AccountId: 011433970860
ContactId: fc1ec692-9a6e-4670-8f3e-f5775f54552e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248289 ms
Total Talk Time (AGENT): 113702 ms
Total Talk Time (CUSTOMER): 62015 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/fc1ec692-9a6e-4670-8f3e-f5775f54552e_20250224T18:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, um, I need to check on a claim and find out what I need to do as far as appealing it or finding out what's going on with it exactly.
[AGENT][NEUTRAL] Sure, I can check on that claim for you. uh, what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, 244-437-4.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, just gonna verify some information really quick, [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. Last thing I need is the email address we've got on file for you. uh, looks like it might be through your employer.
[CUSTOMER][NEUTRAL] Uh, well, there might be two. There's one could be [PII] or [PII], OK.
[AGENT][NEUTRAL] That's it.
[AGENT][POSITIVE] Yeah, it was that first one alrighty thank you so much for verifying that. OK, give me just a moment let me take a look at this claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so I am looking at this claim that was filed. Uh, looks like we received it. Oh goodness, if it wants to think about it, um, [PII]. Does that sound right to you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] So it has been processed and it we were unable to pay a benefit it does state that this condition is not covered under this plan uh based on the policy's definition of the critical illness.
[CUSTOMER][NEUTRAL] OK, and uh I have the policy in front of me on the on the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On page 3 it's got heart attack listed.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] We can definitely get take a closer look at that um if you don't mind [PII] I'm gonna put you on a brief hold and reach out to our claim specialist just so they can review uh what was submitted and make sure that that information was accurate so this was in regards to a heart attack.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Got it. OK, um, I'm just gonna put you on a brief hold and get right back with you, OK?
[CUSTOMER][NEUTRAL] Uh, sure.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you today?
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[CUSTOMER][POSITIVE] I'm good. How are you doing?
[AGENT][NEUTRAL] Doing all right, thank you. I've got an insured on the line. Um, he submitted a claim for a critical illness policy, um, and it denied, as it's stating that the condition doesn't fall under the definition of a critical illness. He wants to review what was submitted. He said it was a heart attack and just wanted to see if the information he submitted was sufficient.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] It is 244-437-4.
[AGENT][NEUTRAL] And it is for part one.
[CUSTOMER][POSITIVE] OK, I have the policy pulled up. Thank you.
[AGENT][POSITIVE] OK, yeah, thank you, bye bye.