AccountId: 011433970860
ContactId: bc1f8ac5-379e-4837-933e-1861feeb7488
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 428850 ms
Total Talk Time (AGENT): 128759 ms
Total Talk Time (CUSTOMER): 96155 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/bc1f8ac5-379e-4837-933e-1861feeb7488_20250513T14:53_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] Hey Miss [PII], I had a couple of um claims that I filed that were not paid out on and I just wanted to call and see why.
[AGENT][NEUTRAL] OK, I can definitely help you with your claims. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII] [PII].
[AGENT][NEUTRAL] Thank you for that, Ms. [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] OK, I don't have it on me right now. Can I give you my, oh hold on.
[CUSTOMER][NEUTRAL] Because I'm on the website so I can oh my policy right here 2552172.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[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] Yes, it's [PII], and it's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um, are these the most, like the two most recent claims here in May or you want to go back as well? We can do both.
[CUSTOMER][NEUTRAL] No, no, no, just the two most recent ones.
[AGENT][NEUTRAL] OK, let's see, hold on one moment.
[AGENT][NEUTRAL] So both of them um have the same denial reason that it's not a covered loss under the plan.
[AGENT][NEUTRAL] Therefore, no amount is payable for the expense. What, what was this like were you in the, I see it says hospital admission benefit. Were you in the hospital?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] So it was a it was a hospital stay. Let me look at the documents. Hold on one moment.
[CUSTOMER][NEUTRAL] Yes, both of them, both of, uh.
[CUSTOMER][NEUTRAL] The first one was, the second one was, I was admitted and then I was transferred for the one that got paid out on, but the first one was a hospital stay.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold while I look at the documents?
[CUSTOMER][POSITIVE] No, that's totally fine.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh Lord, sorry y'all.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, um, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, sir, give me just one moment.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] She pick it up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Great
[CUSTOMER][POSITIVE] OK, that was perfect.
[CUSTOMER][POSITIVE] Please have a good day.
[CUSTOMER][POSITIVE] OK, I'm so sorry about that. Yes, ma'am.
[AGENT][NEUTRAL] Oh, it's OK. Um, OK, so I see what the issue is. So what's submitted is for like the actual treatment that you received like the urinalysis, the ultrasound, the blood tests, all of that. What you need to submit is like your discharge papers may be showing the day that you were admitted and discharged, um.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Because this looks like they're asking us to pay for these services, but your policy, that's why I'm saying it's not covered, because your policy doesn't cover the services, but the hospital, like if you were, you know, confined to the hospital or admitted, that that's when your policy can come into play. So instead of this, I would ask them for just your discharge summary, just showing, you know, when you were admitted when you were discharged and then, you know,
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They usually have like your tips and what's next and all of that on there.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, OK, then I will, I will ask them for that.
[CUSTOMER][POSITIVE] All righty.
[AGENT][NEUTRAL] Alrighty. Well, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, Ms. [PII], thank you so much for your help.
[AGENT][POSITIVE] You're very welcome. Well, thank you for calling [PII]. I hope you have a good day.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yes ma'am, you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye bye.