AccountId: 011433970860
ContactId: 4514e071-2924-4478-84af-cf57cc8f63ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 473049 ms
Total Talk Time (AGENT): 75095 ms
Total Talk Time (CUSTOMER): 109894 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/4514e071-2924-4478-84af-cf57cc8f63ba_20250319T20:35_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Afternoon, thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII]. I was just speaking to [PII], but I don't know what happened to the line, but I was not able to hear her. Um, so let me explain to you why I got this member on the line. Um, this is a disability policy. Um, she submitted a claim. The claim was denied and then she submitted an appeal. The appeal was denied, and she wants to know if she can appeal it again or if uh she needs, uh, what else can she do to have this pay.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is your policy number?
[CUSTOMER][NEUTRAL] It is 250-0346.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, let's see.
[AGENT][POSITIVE] And she's already gotten an appeal, uh.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] From APL?
[CUSTOMER][NEGATIVE] That's what she said that she already got the denial.
[AGENT][NEGATIVE] I see and I see a denial. I don't see anything from an appeal.
[CUSTOMER][NEUTRAL] Mm, she said she got an appeal, a denial for her appeal as well. I don't know where she got that from, but yeah.
[AGENT][NEUTRAL] OK, yeah, tell her she, I don't see, I don't see an appeal, not to say that she did not send one, but she, yes, she can appeal it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How many times can she appealing? Basically, that's her question.
[AGENT][NEUTRAL] Um, at this, at this time I don't see one. Like I said, let, let me see if I can go through her stuff and see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, medical record request, delay request.
[AGENT][NEUTRAL] Come on, I face.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] fine.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Mm, OK, yeah, I see the appeal here was preexisting.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] On which mail number?
[CUSTOMER][NEUTRAL] It doesn't have a mail number. It's under, um, let me see, correspondence on [PII].
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] That looks like from doctor, from the uh medical director.
[AGENT][NEUTRAL] If, if that's what I'm looking for, looking at it's 3 pages.
[CUSTOMER][NEUTRAL] Um, yeah, I believe so. Um, yeah, mhm.
[AGENT][NEUTRAL] Yeah, that's what they request, that's where they um.
[AGENT][NEUTRAL] They requested the medical records and the medical director. That was his review.
[AGENT][NEUTRAL] That's the results of his review.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So give me, I'm still trying to look to see what her information that she sent in as an appeal. If we missed it, then we can go back and um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Put it back in there. Give me one second. Still going through it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Let me go back to her because it's been a while since she's been holding because I lost [PII] in the beginning. OK, one moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you for holding, [PII]. You know what? I talked to her and she said no, she's getting appealed. She, she said that she knows that it's gonna be appealed. I don't know how she knows it's gonna be appealed, so I have no idea. So never mind, just scratch that. She's gonna go ahead and send an appeal to her. She can just go ahead and send one. I didn't find one here.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, because I don't see one either thank you so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You're welcome, and I'm sorry. I just, I mean, she said she wanted to know if she can appeal it again, so I'm like, so she already have people.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, alrighty.
[CUSTOMER][POSITIVE] OK. All right, thank you. Have a good afternoon.
[AGENT][NEUTRAL] Alright you too bye bye.
[CUSTOMER][NEUTRAL] OK.