AccountId: 011433970860
ContactId: 056e5811-4c54-4467-9ff9-d24e02bc65a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 843400 ms
Total Talk Time (AGENT): 223158 ms
Total Talk Time (CUSTOMER): 100589 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/056e5811-4c54-4467-9ff9-d24e02bc65a6_20250314T15:47_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, I was calling about a recent claim that I filed and it was paid, but I just wanted to make sure that I got everything that I needed to get in.
[AGENT][NEUTRAL] OK. Um, let's see what we can do. May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK, my name is [PII] and my phone number [PII].
[AGENT][NEUTRAL] Thank you. And do you have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] The policy number is 02525111.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] May I have your date of birth, mailing address and email address for verification.
[CUSTOMER][NEUTRAL] Date of birth [PII]. Email address is [PII] and my mailing address [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, let me look at the notes on the EOB and see if.
[AGENT][NEUTRAL] Mm, it looks like we paid everything. Let me see. Um.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Are you looking for it, uh-huh, go ahead.
[CUSTOMER][NEUTRAL] I know sometimes
[CUSTOMER][POSITIVE] I just know sometimes um there's some things that I might not know to send in and I just didn't wanna miss anything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so based on the recent claims that you have submitted, I don't see that we have requested anything else, so that means that everything was paid um based on what you send in. Now on the benefits, I can go ahead and go over your benefits and see if you need to send anything else based on the benefits, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me go ahead and pull that information, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm still waiting on the paperwork to upload, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, Miss [PII], this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] OK, so let's see. So for your benefits, you have the radiation, chemotherapy, and immunotherapy, which is $15,000 per year. Then you have uh hormone therapy, which is $50 per treatment up to 12 treatments per year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, you have, let's see.
[AGENT][NEUTRAL] Mastectomy benefits for surgery.
[AGENT][NEUTRAL] And see, it looks like that.
[AGENT][NEUTRAL] $50 per confinement.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is $25 for surgery.
[AGENT][NEUTRAL] And you have $25 for purchases.
[CUSTOMER][NEUTRAL] OK, I have that list, so I, I was just making for sure that I, yeah.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, based on the recent claims you submitted, it looks like we pay for everything. Um, the only thing that we were asking for like additionally, um, let me see this date, let me check and see if we already paid that one on this one.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I was thinking of.
[AGENT][NEUTRAL] And then it looks like that's what we pay here. Yeah, I don't see anything else that we we're missing based on the information you have submitted to us for payment. Mhm.
[CUSTOMER][NEUTRAL] OK, so, um, I know you said it pays 15,000 per year and am I almost at my limit?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm asking [PII].
[AGENT][NEUTRAL] Oh, OK, um, let's see.
[CUSTOMER][NEUTRAL] Does it start every every January or just from when you started it to that next year?
[AGENT][NEUTRAL] Let me go ahead.
[AGENT][NEUTRAL] From when you started, when we started paying for it for the next year, so it's every 12 months to the date. So basically if we started paying in [PII], then you start all over again [PII]. Um, let me go ahead and check and see um where this one is at, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's immunotherapy.
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check the, I will have to go through the history and see exactly when we started paying. Do you mind holding for me?
[CUSTOMER][NEUTRAL] That'll be fine.
[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.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, so so far, um, it looks like the first day of service that we pay was [PII]. Um, so that's gonna be your beginning year and so far you have spent 4.
[CUSTOMER][POSITIVE] Oh, no problem.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It was paid when?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and so far we have paid $4,756.03.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4000 OK.
[CUSTOMER][NEUTRAL] 4000 and what?
[AGENT][NEUTRAL] $4,756.03.
[CUSTOMER][NEUTRAL] OK, alright, OK, so I can keep up with it from here. I was just curious.
[AGENT][NEUTRAL] Mhm. Yeah. OK, yeah, if you have any more, you can go ahead and send it in, OK?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK thank you I appreciate it.
[AGENT][POSITIVE] Mm. You're welcome. Is there anything else I may help you with today, sister?
[CUSTOMER][POSITIVE] That's it I appreciate your time.
[AGENT][POSITIVE] Mhm. You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.