AccountId: 011433970860
ContactId: 4298b1a5-e9af-4a59-8f79-f8558dbabe2f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293019 ms
Total Talk Time (AGENT): 133720 ms
Total Talk Time (CUSTOMER): 113755 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/4298b1a5-e9af-4a59-8f79-f8558dbabe2f_20250319T17:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and um I have a, um, I submitted a claim with, I have a reference number for you.
[AGENT][NEUTRAL] OK, Ms. [PII].
[CUSTOMER][NEUTRAL] Or I think um
[CUSTOMER][NEUTRAL] You prefer the claim number?
[AGENT][NEUTRAL] Uh, yes, but first, can I get your policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK. 024.
[CUSTOMER][NEUTRAL] 18
[CUSTOMER][NEUTRAL] 292.
[AGENT][NEUTRAL] OK, let me pull up your policy real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify for me your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] [PII]. My phone number is [PII] and my email address is [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII]. I appreciate that.
[AGENT][NEUTRAL] And the phone number you just gave me, if we get disconnected, is that a good callback number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, thank you. And then what is the claim number, ma'am?
[CUSTOMER][NEUTRAL] Uh, the claim number is 354-413-9.
[AGENT][NEUTRAL] OK, let me look that up for you.
[AGENT][NEUTRAL] OK, are you just wanting the status of the claim?
[CUSTOMER][NEUTRAL] No, I would like to appeal this claim.
[AGENT][NEUTRAL] OK, you can appeal the claim. You have 180 days from the date the claim was initially processed.
[AGENT][NEUTRAL] And you need to send a letter also why you want to appeal.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] So, where do I send the letter? And
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Right, you're gonna send it to APL claims.
[AGENT][NEUTRAL] And that is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]? Sorry?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that's in [PII] City, [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and can you please guide me as to what am I supposed to send them like.
[CUSTOMER][NEGATIVE] Because all I got back from them was benefits payable under these certificates are limited to those outlined on the schedule of benefits. This is not covered. Loss under the plan, therefore no amount is payable for this expense. That's what I got back.
[AGENT][NEUTRAL] OK, so what that is saying that um per your policy, the way that it's written under your policy, that the claim that you sent in is not covered under your plan. Um, so, well, that's what that means.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm and I basically.
[CUSTOMER][NEGATIVE] OK, and I need to justify why it should be covered, right, basically.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Well, you just need to send the letter why you, why um you're appealing the claim.
[CUSTOMER][NEUTRAL] OK. OK. I'll do that right now then. And then how long should I expect to hear back from you guys?
[AGENT][NEUTRAL] Once we receive your information, it can take up to 15 days for an appeal.
[CUSTOMER][POSITIVE] OK, great. Thank you so much. I'll do that right now so just.
[AGENT][POSITIVE] Oh, you're very welcome.
[CUSTOMER][NEUTRAL] Yes, sorry, before you go, once again, [PII] [PII]. This is, um, it should be appeal claims, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, you could say APL claims and then you could put next to it appeal.
[AGENT][NEUTRAL] And you'll want to make sure I would send a copy of the letter that you received with your letter that you're going to write.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, sounds good. I'll do that.
[AGENT][NEUTRAL] So they can refer back to it.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, alright, well, Miss [PII], is there anything else I can help you with, ma'am?
[CUSTOMER][POSITIVE] Thank you. OK.
[CUSTOMER][POSITIVE] No, that's it. Thank you so much.
[AGENT][POSITIVE] Alright, well, you have a wonderful day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye. Thank you.