea about it?
[AGENT][NEUTRAL] OK and then can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, 217-3202.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][POSITIVE] Oh yeah, I can go ahead and take that. Thank you.
[CUSTOMER][NEUTRAL] 359-066-4
[AGENT][POSITIVE] Awesome thank you for that.
[AGENT][NEUTRAL] I got, I'm just gonna verify some information really quick. Uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Perfect, uh, last thing I need is the email address that we've got on file for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Awesome thank you so much for verifying all of that information. Alrighty, give me just a moment let me take a look here.
[AGENT][NEUTRAL] OK, so this claim did uh of course complete processing. We were unable to pay a benefit as the item does not meet the definition of durable medical equipment.
[AGENT][NEUTRAL] So it's not going to be a covered benefit under this policy.
[CUSTOMER][NEGATIVE] Alright, OK, it's not a durable. What is durable?
[AGENT][NEUTRAL] Durable medical equipment or it's sure durable medical equipment or it's called uh DME uh for short, but the definitions are.
[CUSTOMER][NEGATIVE] Cause it's not disposable.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That they can withstand repeated use, not disposable, uh, used for to serve a medical purpose with respect to treatment of an inpatient covered charge or outpatient cover charge. Uh, it's applicable and is not useful to a person in the absence of a sickness or an injury and is also appropriate for use, is primarily used within the home, uh, is not implantable within the body, and is, of course, covered under another medical plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, basically.
[CUSTOMER][NEGATIVE] They don't, they don't cover that. I mean, after all this shit that they've been making me send papers and papers and papers and papers, they tell me that.
[AGENT][NEUTRAL] Um, I have no, uh, knowledge of all of that. I apologize that you did have to go through all of that information. We do have to have all of that proper.
[CUSTOMER][NEUTRAL] Mm, yeah.
[CUSTOMER][NEUTRAL] Yeah, 1233.
[CUSTOMER][NEGATIVE] Yeah, 3 times I had since 404 411, then 44 I'm sorry, 4248 and then 415. Now, they say that what is it so I can get my doctor to, to help me out on this. What is the reason? I'm sorry, I'm gonna try to write it down, that this is something that is not, uh-huh.
[AGENT][NEUTRAL] Oh sure, um, if you would like.
[AGENT][NEUTRAL] I'm sorry if it's easier for you um as it is quite a bit um I can email you um a copy of this EOB or the explanation of benefits uh and it will have all of this, uh, notated.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK, sure. Thank you, please.
[AGENT][NEUTRAL] Absolutely, um, did you want me to just send it to this uh Ymail account that we've got?
[CUSTOMER][POSITIVE] Yes, yes, please.
[AGENT][POSITIVE] OK, I will get that sent to you um was there anything else I could help you with at the moment? I'm so sorry you had to go through all of that.
[CUSTOMER][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] No, I'm sorry, AP, I guess it's like that, but that's fine. um, let me find out on it before and then we go from there. Thank you.
[AGENT][NEUTRAL] No, no, nothing to apologize for.
[AGENT][POSITIVE] Sure no worries, of course I hope you have a great rest of your day thank you bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye. Bye bye.