AccountId: 011433970860
ContactId: 566f1dcc-68fd-4953-a70e-aad92641092c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 3221459 ms
Total Talk Time (AGENT): 1244297 ms
Total Talk Time (CUSTOMER): 1779296 ms
Interruptions: 22
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/566f1dcc-68fd-4953-a70e-aad92641092c_20250226T17:13_UTC.wav
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[AGENT][POSITIVE] Moi ones gracias apelemiamalike what are you there.
[CUSTOMER][NEUTRAL] OK I I try democ.
[AGENT][NEUTRAL] Yes theme de la Paullia.
[CUSTOMER][NEUTRAL] See that you know it is.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Saroo Jose.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Unreue
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] C M A L A C K.
[AGENT][MIXED] OK, glasses, but veras lache de lasmiento.
[CUSTOMER][NEUTRAL] Cinco this year.
[AGENT][NEUTRAL] OK gracias mm, [PII] de la casa tambien.
[CUSTOMER][NEUTRAL] See re [PII] repeodos in the area.
[AGENT][NEUTRAL] Gracias, it can be verifica so email enumerated the telephone.
[CUSTOMER][NEUTRAL] The email uh [PII] is sooner.
[CUSTOMER][NEUTRAL] Yeah, no it just says.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Does una say curea.
[AGENT][NEUTRAL] OK. Your email is still [PII].
[CUSTOMER][NEUTRAL] OK, uh, I, this is also.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, no, no, no, thank you sir.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Glass, yes.
[CUSTOMER][NEUTRAL] The email is uh [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] [PII].
[AGENT][POSITIVE] Perfect, gracias. Thank you for that.
[CUSTOMER][NEUTRAL] See and then uh inuso.
[CUSTOMER][NEUTRAL] Is for a explanation benefit they want it on the need.
[CUSTOMER][NEUTRAL] Uh, she must seetati correct revisallo on Sunday I er then digoes in its [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's a numeral dressing site.
[CUSTOMER][NEUTRAL] I see it.
[AGENT][NEUTRAL] OK, quite check yeah, long mamadio.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mr. [PII].
[CUSTOMER][NEUTRAL] It's when I
[CUSTOMER][NEUTRAL] What.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this is KSD policy, no, no I beneficials, um.
[AGENT][NEUTRAL] For Cargos Medicals.
[CUSTOMER][NEUTRAL] The caller will call you.
[AGENT][NEUTRAL] Uh-huh, exactly.
[CUSTOMER][NEUTRAL] OK, think the question I S A S A E N E Aotoma is a nomido.
[CUSTOMER][NEUTRAL] Train
[CUSTOMER][NEUTRAL] Culture.
[CUSTOMER][NEUTRAL] Don't really say that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But you can.
[AGENT][NEUTRAL] It is for la feche de [PII] OK.
[CUSTOMER][NEUTRAL] Correct, it's a it's a.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you um
[CUSTOMER][NEUTRAL] Question of the taxes.
[AGENT][NEUTRAL] OK, for chicken.
[CUSTOMER][NEUTRAL] Brussels, uh, see that.
[AGENT][NEUTRAL] I said, it is on.
[AGENT][NEUTRAL] Reclaim the
[AGENT][NEUTRAL] Duplica.
[AGENT][NEUTRAL] What.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] Then go.
[AGENT][NEUTRAL] I check out pork.
[AGENT][NEUTRAL] OK. But it's OK.
[AGENT][NEUTRAL] Suit the old um Erilamopola saladiermegencia.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Abajode relamore uh resin sin cinco dose nueve.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Recipemos estericlamo el Bento de Janeiro.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A tambien summitio clamael de nero apooga porque on on.
[AGENT][NEUTRAL] Duplicado.
[CUSTOMER][NEUTRAL] See, uh, and and and the the morispoinotemo for.
[CUSTOMER][NEUTRAL] Ereiniterere agenda.
[AGENT][NEUTRAL] OK. I is.
[AGENT][NEUTRAL] If there is
[AGENT][NEUTRAL] Remopola Salladiermegencia.
[AGENT][NEUTRAL] Eegado porque is the um.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEGATIVE] El cortico di diagnostico insignifica KI.
[AGENT][NEUTRAL] This
[AGENT][NEUTRAL] Alcoholic?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And no, I beneficials.
[AGENT][NEUTRAL] Inquipo demaspagarinestipolisa.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] It, it's una consulta know it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] regener polo neurit a circolimo ambulance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Um, er me addicted.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh impricaque una persona continuamenteendiente then I'll call you de la la primo queen to the nuncao.
[CUSTOMER][NEUTRAL] Uh, of citacios er Itado deo Itaes um and tornalapolia aundetase polo erian.
[AGENT][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] Uh disorder is emotionalis.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] It is emotional persona equilibr emotional.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In Tanda.
[CUSTOMER][NEUTRAL] Posmente erhutamente er.
[CUSTOMER][NEUTRAL] And I think [PII] according fa mijo.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In golpe for partafa poo er incurro on the enttiendo que elalli Rogasnatacuarta pero circao de que es mija.
[AGENT][NEUTRAL] In Tanvi.
[CUSTOMER][NEUTRAL] I una emotional devano consumer algo call is so er emotional mental que and this.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] is at the print according to your eyes.
[CUSTOMER][NEUTRAL] is a tabuancia er emotional popo so er la.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Inten
[CUSTOMER][NEUTRAL] Pitto porque mosque.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Inten. Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, Nintendo, uh, lo que paso que la la polia iquerevelo beneficials yo queteinion on uh cuenta in our website.
[AGENT][NEUTRAL] Very
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] about my coverage.
[AGENT][NEUTRAL] Is numerro de la Pullia if premier is the numeral loos mhm OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's your TV.
[CUSTOMER][NEUTRAL] Lolo Mirando.
[AGENT][NEUTRAL] OK, Abajo the exclusions and la polia de lascoso que no podemospagar a DCK alcoholism or drug addictions and thus nostamosiendose KA is is only addicivvo de alcohol.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] No, no, no, no sporeo pero and Eos cargos, um, the medicalsten medical.
[AGENT][NEUTRAL] Um, this in the cor recorded diagnostic DC um.
[AGENT][NEUTRAL] ANA alcohol and laystema.
[AGENT][NEUTRAL] Euro er abajo de los exclusions.
[AGENT][NEUTRAL] This no podemospaga for alcohol quando.
[CUSTOMER][NEUTRAL] Claro pero uh claro er [PII] person you know the control cao prime caos either on the er in eaten polo the er the.
[AGENT][NEUTRAL] S for air, sir.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mental or emotional disorder er person emotional emotional consequence can consequential in the polio is a consequentia.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Mm. Oh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I got is a case. It's just the mental or emotional disorder. It's no neurosis una psychopathia or mental or emotional er poresound secao que socio cure po emotion intraar una porque.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm. In the end the noto Mucho.
[CUSTOMER][NEUTRAL] In casoques see when we pare per nijo it's a really was a consequentia so uh proportionale in papel the the fun demijo paraquevianque no medi queloquepao he hibersexit consequenceia sentindo quila claus no cuve I call [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] She
[AGENT][NEUTRAL] Mhm. Mhm. OK.
[CUSTOMER][NEUTRAL] Primi uni isolentdo perfectmente tin viamo quesicur on the emotional disorder in to poo poo po or consequential is.
[AGENT][NEUTRAL] See see.
[CUSTOMER][NEUTRAL] Ah so it's just a conicodo is the it in the seoi can if possibleque show parao receivers.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] CNT and
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And says it's a certain lamente [PII] call cia the consequence.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the reque una delgoo in a in a.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's only it's the name of [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] Glad I could see.
[CUSTOMER][NEUTRAL] But it's OK, OK, er, sip and reversacion.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] AS 4 E cortical diagnostico.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Que significa questaba tomando alcohol is la rason que no podemos pagar beneficials. Pero and la polia abajo the scheduled of benefit CA um.
[AGENT][NEUTRAL] Receive a
[AGENT][NEUTRAL] Tratamiento or
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Emotional disorder, I beneficials, pole tramiento.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Seesosa separa it's [PII] de una consequentia.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK look you all this he sees a por prime a bit.
[CUSTOMER][NEUTRAL] To and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and is it a consequences.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Polio solicitando keep for.
[AGENT][NEUTRAL] See loquetepara said is but a nose espanolon porque is still happen in the end espanol but up.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Paella, uh, appeal.
[CUSTOMER][NEUTRAL] See something.
[AGENT][NEUTRAL] Laci puede um summitir una carta quedeiqueote you know, laraon um queuste.
[AGENT][NEUTRAL] Is that Pendo.
[AGENT][NEUTRAL] OK. Nosotros.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, he, he play the the they said came merejo.
[AGENT][NEUTRAL] In Laitacion, um.
[AGENT][NEUTRAL] For you struggles on the alcohol or on stress or
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] See channel.
[AGENT][NEUTRAL] But puerouna cartaepodemos.
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] In a fasila blossus comunica con mucho ma sense er umano on the uno masqueapel papelalo pino.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The er can landore porquetino the er er in a noolandosa semo for deposit.
[AGENT][NEUTRAL] And 10.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The quiloqueo osmos er mucho ma is porqueloin you know in in in the sam.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Poking a mucho mail and yeah.
[AGENT][NEUTRAL] And handles
[AGENT][NEUTRAL] See el papel condo resimos recimosel papel.
[AGENT][NEUTRAL] Uh, uh, I own.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Unos personas cuandorecis recimospael aus bana todo del reclamo.
[CUSTOMER][NEUTRAL] Yeah, the pors implement porque er er it's the intention of ero.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She in endo endocie.
[AGENT][NEUTRAL] Who said Ali on poco or?
[CUSTOMER][NEUTRAL] Uh no it's it's.
[AGENT][NEUTRAL] OK, porque la persona quevoyarelaliyamada noabli espanolerosis.
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] Not to sum posa permit sum.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It comes to your area, yeah.
[CUSTOMER][NEUTRAL] Latinos and the polisa.
[AGENT][NEUTRAL] Viviana Can La Palisa. OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, Miss pe a momenttito porque voya translalayamado, OK.
[CUSTOMER][NEUTRAL] Port.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I see me spare a momenttito porque voice liarque lapasando, OK.
[CUSTOMER][NEUTRAL] Cor superueta type for legacy.
[AGENT][NEUTRAL] OK, Gracias Moito, OK. Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Bye bye bye.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][POSITIVE] Hey, [PII], I'm so glad I got you.
[CUSTOMER][NEUTRAL] Hey [PII]
[AGENT][NEUTRAL] Hey, you may not be, but I, I am glad I got you. Um, I have, well, he's a Spanish speaker. His policy number, let me give you the policy number, 18613997.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Yeah, [PII]. Now he's calling regarding the claims for [PII] on part 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Part 3, OK.
[AGENT][NEUTRAL] Now we denied them because of alcohol use, OK? So we went over that the policy does not cover, uh, you know, and of course it says addiction, so he's thinking we're saying she's in.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Addict, but I, I explained to him, that's not, yeah. I mean, they're, they're in a bad situation. He lost his son, her brother back in September and his daughter, I'm just gonna cry. And his daughter, of course, is having, you know, she's emotional. She's struggling, she's struggling, yeah. Oh my God.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEGATIVE] She's struggling. Yeah, she's struggling to deal with it.
[CUSTOMER][POSITIVE] [PII] bless her. I can imagine.
[AGENT][NEUTRAL] So, uh, you know, I did go with the fact that he can submit an appeal, and he's just stating, is there anyone that I can just talk to? He said it would take 5 pages to really explain the situation by letter. So, his wife, I'm just sitting here boohooing, his wife, [PII] speaks English, and so they're just wondering if they can talk to someone, you know, maybe.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I mean, I know it won't do, but that's just what they need to do. That's what they need to do.
[CUSTOMER][NEUTRAL] I was just gonna say I mean they they can and I will gladly listen if that makes their heart feel better, yeah, but let me I'm gonna, I'm gonna pull up this policy.
[AGENT][NEUTRAL] And boohoo.
[AGENT][NEUTRAL] Yeah, we did go over the exclusions. Yeah.
[CUSTOMER][MIXED] I don't, I don't feel like it's wrong, but yeah.
[AGENT][NEGATIVE] And this was just, she's not an addict. This is just her trying to deal with the loss of her brother.
[CUSTOMER][NEUTRAL] Situational mhm.
[CUSTOMER][NEUTRAL] I get that I and you know it's hard because.
[CUSTOMER][NEUTRAL] We, we, we can have sympathy but we can't change the policy.
[AGENT][NEUTRAL] Right. And he does he understands that, but he's just, you know, needing to explain. I think that, you know, with it being alcohol and, you know, I think they need to explain it. And I think that's what, I think they need this more.
[CUSTOMER][NEGATIVE] It's so hard.
[AGENT][NEUTRAL] By explaining.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] See, and
[AGENT][NEUTRAL] Then they need the claim paid if that makes sense.
[CUSTOMER][NEUTRAL] Yeah, and you know the thing is like if the exclusions read like for the treatment of alcoholism, I would say, OK, they're not really they're, they're treating, I don't know, I mean, it says alcohol use unspecified, but if they, you know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Emotional.
[AGENT][NEUTRAL] are treating her for emotional disorder.
[CUSTOMER][NEUTRAL] Yeah, for right, like some type of emotional disorder and this was the result and all that, then that might be different.
[AGENT][NEUTRAL] And we did discuss that as well, but he thinks that, and he thinks this is exactly what the reason behind this incident was. Of course it is, you know.
[CUSTOMER][NEUTRAL] Oh yeah, I mean, and everybody deals differently so like zero judgment here because I have no idea what I would do if my sister were to pass away. I have no idea. Um, let's see, I'm trying to.
[AGENT][NEUTRAL] Me too, me too.
[AGENT][NEGATIVE] Yeah, no.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] See here, because a lot of our policies will also say that so here's the thing.
[CUSTOMER][NEUTRAL] Even if the alcoholism wasn't in there, the drinking of alcohol is an intentionally self-inflicted injury or sickness.
[AGENT][NEUTRAL] Uh, you sure sure.
[CUSTOMER][NEUTRAL] You, you know what I'm saying? And then some of them also mention it, uh, emotional disorders that are not an organic disease, and this is not, this would be.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] An emotion, well, shoot.
[CUSTOMER][NEUTRAL] It's more of an emotional response.
[AGENT][NEUTRAL] Yeah, that's how she's dealing.
[CUSTOMER][NEUTRAL] Then it is, yeah, then it is an actual.
[CUSTOMER][MIXED] Organic, my chemical imbalance is off. This is more of an emotional response. Um, like I said, I'm willing to listen. I, I don't think there's anything we can do though.
[AGENT][NEUTRAL] Got you. Got you. So,
[AGENT][NEUTRAL] Yeah, I don't either, but this is the closest thing to him writing an appeal I think, you know, and I'm gonna stay on the line just in case there's a communication.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Barrier. He said his wife. Well, I'll see, I'll see how, let me, let me get her on the line and see, see how she speaks English. OK, thanks. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You gonna tell.
[AGENT][NEUTRAL] OK, gracias por Paciencia. The name was [PII] in Laleia [PII], you know, a spanolisque Viviana ablingles.
[CUSTOMER][NEUTRAL] Number 4.
[CUSTOMER][NEUTRAL] Yes, it be the same and it's a hosterapia, you know, we are communic Carlaar and casa.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] [PII], he's saying that his wife is in therapy right now and so she can't talk to anyone in English. Do you want to try to do it with me translating?
[AGENT][NEGATIVE] [PII], your traire.
[CUSTOMER][NEUTRAL] Um, I
[CUSTOMER][NEUTRAL] People for for.
[AGENT][NEUTRAL] OK, you play
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, can go slow. OK, I, he said that if I can just translate, then he can answer any questions or.
[AGENT][NEUTRAL] And Jodiquesaan relamo issuiho issuiha OK.
[AGENT][NEUTRAL] [PII] city area.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Eusta Pianolamo illa polia tambien, OK.
[CUSTOMER][NEUTRAL] OK, la polisa, you see aelgoamijo er.
[CUSTOMER][POSITIVE] I said look I think consideration sentiendo perfectamente quilapolia er this you know cure gas er er com er noes er addittao and he.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] with the policy.
[AGENT][NEUTRAL] He says that he understands that the policy doesn't cover drugs or alcohol.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But she's not an addict and this was just her, you know, her trying to deal with the loss of her brother.
[CUSTOMER][NEUTRAL] So I guess my question would be since it is not the result of alcoholism, this was like an episode if there is something a physician could write up for them where maybe it could be submitted for reconsideration.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and this, um, CANos unaddicta.
[AGENT][NEUTRAL] Calve step where a configured Al Algo de doctor or
[AGENT][NEUTRAL] Do you know uno dictaro este is soloist.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] Ocaion
[AGENT][NEUTRAL] No calcium.
[CUSTOMER][NEUTRAL] Yeah I see yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Choo.
[AGENT][NEUTRAL] See summitteralgo commodi is no.
[AGENT][NEGATIVE] Nonadita.
[AGENT][NEUTRAL] Pero conel lao lao el city on the emotional.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I don't know as soon as they uh is he in this?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Perfect shopping Cent perfect so yeah so the medical is yes er carta is uh not a medical er comosillos a cigar of the.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Repeat the number 451.
[CUSTOMER][NEUTRAL] So, uh, I call the medical person, Shamala persona America Omica.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The cleverer local.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is the airpoaciala annootrusottambien pueda tete summitillo in a website the apele.
[CUSTOMER][NEUTRAL] OK, perfect solos no no the corporo de queer conversation the case a specific OK solo vo no city specific maintena.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, a key, a key if it's a card but a key claim is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] Mhm. So the nesisita nombre de aya el nummera de la polia.
[AGENT][NEUTRAL] Uh, and the causes, um.
[AGENT][NEUTRAL] Estielon the ebrero play solomente unac uh unsca or un accidente porque esta.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] See the name was.
[AGENT][POSITIVE] Exactly, exactly.
[CUSTOMER][POSITIVE] OK. Perfect.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] So iso components in the pine.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, Ms. [PII], OK. [PII], he's going to contact the doctor, her doctor, and try to get a letter, you know, from him stating that she is definitely not.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] An addict or um and doesn't use alcohol.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] but in this case, due to her emotional distress, you know, just in this one occasion.
[AGENT][NEUTRAL] That, um,
[AGENT][NEUTRAL] And try to get that back to us so we can at least revisit the claim.
[CUSTOMER][NEUTRAL] Yeah, because I mean she's not even, she's not even [PII], so.
[AGENT][NEUTRAL] Yeah, um, does he need to send in, um, maybe diagnosis codes?
[AGENT][NEUTRAL] For that data service or?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Medical records or would anything else help?
[CUSTOMER][NEUTRAL] If he can get any of that or all of that, every bit of information regarding this particular situation from her physicians would be helpful I think because it will, I feel like it will clearly identify that it's not.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alcoholism versus an emotional response to.
[CUSTOMER][NEUTRAL] Loss, you know what I'm saying? So I would say if we, because I mean we have diagnosis codes.
[AGENT][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] Um, where it says alcohol use unspecified and then intoxication unspecified so it, it just indicates that um she was intoxicated and then it's um and then it just says other specified health status so those are the only two.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] That I see um.
[CUSTOMER][NEUTRAL] That's from Fire and Rescue.
[CUSTOMER][NEUTRAL] Um, I'm assuming she went by ambulance maybe.
[AGENT][NEUTRAL] Yes, yes, she did.
[CUSTOMER][NEUTRAL] OK, gosh.
[AGENT][NEUTRAL] OK, I know. OK, let me tell him. OK, ABC quelomas informacion que pue coniglojo Cre coniglas not the.
[CUSTOMER][NEUTRAL] 4 kids.
[AGENT][NEUTRAL] Um, Labecita de la in La Salla de Hemegencia de loss.
[AGENT][NEUTRAL] Uh, medical records.
[AGENT][NEUTRAL] Um, for diagnosis nemos was cortico the diagnosis tennemos solos on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But it is alcohol use.
[AGENT][NEUTRAL] Not the name of Nada the.
[AGENT][NEUTRAL] Lamoal now that is a solamented as alcohol use.
[CUSTOMER][NEUTRAL] I like it it's a I mean the one emergencia it the um
[CUSTOMER][NEUTRAL] Bela la la persona no tambiendomoe esounach get so consumeddica primaria.
[AGENT][NEUTRAL] Mamas, yeah, queue con um de de doctor or de los Doctorres in lossalla de magencia and Major.
[CUSTOMER][NEUTRAL] It's the only call
[CUSTOMER][NEUTRAL] OK, we are from that like it's a queer so it can sit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 6, Mymalasia.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. Your number the Lauter persona is [PII]
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] OK perfect is mee to uh sula was lacific amended gratitude and inarita e que.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh hi yes [PII] Hall.
[CUSTOMER][NEGATIVE] Issues it's a in I momentos and in its quenos muchos ritesa mucho neo queer porque.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To
[AGENT][NEUTRAL] Mm Porto, sir.
[CUSTOMER][NEGATIVE] It's so chico era sangu.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] 22.
[CUSTOMER][NEUTRAL] Mm, now it's a tamejoriposa tambienni of combien and say memento is collaboras tambien see.
[AGENT][NEUTRAL] Yeah, you son Taravi at in.
[CUSTOMER][NEUTRAL] is taps stantegatambia erauno porsua caminatamo.
[AGENT][NEUTRAL] Tatiana, mhm.
[AGENT][NEUTRAL] OK. Um, [PII].
[AGENT][NEUTRAL] Is therapy um
[AGENT][NEUTRAL] [PII] and [PII] both are in therapy. Could they submit claims for that?
[CUSTOMER][NEUTRAL] Mm let me see if they have.
[AGENT][NEUTRAL] It's it's check the CI beneficial for the rest of time here, OK.
[CUSTOMER][NEUTRAL] It says er lasanaindo teapia uh porviaun uh nostoparigen que que argentina porquenosandemas economic.
[AGENT][NEUTRAL] Oh OK.
[AGENT][POSITIVE] No, it's, it's OK, [PII], don't worry.
[CUSTOMER][NEUTRAL] Oh, OK, uh, tango unit, uh, tambienano tambien yes all of that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The it so I won't not no no no not thetamoga in in on there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I'll say no, no, no, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, but in those uanos, um, uando puede configure informacion imitillo in a website or el Doepolifaxia lineformacion andotrus.
[CUSTOMER][NEUTRAL] This is on the logo show uplogna from which you gonna write.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I.
[AGENT][NEUTRAL] Uh, it's it's [PII] [PII], OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] We're supposed to be.
[AGENT][POSITIVE] OK, gracias Parale Aios bye.
[CUSTOMER][NEUTRAL] I feel that
[CUSTOMER][NEUTRAL] Yes, that's idea.
[AGENT][POSITIVE] OK, he's gonna work on getting all the oh my gosh.
[AGENT][NEGATIVE] Just ripped my heart out.
[CUSTOMER][NEGATIVE] I was just gonna say my heart is so broken because, I mean, I, you know, I don't know what he's saying, but
[AGENT][NEUTRAL] You can hear it.
[CUSTOMER][NEUTRAL] You can, yeah, you can hear the sadness in his voice.
[AGENT][NEUTRAL] So, um, they lost his son last September and she's [PII] has had a really hard time dealing with it, and he said it's just this one time.
[CUSTOMER][NEUTRAL] Yeah I mean she's young.
[AGENT][NEUTRAL] You know, that she just couldn't, you know, she was just looking for some relief.
[CUSTOMER][NEUTRAL] Yeah, gosh. Um.
[AGENT][NEUTRAL] But the wife and [PII] now are both in therapy.
[CUSTOMER][NEUTRAL] Did I hear correctly that it was in [PII]?
[AGENT][POSITIVE] They're from [PII] and they have a counselor from [PII] that has given them a good, a good deal.
[CUSTOMER][NEUTRAL] They're from [PII].
[CUSTOMER][NEUTRAL] Oh, so it's outside the [PII], yeah.
[AGENT][POSITIVE] Well, he's here, but he, they're getting a really good deal, so.
[CUSTOMER][NEUTRAL] 00, OK, OK. Was it, was it the, the young part [PII]?
[AGENT][NEUTRAL] I didn't ask.
[AGENT][NEUTRAL] I, I wanted to.
[CUSTOMER][NEUTRAL] Because that's the only that's the only other person on the claim.
[AGENT][NEUTRAL] And he's still active.
[CUSTOMER][NEUTRAL] As of right now.
[AGENT][NEUTRAL] Let's see [PII].
[CUSTOMER][NEUTRAL] Was it an accident or what? I mean, I'm, I'm not trying to be nosy but like I'm just like.
[AGENT][NEUTRAL] So, no, I know. Trying to piece it all together.
[CUSTOMER][NEUTRAL] Yeah, like, gosh, what on earth?
[AGENT][NEUTRAL] What is um S06 let's see.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I found a claim for him in September.
[AGENT][NEUTRAL] Hm. Yeah.
[CUSTOMER][NEUTRAL] Fracture of the skull.
[AGENT][NEUTRAL] Yeah, that's probably him.
[CUSTOMER][NEUTRAL] An accidental discharge from a firearm.
[AGENT][NEUTRAL] Gosh.
[CUSTOMER][NEUTRAL] The oh God.
[CUSTOMER][NEUTRAL] Oh God.
[AGENT][NEUTRAL] Yeah, I'm sure that's him.
[AGENT][NEGATIVE] And it just makes me wanna cry.
[AGENT][NEUTRAL] I mean they're both so young.
[CUSTOMER][NEUTRAL] Very young. I mean, his birthday is in.
[AGENT][NEUTRAL] Oh my gosh. Oh my God.
[CUSTOMER][NEUTRAL] Next week.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] I'm going to lose it. I'm going, this is, you know, this is one of those situations where while it's not as traumatizing, you almost can like put yourself in a situation of a 911 dispatcher because you're just like, I'm gonna need to decompress for a minute, you know, like I'm gonna need to walk away and have a good breakdown and come back and be like OK you know like.
[AGENT][NEUTRAL] Ah
[AGENT][NEUTRAL] The only
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Gee, that was a rough one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That was about one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, I don't even know what I'll put in these notes. I mean.
[CUSTOMER][NEUTRAL] [PII]. That is very, very young.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] I mean, I, I don't even know how to notate this right now.
[AGENT][NEUTRAL] I'm just, my brain is blubber.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm just gonna put in here that um
[AGENT][NEUTRAL] stating that his daughter's not an, an addict and she was experiencing the loss of her brother.
[AGENT][NEUTRAL] And this is a one-time situation.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I reckon I'm gonna uh state that we advised him to get medical records, um.
[AGENT][NEUTRAL] Any information from her doctor.
[AGENT][NEUTRAL] That can support that maybe this was just emotional distress.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, let me go back to that policy because I was actually trying to see if I could.
[CUSTOMER][NEUTRAL] Locate anything.
[CUSTOMER][NEUTRAL] That would
[CUSTOMER][NEUTRAL] This is one of those situations where it's like, what can I do? I wanna do something.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEGATIVE] I am a wreck.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] It's definitely like I can feel my heart racing because I'm just.
[AGENT][NEGATIVE] Me too. I feel like my blood pressure just got up at that shot up, got up, shot up at 100%. Just trying to, oh my [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEGATIVE] He said it's been so hard.
[CUSTOMER][NEUTRAL] So here's my concern.
[CUSTOMER][NEGATIVE] There's so many exclusions that this can fall up under.
[CUSTOMER][NEUTRAL] Because the other one is being intoxicated.
[CUSTOMER][NEUTRAL] And intoxication means that that which is determined and defined by the laws and jurisdiction of the geographical area.
[CUSTOMER][NEUTRAL] So if her medical records come back with a high blood alcohol level, there's another exclusion.
[AGENT][NEUTRAL] Well, I mean, it's better to review everything, anything that we can get and just see if there's any.
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Oh, yeah.
[CUSTOMER][NEGATIVE] I mean, I want so badly to just be like.
[AGENT][NEUTRAL] Let's pay it.
[CUSTOMER][POSITIVE] Yep, like they've already lost one kid. It looks like they're well on their way.
[CUSTOMER][NEUTRAL] God forbid
[AGENT][NEUTRAL] You know that's got to be in their mind.
[CUSTOMER][NEUTRAL] Emotional, at least emotionally.
[CUSTOMER][NEGATIVE] Losing another.
[CUSTOMER][MIXED] You know, because she's struggling. Thank God they put, they went to therapy like that was a very smart move. Um, that doesn't make it easy and it's, and I, so I had a cousin that died in a car accident, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 8 years ago, 7 years ago, 7 years ago. And anytime his birthday comes around or the week of his accident comes around, my aunt and his widow call it Hail Week because it floods all of those memories.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Memories and feelings, yeah.
[CUSTOMER][NEUTRAL] Both the good memories and everything that he's missed because his daughter was 6 when he died.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] And his adopted daughter was 11.
[CUSTOMER][NEUTRAL] And now the adopted daughter is, she may have been older than that because she's in college playing volleyball, and I think she's 2021.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And it's only been 7 years, so.
[CUSTOMER][NEUTRAL] She was likely.
[CUSTOMER][NEUTRAL] 12 or 13?
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Oh my God.
[CUSTOMER][NEUTRAL] And now you know like I said the.
[CUSTOMER][NEUTRAL] The younger the biological daughter is, she'll have a birthday in May and she'll be.
[CUSTOMER][NEUTRAL] 14.
[CUSTOMER][NEUTRAL] 1514 or 15?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I mean it's just.
[CUSTOMER][NEGATIVE] It's hard and even after it's not been 6 months, you know, for them it's been years at this point and it's still so difficult. I mean, his widow all the time posts you should be here and she'll post memories of the girls and what they're doing and any adventures they're going on and her hashtag is always you should be here and he is tagged in everything.
[AGENT][NEGATIVE] It's still hard.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] Yeah, he was like a big brother to me.
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] It's OK, I mean.
[CUSTOMER][NEUTRAL] It was a freak accident. And you know, the, I think the, the hard part is not that he died in a freak accident. The hard part is that the reason why he died is because someone was trying to commit a crime.
[AGENT][NEUTRAL] Uh uh.
[CUSTOMER][NEUTRAL] So what they did, you know, like those gooseneck top trailers that have like the big huge hitch for like 1/5 wheel?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Someone was trying to steal that from a business and.
[CUSTOMER][NEGATIVE] They didn't have the proper truck.
[CUSTOMER][NEUTRAL] And when it came off the truck instead of turning around and trying to get it, they left it in the road and he hit that going about 65 miles an hour.
[AGENT][NEUTRAL] Uh oh.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEGATIVE] Because at the time it's been changed since, but at the time, the road was not well lit and the trailer was black.
[CUSTOMER][NEUTRAL] So he didn't see it until he was on it.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] But he was supposed to have both of his girls with him and they decided to go with mom.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Because they're in separate vehicles.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEGATIVE] Yep, so it's just one of those things where like as awful as it is to lose him, we could have lost the entire family.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] So you know, like you have to look for the silver lining or you know or whatever in the situation because we could have lost all of them and we only lost him but that doesn't, you know, it doesn't make it easy, you know what I'm saying?
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] But yeah, um.
[AGENT][NEUTRAL] While on this.
[CUSTOMER][NEUTRAL] I'm concerned, but about this one.
[AGENT][NEGATIVE] Why on this, yeah, why on this emergency room visit is that only, only the diagnosis code for alcohol use? Why did they take her?
[CUSTOMER][NEUTRAL] I noticed that like they didn't put anything.
[AGENT][NEUTRAL] Why did they take her to the emergency room?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Because the only other thing that was on there that Z code was I think like.
[CUSTOMER][NEUTRAL] Other health something. So it's like.
[AGENT][NEUTRAL] Well, this is from, this is the UV from the emergency room and the, the only thing they have on there was the alcohol abuse.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] It was the it was the ambulance visit.
[AGENT][NEUTRAL] So why did they take her to the emergency room?
[CUSTOMER][NEUTRAL] I think the medical records are gonna be helpful for this. I am concerned that those other exclusions are still going to apply because she was intoxicated.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] But uh yes, we can at least try and look and see.
[AGENT][POSITIVE] But at least it's something we can try.
[CUSTOMER][NEUTRAL] Because while the intoxication may play a part and still end up not being able to pay, maybe at least there will be an additional diagnosis that will.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I feel like for them it's not the payment necessarily it's seeing that we're calling their daughter an alcoholic.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah. And, and we went through that. He doesn't, he did understand it, but he did want to make sure that we knew that she was not an, an addict.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Bless him, he didn't have to explain that to us.
[AGENT][NEUTRAL] Well, I mean, don't tell, yeah, so much of a spectrum of emotions and feelings. I just can't imagine, you know, and see if you think that this sounds, I mean, I sometimes I never know what to put in notes if it's too much or, you know, information.
[CUSTOMER][NEUTRAL] I mean, I understand his reasoning, yeah.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Uh, I will type a book, [PII], so let me tell you.
[AGENT][NEUTRAL] Well, I'll put in here the insured call regarding claims on part 3 stating his daughter is not an addict. She was experiencing the loss of her brother at this time. It was a one-time situation.
[AGENT][NEUTRAL] And was under emotional distress. And I'm just putting here a transfer call to [PII] and claims and translated and it was suggested that he get medical records and notes from doctors so we can review the claim and that he was also advised of the appeal process.
[CUSTOMER][NEUTRAL] Yeah, because like I said we can we can go back and review um.
[CUSTOMER][NEUTRAL] But I feel like it's gonna have to be looked at more on an appeal basis than it would be.
[CUSTOMER][NEUTRAL] On a let's reevaluate, you know, I don't know.
[AGENT][NEUTRAL] And he, he.
[AGENT][NEUTRAL] And he preferred talking to somebody versus
[CUSTOMER][NEUTRAL] Yeah, I would put that just that because of the situation um he preferred to essentially appeal verbally.
[AGENT][NEUTRAL] Like
[CUSTOMER][NEUTRAL] And that is like.
[CUSTOMER][NEUTRAL] Where the records are coming into play, you know what I'm saying?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Just because there's a lot going on with the whole family due to the loss, you know.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I'm just gonna put in here he did not want to submit a letter of appeal.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know, it would be different if I knew that he and it wouldn't be different, they would still be in pain, but to know that he was like having some emotional issues and there was a reason for his loss, but.
[CUSTOMER][NEUTRAL] For it to be accidental.
[CUSTOMER][NEUTRAL] Based off of the diagnosis codes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's one of those things where it was like you almost can sympathize and understand when someone that's having mental issues does it because they feel like that's their escape, but when it happens by accident.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You're like
[CUSTOMER][NEUTRAL] This shouldn't have happened. You know what I'm saying, like,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then all of the what ifs and whys start running through we do need to.
[CUSTOMER][NEUTRAL] I feel like we might need to let customer service know that he passed away from this accident that we have on file.
[AGENT][NEUTRAL] But the only thing is is that I don't, I mean, he didn't say that it was [PII].
[CUSTOMER][NEUTRAL] That's true.
[AGENT][NEUTRAL] What if they have another, I'm sure it's him though.
[CUSTOMER][NEUTRAL] Yeah, I mean he had a skull fracture.
[AGENT][NEUTRAL] It was in September.
[CUSTOMER][NEUTRAL] It was in September. This is dated for September. This is an ER visit. It's a gunshot wound.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like every, everything.
[CUSTOMER][MIXED] Kind of points to it, but you're right that would be making assumptions so.
[AGENT][NEUTRAL] Points
[CUSTOMER][NEUTRAL] I don't know
[CUSTOMER][NEUTRAL] Other specified disorders of right middle ear and mastoid. I wonder if the way it hit him, it caused ear issues.
[CUSTOMER][NEGATIVE] Gosh, gosh, respiratory failure.
[CUSTOMER][NEUTRAL] Like those are all the diagnosis codes that's not even like assumptions, those are all the diagnosis codes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Like you said, it, it's pretty well planning and that's the only other person on the policy, but I don't, that doesn't mean.
[CUSTOMER][NEGATIVE] That they don't have more kids, maybe the other kid just isn't eligible. Like maybe it was an older brother that's just over the age of [PII] and we can't cover them anymore.
[AGENT][NEUTRAL] Yeah, I don't know.
[CUSTOMER][NEUTRAL] I don't, I don't know either, um, I don't want them to have to continue paying a premium on a child that may not be.
[AGENT][NEUTRAL] Well, if it's family coverage, it, it wouldn't change, would it?
[CUSTOMER][POSITIVE] It wouldn't change it that's right, that's right.
[AGENT][POSITIVE] Yeah. Yeah. Well, I'm sorry I got you, but I'm glad I got you cause I knew you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I feel like we're kinda lighthearted.
[CUSTOMER][NEUTRAL] Yes, yes, and I know this is heavy, so.
[CUSTOMER][POSITIVE] Do what you've got to do to be OK. Take care of yourself, we're doing what we can for them.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That's right. And I knew that you would not just treat it as, let's see what the policy says, but this is a person. So thank you.
[CUSTOMER][MIXED] Oh no, absolutely, of course, of course, always happy to. I hate that this is such a heavy situation but.
[AGENT][POSITIVE] You know, and, and he was, and, and I didn't tell you, I apologize, but he said that he was so appreciative of our time and our care and our concern, so.
[CUSTOMER][POSITIVE] I, I really hope we can help them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] He seemed like a
[CUSTOMER][POSITIVE] Like a good guy, you know.
[AGENT][NEUTRAL] I did.
[CUSTOMER][POSITIVE] Yeah, [PII] bless him. OK, well, now, now I've got another name to add to my prayer list because goodness.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, I know. All right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Goodness I.
[AGENT][NEUTRAL] Isn't that the truth?
[CUSTOMER][POSITIVE] OK, well let me know if there's anything else I can do if they reach out and they need something else and you got questions let me know. I'm happy to help if I can um I likely will not be the one that gets them when they're reviewed, um, or when they're submitted, but if you are made aware of them being submitted and you want me to look through them, um, I'll do that too.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I won't know.
[CUSTOMER][NEUTRAL] OK, I didn't think you would like I feel, I feel like we would just have to write down the policy number and just keep an eye on it, but um we'll see.
[AGENT][NEUTRAL] [PII], if I did all, if I did that for all the ones that I.
[CUSTOMER][NEUTRAL] That's what you'd be doing all day, isn't it?
[AGENT][NEUTRAL] Right? That's what I'd be doing.
[AGENT][POSITIVE] Oh, [PII], well, I, thank goodness it's my lunchtime and I can go breathe a minute.
[CUSTOMER][POSITIVE] Oh goodness.
[CUSTOMER][NEUTRAL] I know I was to say I've got like I've got like 5 minutes before mine so I feel you.
[AGENT][NEUTRAL] Well, let's go take a lunch and breathe for a minute.
[CUSTOMER][POSITIVE] Yes, absolutely, absolutely.
[AGENT][POSITIVE] I appreciate you, [PII].
[CUSTOMER][POSITIVE] You're very welcome.
[AGENT][POSITIVE] And have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thanks. Bye-bye.
[CUSTOMER][NEUTRAL] All right, bye.