AccountId: 011433970860
ContactId: b4827cdf-ea10-4fdf-9a38-5fac8906bd3b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 645369 ms
Total Talk Time (AGENT): 213047 ms
Total Talk Time (CUSTOMER): 127123 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/b4827cdf-ea10-4fdf-9a38-5fac8906bd3b_20250220T15:26_UTC.wav
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[CUSTOMER][NEUTRAL] The finish starts at.
[AGENT][NEUTRAL] Well, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] 4.
[AGENT][NEUTRAL] This is [PII] with APL. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh yes, my name is uh [PII].
[CUSTOMER][NEUTRAL] And I have medical insurance with APL.
[CUSTOMER][NEUTRAL] And uh I uh the that office submitted a claim.
[CUSTOMER][NEUTRAL] For a welding shape.
[CUSTOMER][NEGATIVE] And I was wondering why you, I got a letter that uh yesterday saying that y'all do not pay for a well the check.
[AGENT][NEUTRAL] OK, I can check your claim status for you, [PII]. Uh, can I please get your policy number?
[CUSTOMER][NEUTRAL] My policy number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, let me get my glass.
[AGENT][POSITIVE] Yes, sir. Go ahead and take your time.
[CUSTOMER][NEUTRAL] My policy number.
[CUSTOMER][NEUTRAL] Is uh
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 55
[CUSTOMER][NEUTRAL] 9061.
[AGENT][NEUTRAL] OK, let me look that policy up real quick for us.
[AGENT][NEUTRAL] OK, you said the policy and let me repeat it back to you, was 02559061?
[CUSTOMER][NEUTRAL] 51.
[AGENT][NEUTRAL] 9051.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK. Thank you, sir.
[AGENT][NEUTRAL] OK, I've got you pulled up right here, sir. Uh, can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then also for security reasons, I'll need for you to verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] My address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, my email address is [PII].
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And uh what else you have for?
[AGENT][NEUTRAL] Your phone number please.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you sir for verifying that for me and the phone number that you just gave me, if our call gets dropped is that a good number to call you back on?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you. And then what is the claim number?
[AGENT][NEUTRAL] That you received on your letter. Yes, sir.
[CUSTOMER][NEUTRAL] Decline
[CUSTOMER][NEUTRAL] Uh, let me look at it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim number
[CUSTOMER][NEUTRAL] 35
[CUSTOMER][NEUTRAL] 62
[CUSTOMER][NEUTRAL] 376.
[AGENT][NEUTRAL] OK, let me look at that claim.
[CUSTOMER][NEUTRAL] I got
[CUSTOMER][NEUTRAL] On, on the claim, uh, on each one of these papers they different, they got a different, uh, claim number.
[AGENT][NEUTRAL] OK, um, um, I'll go through them one by one for you if you would like for me to do that, um, on this claim number 3562376, the remark on the claim is.
[AGENT][NEUTRAL] It's noncovered under the plan. Benefits payable under this certificate are limited to those outlined on the schedule of benefits. So per your policy on this particular claim, it's not covered.
[AGENT][NEUTRAL] Loss under the plan, therefore no amount is payable for the expense.
[CUSTOMER][NEUTRAL] But this, this is uh wellness check though, you know, the regular uh physical.
[AGENT][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Oh this is um.
[CUSTOMER][NEUTRAL] That's what I'm saying.
[CUSTOMER][NEUTRAL] And uh.
[AGENT][NEUTRAL] Right. Well, I can go.
[AGENT][NEUTRAL] I can go through and tell you what each claim says I can only tell you how the claim was processed if you need um somebody from the claims department to give you a call back and explain it to you better we can do that. Would you like for somebody to call you back?
[CUSTOMER][NEUTRAL] Yes, ma'am, because, uh, for, for a well to check for a regular physical.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause the only thing they did was um my blood work and everything.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][POSITIVE] You know, making sure that I'm still healthy and everything, and
[AGENT][POSITIVE] You're right, right.
[CUSTOMER][NEGATIVE] I don't, I don't understand why it's not payable.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, would you like me to give you the remarks on the other claims that you said that there were several? Would you like for me to read those to you too and we'll still send in the request for somebody from the claims department to call you back.
[CUSTOMER][NEUTRAL] Yes, ma'am. The other claim number is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The other claim number is 356.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2370.
[AGENT][NEUTRAL] OK, let me look at that one.
[AGENT][NEUTRAL] Yeah it's um it's the same reason benefits payable under this certificate are limited to those outlined on the the schedule of benefits um so per your policy it's not a covered loss under the plan.
[AGENT][NEUTRAL] So what I'm going to do um is I'm going to
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Put in a request for somebody in the claims department to give you a call back that can better explain it to you in detail um why the claim was denied.
[AGENT][NEUTRAL] And I'm gonna put you on a brief hold while I get that in for you and I'll be right back.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] OK, you're so welcome [PII]. Hold on real quick. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK [PII], I've got that request in for somebody to give you a call back from the claims department and you should receive a call within 24 hours. Um, we're open until [PII] this evening and then we are open again at [PII] in the morning, so it'll be before [PII] tonight if they call today or if it's tomorrow it'll be after [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're very welcome, [PII]. I hope you have a blessed day and thanks for calling APL.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] Bye-bye, sir. You're welcome.