AccountId: 011433970860
ContactId: 48ef7cdc-f7e2-4e8b-a641-7b1bc2bc3a43
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1069310 ms
Total Talk Time (AGENT): 345462 ms
Total Talk Time (CUSTOMER): 394422 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/48ef7cdc-f7e2-4e8b-a641-7b1bc2bc3a43_20250618T20:18_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, I need to find out if um my claim went through.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status. May I have your name?
[CUSTOMER][NEUTRAL] It's um
[CUSTOMER][NEUTRAL] It's for my husband. It's [PII].
[AGENT][NEUTRAL] OK, and may I have your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you and may I have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] It's 257-6700.
[AGENT][NEUTRAL] OK. Thank you. And and for security, may I have your date of birth and mailing address on file?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And what else did you need?
[AGENT][NEUTRAL] Mailing address.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right, OK.
[AGENT][NEUTRAL] OK, let me look at um looks like we received a claim on the [PII] and the [PII], and let me check and see what they have determined.
[AGENT][NEUTRAL] Report the documents.
[AGENT][NEUTRAL] You can't waiting on the system for the documents.
[AGENT][NEUTRAL] OK, so basically, um, what I see here on the [PII], um they have processed the claim and indicated that the policy provides benefits due to a cover accident which is independent of disease or bodily.
[AGENT][NEUTRAL] Infirmity, illness or infections?
[CUSTOMER][NEUTRAL] OK, but
[CUSTOMER][NEGATIVE] I mean, it was a, a, uh, a bite and it swole up. We're not exactly sure what happened or he injured his hand. I don't understand how y'all can't.
[CUSTOMER][NEGATIVE] That's not covered.
[CUSTOMER][NEUTRAL] Is that what you're telling me?
[AGENT][NEGATIVE] Based on what is on this explanation of benefits, that is the denial reason. It's indicated that it is not um.
[AGENT][NEUTRAL] Noted as an accident, um, what you can do is send us a um.
[AGENT][NEUTRAL] Any itemized bills or any information that may change that that will say that it was an accident but based on the information they have when they process the claim that is the determination of the claim.
[CUSTOMER][NEUTRAL] OK, well, I sent like everything that the doctor had sent. Everything that was done that day, I sent everything over.
[AGENT][NEUTRAL] OK, the only other thing that I can tell you to do at this moment is send an appeal.
[CUSTOMER][NEUTRAL] OK, and also there's another claim that was sent in also.
[AGENT][NEUTRAL] OK. Let me look at this one.
[AGENT][NEUTRAL] I'm waiting on the documents on this one. OK, one moment.
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for the other one that I have here, um, it was also denied saying that there's no, there are no benefits payable for the suspense. Uh, now this, this particular denial, let me give you the dates of service, so you know which denial was which one. OK, so the denial that it was not a non-cover service is [PII]. So on [PII] they're stating that um.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] This is a non-cover service.
[AGENT][NEUTRAL] Now, for the previous denial that I just mentioned.
[AGENT][NEUTRAL] It was for date of service.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, which is crazy to me that there are two claims.
[CUSTOMER][NEGATIVE] I called and asked about, you know, if that would be something that that we need to file a claim for. They said it would be covered, should be covered under our accident policy and then now they're saying, oh well it's not covered.
[CUSTOMER][NEUTRAL] I mean, both of them were something that, that was caused by doing something. So like my husband was cutting grass and something got, got him.
[CUSTOMER][NEUTRAL] Um, it was either caused by straining to do what he was doing or from
[CUSTOMER][NEUTRAL] Some kind of um insect bite.
[CUSTOMER][NEGATIVE] And the other one should have been covered also.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] It was, we went in for um.
[CUSTOMER][NEGATIVE] What we thought could have been an injury, but it ended up it wasn't that it was something else, but the thing is it's like two claims back to back that y'all are not covering. I mean it's not worth us to keep paying insurance for something that y'all are just gonna um just not cover anything.
[AGENT][NEUTRAL] OK, um, yeah, this is an accident policy, so it has to be bodily injured, um, and again, you can always send uh an appeal, go ahead.
[CUSTOMER][NEUTRAL] OK, so the, so.
[CUSTOMER][NEUTRAL] Yeah, but the bite, that should have been sufficient enough.
[CUSTOMER][NEUTRAL] That was an injury to his arm.
[CUSTOMER][NEGATIVE] He had a hole and a spot on his arm, and it was also a um swelling.
[CUSTOMER][NEGATIVE] And pain
[CUSTOMER][NEUTRAL] And I noted that in the claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] OK, uh, uh, again.
[CUSTOMER][NEUTRAL] So I don't
[CUSTOMER][NEUTRAL] Cover it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so, um, with the information we got, that was the denial. So, um, what I'm asking if you can send an appeal.
[AGENT][NEUTRAL] Um, with the information like you believe that it should have been paid, um, just give us more details if you have any other itemized deal or any other bills or any other notes from the doctor that might help, you want to just add that to the claim and and send it.
[CUSTOMER][NEUTRAL] So I, I it.
[CUSTOMER][NEGATIVE] Way too much information already. I sent everything that that I could get from the visit. I sent it all in and I wrote on the form.
[CUSTOMER][NEUTRAL] Um, what, you know, what happened?
[CUSTOMER][NEGATIVE] I mean, this is ridiculous. Like, we've had Aflac accident policy and they always covered.
[CUSTOMER][POSITIVE] Never had any problems like this with stuff. My son got an insect bite by a spider and um it covered it.
[CUSTOMER][NEUTRAL] So what good does it mean? I mean, what more information can I send in? I sent everything I could possibly send because I know it's got to be in depth.
[CUSTOMER][NEGATIVE] What would you send in and y'all still didn't cover it.
[CUSTOMER][NEUTRAL] I mean, is it just, it's not just covering um like a um a break of a bone or a sprain or
[AGENT][NEUTRAL] OK, um, let me go ahead and send a request for review to the claims department and to have somebody to call you. Is that OK?
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] OK, so let me go ahead and send the report in uh for this to be reviewed. Do you mind holding for me?
[CUSTOMER][NEGATIVE] Um, and just a sec, just let me ask one more question. The other thing is I have, when I first contacted y'all about this to try to find out how to go about doing this, I asked y'all to send me out a book of what is covered, what's not covered, um, you know, information on my all my policies and all that, and I never got it. It never came in the mail, uh, so I called back last week.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Ask the same thing she's supposed to send it off, still have not received anything.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, I see where there was a request on [PII].
[CUSTOMER][NEUTRAL] She put another
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you said that the address [PII] is correct?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] I can go ahead and send another request. I do see that um Ms. Down sent a request on the [PII]. I should have been there by now.
[CUSTOMER][NEUTRAL] But there was another request sent last week.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But already I don't like this company that we're dealing with so I'm not sure that we're gonna resign and use this policy because of the fact that I'm already having issues. I had issues from the day one when I called. She gave me heck about trying to find out what's covered, what's not covered because I wasn't number one on the policy.
[AGENT][POSITIVE] Um, I'm sorry for that.
[CUSTOMER][NEUTRAL] I said so.
[CUSTOMER][NEUTRAL] any information about this policy when my name is on the policy also.
[CUSTOMER][NEUTRAL] And then she comes back on the phone and she said, well, you'll have to, you know, talk to somebody else. I don't know what else to tell you. And I said, well, I wanna speak to a supervisor and when I said that she's like, oh well, um.
[CUSTOMER][NEUTRAL] I can go ahead and um.
[CUSTOMER][NEUTRAL] Do it, um, I see where they've approved now that that we can speak with you. I said I didn't ask you the information about my husband. I just wanna know how this policy works because we don't have any information on it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so I asked her about the booklet.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] So that I could read up on it and look at it and see because it looks like to me y'all are being very picky about what y'all are covering but yet y'all are taking money from us every month to pay for this policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, do you want me to send this information to the email address on file? Do you want like electronic documentation or do you want this information to be sent to your mail, like regular mail?
[CUSTOMER][NEGATIVE] So I would have failed.
[AGENT][NEUTRAL] I'm sorry, you broke up. Can you repeat that?
[CUSTOMER][NEUTRAL] Yes, I want it mailed.
[AGENT][NEUTRAL] Male, regular mail, OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] Apparently
[CUSTOMER][NEGATIVE] We're having even problems just getting a booklet on this information.
[AGENT][NEUTRAL] OK, I'm gonna go ahead and send that out to you.
[AGENT][NEUTRAL] Like I said, it looks like they did request that back then in [PII], but I don't, I don't know what happened to it, so I'm gonna go ahead and
[AGENT][NEUTRAL] Send this by mail, you know, on an electronically let's see.
[AGENT][NEUTRAL] OK billing address on file.
[CUSTOMER][NEUTRAL] Or that I'll probably getting a letter in the mail and they can find my address for that.
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] I said
[CUSTOMER][NEGATIVE] I'm sure that they're gonna be sending out a denial letter, but that's gonna come in the mail. But yet the booklet after I've called 2 times, this will be the [PII], I still haven't received it.
[AGENT][NEUTRAL] Yeah, I'm sorry for that. I'm not really sure what happened, um.
[AGENT][NEUTRAL] OK, so I went ahead and send a request to customer service. Um, they're the ones that send out the booklet. Um, so they, they will be, um, printing this out and send it to you. It usually takes 5 to 7 business days for you to get it by regular mail.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now if, if you want to view this information a little bit quicker and you have a computer, you can always go to our website at [PII] and register and you'll you're gonna be able to see the information as well, OK?
[CUSTOMER][NEUTRAL] OK, and the other thing is, you know, it's like the people that I've talked to before didn't want me to mail it in they wanted me to file the claim online but y'all were changing some information on the website and so I was gonna have to re-register all over again.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] After y'all got your stuff straight online, so it wasn't worth me at the time filling it all out.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, we have work on that and everything is set up. Everybody needs to go ahead and create the account again, um, so, um, you can get in. So everything has been worked on right now, so everything is up to date. All you need to do is go and register, OK?
[CUSTOMER][NEUTRAL] OK, and when can I expect a call from somebody?
[AGENT][NEUTRAL] OK, that is gonna be 24 hours.
[CUSTOMER][POSITIVE] All right well thanks a bunch.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Um, that's it. Thank you.
[AGENT][POSITIVE] OK. You're welcome and thank you for calling ATL. Have a good afternoon.