AccountId: 011433970860
ContactId: 77b5467e-69c4-4248-80d5-ba26b2097e6b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 686479 ms
Total Talk Time (AGENT): 373166 ms
Total Talk Time (CUSTOMER): 148944 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/77b5467e-69c4-4248-80d5-ba26b2097e6b_20250331T15:20_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], um, my name is [PII]. I was calling to check on the status of my, um, review that's going on right now.
[AGENT][NEUTRAL] OK, [PII], you're the insured in the claim that you're wanting to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And your last name?
[CUSTOMER][NEUTRAL] That one.
[AGENT][NEUTRAL] I'm so sorry, did you say [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And what is your policy number, please?
[CUSTOMER][NEUTRAL] I don't know it, but I'll give you my social [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 33 12 22.
[AGENT][NEUTRAL] OK, thank you one moment while I locate your information first, please.
[AGENT][NEUTRAL] OK, and which of your policies is your claim on that you're checking status?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Most current one,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It had it opened a little bit ago, um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's first verify your information and then I can ask you some. So, again, I will need to verify several things first for security, and then any information that I do provide for you, [PII] would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, also your home mailing address?
[CUSTOMER][NEUTRAL] We live in [PII].
[AGENT][NEUTRAL] OK, and one more time, the street number?
[AGENT][NEUTRAL] What did you say? [PII]. OK, thank you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] And the phone number we have for you is the same as the one that you provided for me, so that is your best contact number, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you and lastly your email address.
[CUSTOMER][NEUTRAL] Um, [PII] or [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, ma'am. It was the first one that we have. OK, so on, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So this is on your disability that you're checking status on?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I can say that we just process.
[AGENT][NEUTRAL] That's the claim um on today. Give me a moment to look at the remarks on this particular claim. It has been denied, [PII].
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, I'm gonna read you the remark, and you can't see this explanation of benefits yet, but you will be able to see that uh tomorrow, OK? Um.
[AGENT][NEUTRAL] Um, because it has to go through the overnight process for that to be viewable to you.
[AGENT][NEUTRAL] But it states, and I'm just gonna read it to you, OK?
[AGENT][NEUTRAL] Pre-existing.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Condition as defined in section 4 of means a disease, injury, sickness, physical condition, or mental illness for which, excuse me, for which received treatment, incurred expense, took medication, received care, or services including diagnostic testing or.
[AGENT][NEUTRAL] Related measures or received a diagnosis or a position during the period immediately before the effective date of your coverage. No disability will be payable if disability is caused by or resulting from a pre-existing condition.
[AGENT][NEUTRAL] The limitation will not apply to a disability resulting from a preexisting condition that begins after you have been continuously covered under the policy for 12 months. Based on claim documentation, the current condition was determined to be a pre-existing condition and no benefits are payable.
[CUSTOMER][NEUTRAL] OK, and it has not been determined because I'm still under testing. OK, alright then, mm, that's interesting. OK, OK, OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Now, you, you may file an appeal on this, [PII]. Uh, you do have 180 days from the date of the decision date, which was the [PII] today to file an appeal that can be um I can give you the mailing address for where to send that and it would be put to attention appeals department.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that mailing address, just let me know when you're ready.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Um, appeal.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am, so address it to APL and then a.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Pension Appeals department.
[CUSTOMER][NEUTRAL] Appeals
[CUSTOMER][NEUTRAL] Department.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, do they have any notes attached such as whatever they're talking about that was supposedly, um, how to say diagnosed from before?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I'm sorry, I didn't hear the first part you just said, [PII]. So, can you repeat that again, your question?
[CUSTOMER][NEUTRAL] What, what is it, it
[CUSTOMER][NEUTRAL] What does it say that I was diagnosed with, that I was treated from before?
[AGENT][NEUTRAL] All I can see, yeah, ma'am, I read the exact remark that's on here that if you've
[CUSTOMER][NEUTRAL] Does it stays an exact whatever?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And read me those last 3 word last three sentences.
[AGENT][NEUTRAL] You, if you had received treatment.
[CUSTOMER][NEUTRAL] OK. Did I had eat?
[AGENT][NEUTRAL] Excuse me, OK.
[AGENT][POSITIVE] No, no disability.
[CUSTOMER][NEUTRAL] The last three sentences.
[AGENT][NEUTRAL] OK. No disability will be payable if disability is caused by or resulting from a pre-existing condition.
[AGENT][NEUTRAL] The limitation will not apply to a disability resulting from a pre-existing condition that begins.
[AGENT][NEUTRAL] You have been continuously covered for 12 months.
[AGENT][NEUTRAL] Based on claim documentation, the current condition was determined to be a pre-existing condition and no benefits are payable.
[CUSTOMER][NEUTRAL] OK, the current edition is what the preexisting edition. OK, I understand now, alright.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, ma'am. OK.
[AGENT][NEUTRAL] So is there and again this um explanation of benefits because I can see you're set up in the online service center you this should be available to you like it may even be tomorrow afternoon but you will be able to access that in your portal.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it you, is there a way you can make note to have uh the how you say reviewer give me a call back and tell me what the current condition is they have listed?
[CUSTOMER][NEUTRAL] So I'm trying to figure out how they have a current condition in my doctor.
[AGENT][NEUTRAL] Um, what your diet.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I'm, I'm trying to figure that part out.
[AGENT][NEUTRAL] I guess, ma'am, I can.
[AGENT][NEUTRAL] OK, so let me, give me just a moment.
[CUSTOMER][NEUTRAL] I'm thinking that current
[CUSTOMER][NEUTRAL] But the doctor.
[CUSTOMER][NEUTRAL] That's what makes sense to me, but I could be wrong.
[AGENT][NEUTRAL] Alright, bear with me.
[AGENT][NEUTRAL] Um, let me see if I can, if I could provide, I might can provide you with what the diagnosis is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. One of the two diagnoses obstructive sleep apnea.
[AGENT][NEUTRAL] And the other one shows narcolepsy without cataplexy.
[CUSTOMER][NEUTRAL] Mark narcole C.
[AGENT][NEUTRAL] Mhm. Without and then it has cataplexy, C A T A P L E X Y.
[CUSTOMER][NEUTRAL] What the?
[AGENT][NEUTRAL] It's how that word is spelled.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You have lepsy without lepsy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. All right, thank you.
[AGENT][POSITIVE] Well, you are very welcome. Is there anything else that I can help you with this morning?
[CUSTOMER][POSITIVE] That's everything. Thank you.
[AGENT][POSITIVE] OK. Well, you're welcome, [PII], and thank you for calling APL. I hope you have a very nice day.
[CUSTOMER][NEUTRAL] You too goodbye.
[AGENT][NEUTRAL] Yes