AccountId: 011433970860
ContactId: b5c05b31-d1c1-490e-a5ab-83a0e0dfe882
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 213460 ms
Total Talk Time (AGENT): 120640 ms
Total Talk Time (CUSTOMER): 72503 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/b5c05b31-d1c1-490e-a5ab-83a0e0dfe882_20250124T14:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. With whom am I speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII]. How are you doing?
[AGENT][POSITIVE] Hi, I'm good. [PII], and you?
[CUSTOMER][POSITIVE] I'm doing good um I don't know if I'm confusing myself or not, but I'm glad I got you.
[AGENT][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Um, you want the policy number?
[AGENT][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] OK, it's 214.
[CUSTOMER][NEUTRAL] 8482.
[AGENT][NEUTRAL] OK. All right. Let me get that pulled up.
[AGENT][NEUTRAL] And who is that for?
[CUSTOMER][NEUTRAL] Um, it's for part, oh no, this is for her, [PII].
[AGENT][NEUTRAL] OK, OK, what's your question?
[CUSTOMER][NEUTRAL] OK, for claim 3,458,590.
[AGENT][NEUTRAL] OK, the very first one all the way down at the bottom, OK.
[CUSTOMER][NEUTRAL] OK, so we, so we we denied it saying that it was um exhausted in the plane here, but this was the first, the only claim for [PII].
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Let me take a look. OK, go ahead.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] But since it's over 180 days, I didn't know when something is sent back to be reprocessed, is that the same as an appeal?
[AGENT][NEUTRAL] Oh, we don't have, we don't, um, no, see, that's, that's a new one. I don't know if you heard that somebody told you that, but I've never been told that. I mean, if you find the error and it could be a year, 2 years later, it just goes to that person for them to, uh, reprocess that claim. I've, I've never heard that.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] What? 180 days?
[AGENT][NEUTRAL] Yeah, I ain't never heard that.
[CUSTOMER][NEUTRAL] Oh, OK. I was, so yeah, I, I had put it in our chat.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] I can't even get this. OK. Uh-huh, go ahead. You did?
[CUSTOMER][NEUTRAL] I put it in our chat. Yeah, I mean, that's always what they said to me for an appeal, but I didn't know, well then if I take it the way you.
[AGENT][NEUTRAL] But it's, but this, but this is not an appeal if it was processed wrong.
[CUSTOMER][NEUTRAL] OK. That was where I was hung up on. I didn't know. OK.
[AGENT][NEUTRAL] Follow me. So, so if it was processed wrong, then let me take a look at something. Why she got all these.
[AGENT][NEUTRAL] Oh, that's the accident. We're looking at the critical illness is what we're looking at. Um, let's take, let me look at it one more time. I just wanna make sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I could tell you because then that's not considered an appeal if something was processed wrong, let's see.
[AGENT][NEUTRAL] year [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Just bear with me one minute. I'm just double checking to see I make sure I see what you see.
[CUSTOMER][POSITIVE] Oh thank you I appreciate it.
[AGENT][POSITIVE] You're right.
[AGENT][NEGATIVE] I don't see that that was paid.
[AGENT][NEUTRAL] Uh, for [PII], and I don't see any other policy that it would have went up under like she would have had a continuing this is the only critical illness policy that I see, um, but it was paid for 23 and 24, but I'm not showing that it was paid for [PII].
[AGENT][NEGATIVE] So to me I would send that back to the original processor, stating what you said that it was never paid please reconsider mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] All right. You're welcome. Have a good one, OK?
[CUSTOMER][NEUTRAL] Alright, you too.
[AGENT][NEUTRAL] Uh huh bye bye.
[CUSTOMER][NEUTRAL] Bye bye