AccountId: 011433970860
ContactId: 4d705314-3fba-4356-8ede-c76baff3c5b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 461980 ms
Total Talk Time (AGENT): 71522 ms
Total Talk Time (CUSTOMER): 59758 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/4d705314-3fba-4356-8ede-c76baff3c5b1_20250613T14:42_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from the care team. I have a Miss [PII] on the line. Um, it looks like her claim got denied. Um, it said that the, um, what they billed for or whatever, the, the illness isn't covered under her policy, but then when I looked under the policy because she said it was a heart attack, I'm showing that it's covered, so I was wondering if you could help me out um and look into what she.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] OK. It's 2387.
[CUSTOMER][NEUTRAL] 081.
[CUSTOMER][NEUTRAL] And it's that second claim uh ending in 9718.
[AGENT][NEUTRAL] I'm just trying to see what we got in.
[AGENT][NEUTRAL] So you said, she said she had a stroke, you said?
[CUSTOMER][NEUTRAL] Heart attack?
[AGENT][NEUTRAL] Heart attack? OK. Let's see here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it looks like she sent it 3 times.
[AGENT][NEUTRAL] Yeah, I'm trying to see what the policy wording says regarding that benefit.
[AGENT][NEUTRAL] Mm let me see what these other documents is she sent other documents as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment. I'm gonna put you on a brief hold. I'll check something further.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding. Yeah, it looks like based off the information that we have, it's not covered because it does not meet the policy provisions of a heart attack. Looks like based off the information she sent to us, her heart test results were in normal range.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it does not meet the definition of a heart attack within the policy.
[CUSTOMER][NEUTRAL] OK, let me write that down or do you want me to transfer her to you?
[AGENT][NEUTRAL] You can let her know
[CUSTOMER][NEUTRAL] OK. Um, so you said it wasn't covered because what was in the normal range?
[AGENT][NEUTRAL] It looks like that her test results were in normal range and it does not meet the definition of a heart attack within the policy.
[AGENT][NEUTRAL] And then within the policy, it has a verbiage for a heart attack.
[AGENT][NEUTRAL] Which will result in blockage and it looks like based on the information we have.
[AGENT][NEGATIVE] It does not meet that qualification for that heart attack.
[AGENT][POSITIVE] Benefit under the plan.
[CUSTOMER][POSITIVE] OK, I'll let her know thank you so much.
[AGENT][POSITIVE] OK. You're welcome.
[AGENT][NEUTRAL] Mm bye.
[CUSTOMER][NEUTRAL] Alright bye.