AccountId: 011433970860
ContactId: 94fff643-d15d-4802-974a-cb6d07054e02
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408869 ms
Total Talk Time (AGENT): 210056 ms
Total Talk Time (CUSTOMER): 170565 ms
Interruptions: 11
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/94fff643-d15d-4802-974a-cb6d07054e02_20250527T17:29_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi. Um, my name is [PII], and, um, I'm, I was calling because, um, I made some claims because I had called before and um I was told I had coverage during a certain year and then I got the claim response back and it said that
[CUSTOMER][NEGATIVE] Um, it wasn't paid because I didn't have coverage.
[CUSTOMER][NEUTRAL] So the only reason I, yeah.
[AGENT][NEUTRAL] OK, Miss.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so you've filed claims. OK, so you filed claims, you said that.
[CUSTOMER][NEUTRAL] So that's it.
[AGENT][NEUTRAL] These were for back data claims, but now you in which you thought your policy was active, but you've received correspondence stating that it was was not active for the data service you filed for.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] OK, yes ma'am. I'll be happy to look at that for you. And so first off, what's a good callback number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, area code [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And your policy number?
[CUSTOMER][NEUTRAL] My policy, it's on here, um 021-41845.
[AGENT][NEUTRAL] OK, thank you. Give me a moment please to get your information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I will need to verify several things with you first for security and then also any information that is provided will be a verification of benefits and not a guarantee of payment. So first off, if you would please verify your date of birth.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you provided for me as one of the contact numbers. So that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Thank you and lastly your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so I don't know if this was a work email but this we have something different.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, Ms. [PII], so the policy number that you gave me was active.
[AGENT][NEUTRAL] From [PII].
[AGENT][NEUTRAL] Is did your claims fall within that date range?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, it wasn't active after that at all. I didn't activate it again until [PII]. Is that what happened?
[AGENT][NEUTRAL] I was, I was gonna say the next, the next time that you had a policy that became active with us is just last month. You do have an active policy that went into effect [PII], but you did not have between [PII].
[CUSTOMER][NEUTRAL] I was in.
[CUSTOMER][NEGATIVE] Definitely not those are all.
[CUSTOMER][NEUTRAL] OK my name is calling.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Well, that would explain it. Sounds like me.
[AGENT][NEUTRAL] Uh, now I can see, I mean you are set up in the online service center so you should be able to see those policies in there.
[CUSTOMER][NEUTRAL] Sounds like.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, that show those effective dates, so I was looking here, um, let me just because I do see there's two claims on file that we've recently received for you now one of them.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, and I can see that they were both denied, but it's, give me just a moment.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so under the, OK, so under claim number 3603511.
[CUSTOMER][NEUTRAL] Um, yeah, yeah, I got that, yeah.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] They said they're right, so for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $50 and I get.
[AGENT][NEUTRAL] Data service [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Two of the codes on that claim were denied for, because there's no um benefits.
[CUSTOMER][NEUTRAL] Yes, we have you know.
[CUSTOMER][NEUTRAL] OK, yeah, OK, cause I
[AGENT][NEUTRAL] For dental and vision.
[AGENT][NEUTRAL] And then the other one was for data service of [PII] and [PII] and of course those were denied because the services were rendered after the coverage terminated.
[CUSTOMER][POSITIVE] So I, I hope I'll get there you send it fast.
[AGENT][NEUTRAL] And then the other claim, yes, ma'am, it was denied for the same reason as far as services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] Right. Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, all the claims except for those. I just had a fibroma removed from my gum, and I thought like outpatient surgery was covered. I mean, I know he's listed as a dentist, but he's an oral surgeon, but nothing's covered that involves the teeth or gums.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Correct. That is correct. That's it, that's an exclusion, but yes, ma'am.
[CUSTOMER][NEUTRAL] OK, that's fine. Yeah.
[CUSTOMER][POSITIVE] All right. Well, I appreciate your time. Thank you so much.
[AGENT][POSITIVE] Oh, well, you're certainly, absolutely, you're very welcome. Is there anything else, Miss [PII] I can help you with today?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] In the service as well.
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for, oh, you're very welcome and thank you for calling APL. I hope you have a nice afternoon.
[CUSTOMER][POSITIVE] I appreciate it.
[CUSTOMER][NEUTRAL] All right. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.