AccountId: 011433970860
ContactId: 433185b1-7f9a-46b3-8833-f0601c077c04
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 480079 ms
Total Talk Time (AGENT): 259829 ms
Total Talk Time (CUSTOMER): 128390 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/433185b1-7f9a-46b3-8833-f0601c077c04_20250508T13:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I needed to know why my son's claim was denied.
[AGENT][NEUTRAL] OK, so you're the insured and you're calling to get the reason behind the denial for your son, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hi Ms. [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] hold on it is.
[CUSTOMER][NEUTRAL] OK. It is 01392608.
[AGENT][NEUTRAL] OK, Ms. [PII], thank you. Give me a couple of moments please to get the policy information pulled up first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once I do, I will need to verify several things with you first for security. So first off, if you could please, and again, any information provided is a verification of benefits and not a guarantee of payment. So first off, uh, if you could please verify your date of birth and then your son's name and his date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII], [PII] [PII], I mean [PII].
[AGENT][NEUTRAL] OK, thank you. And your home excuse me, your home mailing address, Miss [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your zip code?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. The phone number that we have on file for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] That's correct.
[AGENT][POSITIVE] Thank you, and then lastly your email address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. So one moment, please.
[AGENT][NEUTRAL] What's the data service, Miss [PII] for him that I'm looking for?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I can't remember the date of service, but I submitted it last Thursday for him.
[AGENT][NEUTRAL] OK, so you're looking for the status on the most recent claim that we received for him, is that correct?
[CUSTOMER][NEGATIVE] Yeah, well, it, I think it was denied.
[AGENT][NEUTRAL] But I mean, the one that, the most recent re oh, I'm so sorry, but you're one, OK.
[CUSTOMER][NEUTRAL] And um I'm not sure.
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] All right. Was this for data service of [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] I need to know was there not enough information? What was the reason for the denial?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] And just so you know that um because this claim just went through our processing yesterday or last night the [PII], by late this afternoon you should be able to see the explanation of benefits in your portal that will have the remarks on the second page. It's probably not there yet, like I said, just because it went through nightly processing, but it should be available to you later this afternoon.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So I can see that one of the
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Go ahead. I'm listening.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so on one of the remarks, it states, we need the enclosed claim form completed by the insured, giving a description of the accident.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh, excuse me. Let me start over. let me, I messed that up. So let me start that again, Ms. [PII]. I'm sorry. We need the enclosed claim form completed by the insured giving a detailed description of the accident or diagnosis of sickness. And then the other remark, there were two remarks on here.
[CUSTOMER][POSITIVE] Oh, OK, I got you.
[CUSTOMER][POSITIVE] OK, you're good.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The second one states that this policy does not cover diagnostic X-rays.
[CUSTOMER][NEUTRAL] Diagnostic X-rays?
[AGENT][NEGATIVE] Yes, the X-ray is not covered.
[CUSTOMER][NEUTRAL] OK, so when they, when they stop, uh, covering X-rays?
[AGENT][NEUTRAL] I can pull your policy information up. Give me just a moment to see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this may be the specific type of X-ray, but I can't. Um, give me just a moment.
[CUSTOMER][NEUTRAL] Because I had many X-rays and they covered the uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The X-ray. I mean, it's whatever within the policy.
[CUSTOMER][NEUTRAL] supposed to be covered.
[AGENT][NEUTRAL] Give me, yeah, give me just a moment to look at this and then I may need to, I can.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh you.
[CUSTOMER][NEUTRAL] No we
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] So I'm not.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm not understanding, I'm not understanding it based on looking at your policy language. Now, I would be happy to send a request to have this re-reviewed and to give you a call as far as that portion of it. Um, but we still will have to have.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Give me just a moment, but as far as the other portion of it, we will still have to have that claim form, so you did not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I'll get that to you, but.
[AGENT][NEUTRAL] OK. Now, um,
[CUSTOMER][NEUTRAL] I know, I didn't submit it. I, I, I remember.
[AGENT][NEUTRAL] Uh, OK, all right. So give me one moment so I can do your request to have this other code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's gonna, do you have just a moment cause it's gonna take me just a a couple of minutes to have this submitted, OK?
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can you do it and um because I'm at, I'm at work, would I be able you could you call me back?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I'm gonna send a request and it could be up to 24 hours before someone would give you a call back anyway. Again, I'm just gonna have to send a request.
[CUSTOMER][NEUTRAL] On that number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh-huh.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with at the moment?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] That's it. Thank you so much.
[AGENT][POSITIVE] Absolutely. Well, you're very welcome. So if that's all I can help you with, Ms. [PII], thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Alright, you too.
[AGENT][NEUTRAL] Yes