AccountId: 011433970860
ContactId: f68f7dec-5556-499c-87e8-ce2bfdf2cc93
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1014890 ms
Total Talk Time (AGENT): 360553 ms
Total Talk Time (CUSTOMER): 169776 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/f68f7dec-5556-499c-87e8-ce2bfdf2cc93_20250109T18:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATO. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] And it's bad.
[CUSTOMER][NEUTRAL] Yes, ma'am. My name is [PII]. I had called on Tuesday. I had filed like a critical illness claim.
[CUSTOMER][NEGATIVE] Um, for my husband and I spoke to the lady and she said she was sending it to claims to be researched and someone would call me, but no one ever called me.
[AGENT][NEUTRAL] OK. All right, Ms. [PII] said you did call in to check claim status on a claim you said you filed for your husband, but there was some research going to have to be done and you haven't heard back from anyone, is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, yes ma'am. Well, I can um help you with this. What I'll need to do, Ms. [PII], is to first pull up your policy information. So, um, what is a good callback number for you in case we were to be disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And do you have the policy number?
[CUSTOMER][NEUTRAL] No, ma'am, I can give you my social.
[AGENT][POSITIVE] OK, that'll be fine. I'm ready.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] And they can
[AGENT][NEUTRAL] OK, Miss [PII], and any information I'm able to provide for you today would be a verification of benefits and not a guarantee of payment. First off, um, could you please verify your date of birth and then your husband's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII], [PII].
[AGENT][POSITIVE] OK. Thank you. And, oh, and happy birthday. You had a birthday yesterday.
[CUSTOMER][NEUTRAL] I did.
[AGENT][POSITIVE] Well, happy belated birthday. And then also, you're welcome. Your home mailing address, please?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, thank you. And lastly your email address?
[CUSTOMER][NEUTRAL] Is that [PII]?
[AGENT][NEUTRAL] OK, thank you. If you don't mind, give me just one moment to look at some notes.
[AGENT][NEUTRAL] OK. Do you know who you spoke with, uh, Ms. [PII]?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] No, it was on Tuesday at about [PII] and she said that she couldn't transfer me to anybody in claims. So it was [PII], about [PII], and she said she couldn't get me transferred to anybody in claims, but that she was gonna send a note um and someone should be calling me back, but no one ever called me back.
[CUSTOMER][NEUTRAL] Because they denied the claim, saying that um the benefits wasn't covered, but he did have a stroke. He had a um subarachnoid hemorrhage, which is a stroke. And so like my question is, you know, like I said in all of the MRIs, the CT showing where he was diagnosed with a subarachnoid hemorrhage. He had a subarachnoid hemorrhage and a subdural hemorrhage.
[AGENT][NEUTRAL] OK, um, OK.
[AGENT][NEUTRAL] And you said that you had called 2 days ago, you said, is that correct, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, on Tuesday about [PII].
[AGENT][NEUTRAL] Let me just look through a couple and I see that you have a couple of policies. So give, give me just a second.
[AGENT][NEUTRAL] Before I
[AGENT][POSITIVE] know exactly how to handle this for you to make sure you can speak to someone. So bear with me if you don't mind, please. I really appreciate it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When I leave out there getting the salad.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so do you mind letting me place you on a brief hold for a moment, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I, I mean,
[AGENT][NEGATIVE] I, I'm not gonna do this.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hi, Ms. [PII]. I was just checking in to let you know I haven't forgotten about you. I appreciate your patience. I'm still looking into this for you, OK?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Right
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] it's me off.
[AGENT][NEUTRAL] OK, Ms. [PII], thank you so much for holding for me. So again, just to clarify, you were wanting to go over this most recently received claim. Is that correct?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And that was not um covered that had been denied. Is that, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, because I can see when you the latest claim does state that this is not a covered and you are on the portal. Have you already seen this comment on this review, this latest claim?
[CUSTOMER][NEUTRAL] Yeah, I thought, and my thing is like when um he was in the hospital, you know, they told us that it was a stroke, but it's a, it wasn't an ischemic stroke. It was a hemorrhagic stroke, like a subarachnoid hemorrhage, and that is a stroke. So I'm unsure, you know, what more they needed or what because um it's just, it's not adding up to me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So give me a moment, just let me pull your policy information up.
[AGENT][NEUTRAL] And I do apologize that you have not received a call back that, uh, uh, that could be due to the policy was this most recent claim was still being reviewed at that time.
[AGENT][NEUTRAL] Um, give me just one moment, but I don't want to misspeak or give you any incorrect information.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because I'm only able to see the same remark, um, as far as what the reason behind the denial was, and that is states this condition is not covered under this plan based on the policy's definition of the critical illness being claimed. Please refer to your policy for plan details.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] So what I am going to do is since you have not received a call back, Ms. [PII], I'm going to connect you, I am going to connect you over to one of the examiners in that division to see if they can look at that information that was received.
[AGENT][POSITIVE] For this, you know, for this claim, OK? And again, I am sorry that you haven't received that call back, but we will certainly try to get, get you taken care of today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and when I do connect you, you will not have to re verify any of your information?
[AGENT][NEUTRAL] I will give them the policy number. Now, would you like to write your policy number number or down or you know where you can do that right now?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, give me a minute.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And 2 in your
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] Yes, ma'am, sure. It is.
[AGENT][NEUTRAL] 02439986.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there is, I'm sure you're already aware of this, but just to, just to make sure each of your policies that you have with APL are in your portal online so that you can look, you know, yourself when you have an opportunity at the benefit information in each since this does refer you to your policy for plan details.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Well, if that's all that I can help you with, thank you again for calling APL today, Ms. [PII], and if you'll give me one moment, I will get you connected.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And again thank you for calling APL.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] For calling AVL, this is [PII]. With whom am I speaking and how may I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. How are you?
[CUSTOMER][NEUTRAL] I'm fine.
[AGENT][POSITIVE] Good.
[AGENT][NEUTRAL] I have an insured on the line who had called on the [PII]. She doesn't know who she spoke to. Does she have a note in line, but she was told that she would be getting a call back on this, on her husband's claim, and she hasn't been called, but I don't see a note by whomever she did speak to.
[AGENT][NEUTRAL] And I have gone over the remark, but she, she just doesn't understand.
[AGENT][NEUTRAL] The denial on this claim. It is 02439986.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] The claim is gonna be for part 2.
[AGENT][NEUTRAL] And it's claim number 3547421.
[CUSTOMER][NEUTRAL] And what's the callback number?
[AGENT][NEUTRAL] Um, it is her phone number that's listed in line because this is Ms. [PII] on the phone, but it's [PII].
[CUSTOMER][NEUTRAL] OK, you can go ahead and send her over.
[AGENT][POSITIVE] All right. Thank you so much. Have a good afternoon.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, you too.
[AGENT][POSITIVE] Thanks.