AccountId: 011433970860
ContactId: 81888caa-7f97-409f-a7cf-af247cab9e74
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 636789 ms
Total Talk Time (AGENT): 163402 ms
Total Talk Time (CUSTOMER): 111849 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/81888caa-7f97-409f-a7cf-af247cab9e74_20250410T13:27_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], this is [PII], and I had filed a claim and I got um a denial on it so I wanted to see uh what the uh reason for the denial was if y'all needed additional information or just exactly what's going on.
[AGENT][POSITIVE] OK, well, I can definitely help you with your claim. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] 02570162
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] 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].
[AGENT][NEUTRAL] And the mailing address and email address on file?
[CUSTOMER][NEUTRAL] Uh I'm sorry hang on just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Yes, ma'am, I'm here.
[CUSTOMER][NEUTRAL] Hello, I'm, I'm sorry, my, my, uh, AirPods, uh, gave out.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, it's OK.
[CUSTOMER][NEUTRAL] It it went, yeah, it, it went to my phone and, and I've got my AirPods in. Um, I'm sorry, what was your question?
[AGENT][NEUTRAL] Um, just your, um, mailing address and your email address on file.
[CUSTOMER][NEUTRAL] Oh, mailing address is [PII]. Email address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Now is the claim for you or would it be for your spouse, because I don't see anything under you.
[CUSTOMER][NEUTRAL] For my spouse.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So are we looking at both claims or just this last, this last claim here um from that was received on [PII] or is this?
[AGENT][NEUTRAL] Uh, one is just
[CUSTOMER][NEUTRAL] Well, I, I've only
[CUSTOMER][NEUTRAL] It's all one I had uh I had sent in the invoice from the hospital for his immunotherapy and then y'all asked for the uh EOB so I sent that in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, I've always paid for his immunotherapy in the past, so I'm not sure why it's been denied this time.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][POSITIVE] Yes I can.
[AGENT][NEUTRAL] I don't know what just happened. I, I was asking if it's OK if I place you on just a brief hold. I'm just gonna look through the claims and these reasonings and just get everything together for you. OK, hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Mrs. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I was looking through the claims and
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] So the first and now reason I saw the explanation of benefits. The second one, it says that the benefits have been used for the benefit period, but this is the first claim, um.
[AGENT][NEUTRAL] I went back to the previous policy thinking like, well, maybe we, maybe we paid out on there, but there wasn't any claims. So I'm gonna send this back to claims to be reprocessed or to at least research to
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because from what I see, it doesn't look correct because this was the first claim, so
[AGENT][NEUTRAL] And it wasn't paid out on, so I don't know how the max was met, so I'm gonna have them relook at this, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And reprocess if needed. If it's right, they'll let us know, but if not, it'll be reprocessed and you'll get that new decision. I just don't see where the benefit has been used before.
[CUSTOMER][NEUTRAL] Yeah, for this year it has not, no, this is the first claim that I've that I've turned in for this year.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Yes, I'm definitely sorry for the confusion. I'm glad you brought it up to us. Um, I'm gonna definitely have them process this claim and then it won't, it shouldn't take the full 7 to 10 business days, we just say that just to be on the safe side, um, but you'll definitely receive the decision through the online service center if you use it and you'll get it through text and mail as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. OK, perfect. Thank you so much for your help.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. I apologize for that. I'm definitely, I'm sending it over to them right now and it's urgent.
[CUSTOMER][POSITIVE] Sounds good thank you so much appreciate it.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am, that's it. I appreciate you.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] You too thanks bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.