AccountId: 011433970860
ContactId: ea08610d-72bb-4ee6-af6b-3479a7ccd64e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1152390 ms
Total Talk Time (AGENT): 270682 ms
Total Talk Time (CUSTOMER): 165674 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/ea08610d-72bb-4ee6-af6b-3479a7ccd64e_20250319T20:24_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, hi. Um,
[CUSTOMER][NEUTRAL] I am [PII]. Um, I have a short term disability policy with y'all, and, um, I'm going through the appeal process and my one question I had was if you make an appeal and then it's denied again, what happens?
[AGENT][NEUTRAL] Um, you can send me a second appeal if you would like.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] You can submit a second appeal if you would like.
[CUSTOMER][NEUTRAL] You can just keep submitting them.
[AGENT][NEUTRAL] Um, I can check and see how many you can submit, um, but I know that, um, once the appeal is denied, um, a lot of people try to send the second one. I'm not sure if they try to send a third one or not, but I can check, um, what, what will be the instructions after the 2nd 1 may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, do you have the policy number, Miss. No?
[CUSTOMER][NEUTRAL] Um, 2500.
[CUSTOMER][NEUTRAL] 346.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK. May I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] [PII] and then email is [PII].
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] You needed my address?
[AGENT][NEUTRAL] Yes, and regular mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let me go ahead and get that information for you. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hi [PII], how are you? This is [PII].
[CUSTOMER][NEUTRAL] Hi [PII] how are you?
[AGENT][POSITIVE] Hey, I'm good. How about you?
[CUSTOMER][POSITIVE] Good thanks.
[AGENT][NEUTRAL] Good. Um, I have a member on the line that, um, she has a, a disability policy and she has submitted a claim. It was denied, so she submitted an appeal, it was denied, and she's asking, can she send another appeal, how many appeals can she send or what else can she do about this?
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] I believe
[AGENT][NEUTRAL] Hello, Ms. [PII], you still there?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, Ms. [PII], I cannot hear you.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Hm, I'm gonna try to call back. I, I cannot hear you.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Ferring
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII]. This is [PII]. I was just speaking to [PII], but I don't know what happened to the line, but I was not able to hear her. Um, so let me explain to you why I got this member on the line. Um, this is a disability policy. Um, she submitted a claim. The claim was denied and then she submitted an appeal. The appeal was denied, and she wants to know if she can appeal it again or if uh she needs, uh, what else can she do to have this pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is your policy number?
[AGENT][NEUTRAL] It is 250-0346.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][POSITIVE] And she's already gotten an appeal, uh.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] From APL?
[AGENT][NEGATIVE] That's what she said that she already got the denial.
[CUSTOMER][NEGATIVE] I see and I see a denial. I don't see anything from an appeal.
[AGENT][NEUTRAL] Mm, she said she got an appeal, a denial from her appeal as well. I don't know where she got that from, but yeah.
[CUSTOMER][NEUTRAL] OK, yeah, tell her she, I don't see, I don't see an appeal, not to say that she did not send one, but she, yes, she can appeal it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] How many times can she appealing? Basically, that's her question.
[CUSTOMER][NEUTRAL] Um, at this, at this time I don't see one. Like I said, let, let me see if I can go through her stuff and see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK medical record request delay request.
[CUSTOMER][NEUTRAL] Come on, I'm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] fine.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Mm, OK. I see the appeal here. It was preexisting.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] On which mail number?
[AGENT][NEUTRAL] It doesn't have a mail number. It's under, um, let me see, correspondence on [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That looks like from doctor, from the uh medical director.
[CUSTOMER][NEUTRAL] If, if that's what I'm looking for, looking at it 3 pages.
[AGENT][NEUTRAL] Um, yeah, I believe so, um, yeah, mhm.
[CUSTOMER][NEUTRAL] Yeah, that's what they request, that's where they um.
[CUSTOMER][NEUTRAL] They requested the medical records and the medical director. That was his review.
[CUSTOMER][NEUTRAL] That's the results of his review.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So give me, I'm still trying to look to see what her information that she sent in as an appeal. If we missed it, then we can go back and um.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Put it back in. Give me one second. Still going through it.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Let me go back to her because it's been a while since she's been holding because I lost Roxy in the beginning. OK, one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding, Ms. [PII]. I do apologize for that long wait. I'm with the claims department on the other line and they're trying to uh find the information. um, but, um, did you say you already appealed the decision the first time?
[CUSTOMER][NEUTRAL] No, not yet.
[AGENT][NEUTRAL] No, no, you haven't. Oh, OK. Yeah, you can always submit an appeal. You have 180 days to submit an appeal and then you can send a second appeal if you would like. If you, if it's not, um, yeah, if it's not, um.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][POSITIVE] Resolve with with the first one. Yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] You're welcome. Do you need uh instructions on where to send it or anything else?
[CUSTOMER][NEUTRAL] Yeah, um, so can I just upload it like digitally like where I did the first claim?
[AGENT][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] Um, you can, yeah, you can go ahead and upload it to your account. Uh, it will not let you upload it to the claim that we already processed, but you can upload it as a new claim, and we'll go ahead and take a look at it from there. Yes. Mhm.
[CUSTOMER][NEUTRAL] Same place?
[CUSTOMER][POSITIVE] Oh, OK, thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I'm gonna help you with today? And I do apologize for that long wait. We were looking for the appeal, but I guess, yeah, I thought you sent one already.
[CUSTOMER][NEUTRAL] Oh my bad, um.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Yeah, that's it.
[AGENT][POSITIVE] OK. All right, well, thank you for calling APL. Have a good afternoon, Ms. [PII].
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you you're welcome. Bye bye.
[AGENT][NEUTRAL] Thank you for holding, [PII]. You know what, I talked to her and she said no, she didn't appeal. She, she said that she knows that it's gonna be appealed. I don't know how she knows it's gonna be appealed, so I have no idea. So never mind, just scratch that. She's gonna go ahead and send an appeal. I told her she can just go ahead and send one. I didn't find one here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, because I don't see one either thank you so.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] You're welcome, and I'm sorry. I just, I mean, she said she wanted to know if she can appeal it again, so I'm like, so she already.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alrighty.
[AGENT][POSITIVE] OK. All right, thank you. Have a good afternoon.
[CUSTOMER][NEUTRAL] Alright you too bye bye.
[AGENT][NEUTRAL] OK.