AccountId: 011433970860
ContactId: 5e42a752-9e41-41c7-8cc2-6fe138e956e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343940 ms
Total Talk Time (AGENT): 125530 ms
Total Talk Time (CUSTOMER): 82910 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/5e42a752-9e41-41c7-8cc2-6fe138e956e1_20250311T16:11_UTC.wav
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[CUSTOMER][NEUTRAL] morning
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hi, [PII]. I have a question about a claim that you guys denied.
[AGENT][NEUTRAL] OK, I can help you with your claim. May I have your name?
[CUSTOMER][NEUTRAL] Sure, [PII] Last name [PII]
[AGENT][NEUTRAL] OK. And [PII], may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] Sure, 551-20 yeah 206-2821.
[AGENT][NEUTRAL] Thank you for that. And then your policy number or the claim number?
[CUSTOMER][NEUTRAL] I'm going um 357-1785.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] OK, and I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Uh, [PII] mailing address is [PII]. Uh, email on file is [PII].
[AGENT][NEUTRAL] Alrighty, and thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment, and this is for the
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] My
[AGENT][NEUTRAL] The most recent claim.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Was the date of surgery?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And what was the max? Hold on one second.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and do you mind if I place you on, I see what happened, but do you mind if I place you on just a brief hold so I can make sure I explain it correctly.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, wait a minute. So,
[AGENT][NEUTRAL] Yeah, it's the same calendar year, but what was the max in case she asked me. So it's A S S U R G O P.
[AGENT][NEUTRAL] Is it per day?
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] Where is the
[AGENT][NEUTRAL] Because I don't understand. Is it calendar day or?
[AGENT][NEUTRAL] Wait, these are two different lines.
[AGENT][NEUTRAL] Yeah, but it still doesn't say Y or D.
[AGENT][NEUTRAL] Just, just.
[AGENT][NEUTRAL] I'll see how it's listed.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Excuse me, so it's $300 yeah.
[AGENT][NEUTRAL] And then the other one is, what is that?
[AGENT][NEUTRAL] GEN.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So, um, I was trying to see the denial reason for the most recent claim. So the benefits um were used for the calendar year. So what questions did you have?
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you go from January to January?
[AGENT][NEUTRAL] Right, this is a calendar year policy. So every um January [PII] every year your benefits will populate again.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] OK, no worries.
[CUSTOMER][NEUTRAL] OK, that's it. That's all I need to know. I had a feeling it was January, January. I just wanna make sure.
[AGENT][NEUTRAL] All right, was there any
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Cause somebody told me it was policy from policy tool, you know, yearly from your policy renewal.
[AGENT][NEUTRAL] Now, some of them are, it depends. So someone could have that, um, it just depends on how they selected.
[CUSTOMER][NEUTRAL] Oh, got you.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] OK, no worries, thank you for your for uh explaining.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] No, not today, thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] I don't know if there's a spot over there if I'm gonna end up getting it, but we'll try, I guess.