AccountId: 011433970860
ContactId: a9febc18-e0f0-4316-87ed-18c1cbd27463
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 394970 ms
Total Talk Time (AGENT): 93747 ms
Total Talk Time (CUSTOMER): 103851 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/a9febc18-e0f0-4316-87ed-18c1cbd27463_20250430T14:33_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] How great I am just checking on uh.
[CUSTOMER][NEUTRAL] Uh, the claim number.
[CUSTOMER][NEUTRAL] Uh that is 358-436-4.
[AGENT][NEUTRAL] OK, I'm sorry, I didn't hear the first part. Did you say you're, what is this for yourself or you're with the provider?
[CUSTOMER][NEUTRAL] Oh, for my, it's for my husband and I am listed as an authorized third party.
[AGENT][NEUTRAL] OK, do you have the policy number or the plan?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hold on, I can pull it up.
[CUSTOMER][NEUTRAL] I had it up
[CUSTOMER][NEUTRAL] The policy number I think it's called the indemnity 2333213.
[AGENT][NEUTRAL] OK, and the name on the policy?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the address on the plan?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And then what was your name?
[CUSTOMER][NEUTRAL] Boy, [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, and you said you're authorized to speak on the account?
[CUSTOMER][NEUTRAL] I am.
[CUSTOMER][NEUTRAL] There should be a form there.
[AGENT][NEUTRAL] OK, OK, got it pulled up. OK. And what was, OK, I've got the claim number 3584364, is that right?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] I have a 3584544. Let's see in a 64.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that a 358-4364 is what I keep getting a text about.
[AGENT][NEUTRAL] OK, maybe. Do you have a different policy perhaps?
[CUSTOMER][NEUTRAL] Well, there's, he has a couple of different policies.
[CUSTOMER][NEUTRAL] Uh, through his employer, could it be the maybe short term disability 2605764?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, looks like that's what that's for.
[AGENT][NEUTRAL] pull up that policy.
[AGENT][NEUTRAL] OK. OK, for this one, it looks like.
[AGENT][NEUTRAL] Looks like it was determined that the.
[AGENT][NEUTRAL] The claim that was submitted was preexisting. It's a pre-existing condition, so it's something that he was treated for in the 12 months prior to his effective date.
[CUSTOMER][POSITIVE] It was so funny and it was the week, it was just the week before.
[AGENT][NEUTRAL] Yeah, it's anything treated in the 12 months prior to [PII]?
[CUSTOMER][NEUTRAL] 3 week uh yeah but I thought that that claim was already determined. I just keep getting.
[CUSTOMER][NEUTRAL] Uh, messages saying that it's in review.
[AGENT][NEUTRAL] Um, yeah, it's processed. Um, I don't know why, when was the last message you received?
[CUSTOMER][NEUTRAL] Just this morning, that's why I called.
[CUSTOMER][NEUTRAL] Because I kept saying I didn't open a new claim. Now I have a question on this.
[CUSTOMER][NEUTRAL] So the first surgery.
[CUSTOMER][NEUTRAL] He had gone into the hospital to the emergency room the week prior.
[CUSTOMER][NEUTRAL] And so they considered that preexisting because it was 1 week prior to the effective date. But the second surgery was
[CUSTOMER][NEUTRAL] Complications due to the first surgery. Would that still be considered for pre-existing?
[AGENT][NEUTRAL] Yes, cause it's related to the, the first condition.
[AGENT][NEUTRAL] Directly related to that condition. Um, let me see if we received something additional and why that's why it was putting
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Oh, I think this is the records, um, the request of information records from the [PII].
[AGENT][NEUTRAL] Um, so they had submitted those.
[CUSTOMER][NEUTRAL] No, I sent the records from the.
[CUSTOMER][NEUTRAL] OK, yeah, I sent the records from the [PII] though.
[AGENT][NEUTRAL] I guess they had sent them as well, so that's what generated that, so.
[CUSTOMER][NEUTRAL] Oh, OK, alrighty.
[CUSTOMER][POSITIVE] That's all I need to know. Thank you so much for your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Mhm.