AccountId: 011433970860
ContactId: 631e1562-52ab-4126-9d39-16dd31c19f90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 183169 ms
Total Talk Time (AGENT): 90107 ms
Total Talk Time (CUSTOMER): 61265 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/631e1562-52ab-4126-9d39-16dd31c19f90_20250218T14:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], hi, good day. I'm calling um because the claim was denied, but you guys didn't send me a reason why it was denied.
[AGENT][NEUTRAL] OK, I can look into the claim for you. You said are we going to or have we?
[CUSTOMER][NEGATIVE] No, I think you guys processed it and but didn't give me a reason why it was denied.
[AGENT][NEUTRAL] OK, I can definitely look into the claim for you. May I have your first and last name and your um a good contact number?
[CUSTOMER][NEUTRAL] Uh, well, [PII], my phone number is [PII].
[AGENT][NEUTRAL] Thank you for that and your policy number?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] It's gonna be 234.
[CUSTOMER][NEUTRAL] 1738.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify um your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Uh [PII] uh [PII].
[AGENT][NEUTRAL] And your mailing address?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And is the claim for you, your spouse or dependent?
[CUSTOMER][NEUTRAL] My spouse.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the claim number?
[CUSTOMER][NEUTRAL] Um, let me see the claim number.
[AGENT][NEUTRAL] Actually, it's only one claim here. I got it.
[AGENT][NEUTRAL] Hold on one second, there was only 1.
[AGENT][NEUTRAL] OK, so it looks like the claim was denied.
[AGENT][NEUTRAL] Because benefits are only, so we can only pay out if your primary insurance pays to the claim. So it's showing from what we received the documents that the primary insurance has not applied anything. So if there is an explanation of benefits from your primary insurance showing that they have paid towards this claim, just submit that to us and we can go ahead and reprocess. We just can't apply as second if first has not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so the primary insurance have to process the claim first before APL can process.
[AGENT][NEUTRAL] Right, um, we're second only to your primary, so if primary hasn't applied or if primary denies something, we cannot apply a second.
[CUSTOMER][POSITIVE] OK alright then thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that'll be all.
[AGENT][POSITIVE] Alright, well thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Alright thank you bye.
[AGENT][NEUTRAL] Bye bye.