AccountId: 011433970860
ContactId: f7856413-5bdb-4741-a4e1-5dfa4bbcc6f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408570 ms
Total Talk Time (AGENT): 145412 ms
Total Talk Time (CUSTOMER): 170257 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/f7856413-5bdb-4741-a4e1-5dfa4bbcc6f4_20250220T17:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey Ms [PII], how you doing?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Hey [PII]. I'm good. How are you?
[CUSTOMER][NEUTRAL] Miss [PII], I've never gotten you on the phone. Miss [PII], did I call the right department for HI claims?
[AGENT][NEUTRAL] Um, you probably did. Did you, did you call the, uh,
[CUSTOMER][NEUTRAL] APL claim support?
[AGENT][NEUTRAL] Mhm yeah we in that queue.
[CUSTOMER][NEUTRAL] OK, I have an insured on the phone. I was trying to help her with the claim. I did, you know, I was able to read the information, tell her it wasn't covered, but she won't know other stuff, so I don't know anything about it really with HI.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me know when you're ready for the policy number.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] It's 972-6887.
[CUSTOMER][NEGATIVE] For [PII], I'm not, I'm not gonna even try to pronounce her last name.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yup. And, but she
[AGENT][NEUTRAL] OK. Which client she was calling about?
[CUSTOMER][NEUTRAL] 356-422-0
[AGENT][NEUTRAL] OK, see what this one is.
[AGENT][NEUTRAL] Surgical procedures not covered.
[AGENT][NEGATIVE] Anesthesia not covered.
[AGENT][NEUTRAL] Yeah, she just got the daily hospital first occurs and an emergency accident driver. OK, you can send her on over.
[CUSTOMER][POSITIVE] All righty, thank you, Miss [PII]. Hold one moment.
[AGENT][POSITIVE] No problem, OK.
[CUSTOMER][POSITIVE] Hello Ms. [PII], I'm gonna transfer you over to [PII] so she could better assist you. Thanks for calling APL and have a good day. You're welcome. Thank you. Bye bye. Thank you, [PII].
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Good morning. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I, I was calling to check on the status of the claim, please.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And she told me that you were calling to check on the claim that was denied. I'm sorry.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, and what was your question?
[CUSTOMER][NEUTRAL] I would like to know the reason why the claim is denied.
[AGENT][NEUTRAL] Oh, I'm sorry, I thought she had given you the reason that the claim was denied. Give me one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like the claim was denied because it does not have uh benefits for surgical procedures.
[AGENT][NEUTRAL] Nor does the policy provide benefits for anesthesia services.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And looking at your benefits, your policy only has the benefits for.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Is she's very seriously notwithstanding still.
[AGENT][NEUTRAL] Oh, OK, give me one second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] up.
[AGENT][NEUTRAL] It only has a daily hospital confinement benefit that would pay a benefit for each day that you're confined to the hospital. It has an annual first occurrence benefit that pays a lump sum payment whenever you're confined to the hospital, and it has an emergency accident rider that would pay whenever you're in an accident that requires emergency care.
[AGENT][NEUTRAL] So it doesn't cover any surgeries or anything like that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This year.
[CUSTOMER][NEUTRAL] Yeah, but I was hospitalized.
[CUSTOMER][NEUTRAL] I was.
[AGENT][NEUTRAL] OK, they pull up your information.
[CUSTOMER][NEUTRAL] there
[AGENT][NEUTRAL] Give me 1 2nd to see what you submitted to us, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] and now.
[CUSTOMER][NEUTRAL] is.
[CUSTOMER][NEUTRAL] He got status for those.
[CUSTOMER][NEUTRAL] out on [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, 655-71.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Get
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] for
[CUSTOMER][NEUTRAL] Basically right now.
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The
[CUSTOMER][POSITIVE] That are one of the best venues to show um and and the musical um we've got a great lot of.
[CUSTOMER][POSITIVE] Shows that for audiences a lot of fun. There's a lot of joy. There's something more serious, you know, for any show, so it's great that.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] To your backyard right right.
[CUSTOMER][NEUTRAL] and
[AGENT][NEUTRAL] OK, I'm still here, um, going through your information.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because I, I saw, I ask that you be your phone with the completed application.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][POSITIVE] Really good, yeah, personally a great thing so.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] start for her phone coming up.
[AGENT][NEUTRAL] OK, so I'm looking at your the UV and the other information that you sent in to us.
[CUSTOMER][NEUTRAL] Right now
[AGENT][NEUTRAL] So with your policy you have to be confined to the hospital for at least 24 hours.
[AGENT][NEUTRAL] And this information does, OK, so the information you sent in does not show that you were confined for 24. I can see 17 hours.
[CUSTOMER][NEUTRAL] And I was
[CUSTOMER][NEUTRAL] What can I do?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, so is there any way that you can get the admit and discharge papers that shows the time that you were admitted and the time that you were discharged from the hospital?
[CUSTOMER][NEUTRAL] And get started and.com.
[CUSTOMER][NEUTRAL] OK. I can just go to the hospital and request it.
[AGENT][NEUTRAL] Yes ma'am, the admit and discharge times.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] All right, no problem, thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that would be all.
[AGENT][POSITIVE] OK, well thanks for calling APL and have a great rest of your day.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][NEUTRAL] Alright bye bye.