AccountId: 011433970860
ContactId: 0ea04202-4f2a-4d76-9499-5440138cef60
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295880 ms
Total Talk Time (AGENT): 81651 ms
Total Talk Time (CUSTOMER): 123434 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/0ea04202-4f2a-4d76-9499-5440138cef60_20250418T14:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. Um, I just finished calling my Cigna insurance. They told me that they sent a claim over to your company [PII], uh, but you never paid the insurance that I had back then, so we ended up paying it.
[AGENT][NEUTRAL] OK, so you said you called the insurance company?
[CUSTOMER][NEUTRAL] Yeah, we have Cigna, the first insurance and we have APL the second insurance.
[CUSTOMER][NEUTRAL] And we received the bill, and um when I called them, they told me um they, Cigna paid.
[CUSTOMER][NEGATIVE] Some of them the invoice and then the APL never paid the difference.
[CUSTOMER][NEUTRAL] And then I called them back today again and they told told me that they sent you.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] By fax a uh claim but you guys never paid it.
[AGENT][NEUTRAL] OK. May I have your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], may I please have your policy number?
[CUSTOMER][NEUTRAL] Um, it is the invoice or the policy number of the of the insurance?
[AGENT][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] OK, I have 02255705 M as in Mary, L as in Larry 7.
[AGENT][NEUTRAL] And is this claim for you or someone else listed on the policy?
[CUSTOMER][NEUTRAL] It's me, me on the policy. I mean, it's like my husband, but then I'm, I'm.
[AGENT][NEUTRAL] OK. And may I have your
[AGENT][NEUTRAL] Yes, but the claim is for you.
[CUSTOMER][NEUTRAL] Yes, it's for me.
[AGENT][NEUTRAL] OK. May I have your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I do need to verify the mailing address listed on the system.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And do you have that date of service for that claim?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And this is for an urgent care visit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm pulling it up for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it does look like we did receive that claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Once we received that claim and process it, it shows that your per calendar year max had been met, so there was no benefits that could be paid out for that claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, OK, so I'm sorry, what was that, um, that, um.
[CUSTOMER][NEUTRAL] The first sentence you said about uh we pay?
[AGENT][NEUTRAL] We had paid your calendar year.
[CUSTOMER][NEUTRAL] Can you repeat?
[AGENT][NEUTRAL] We had paid your calendar year max for the year of [PII], so there was no benefits available once that claim came in.
[CUSTOMER][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] So they denied it in other words.
[AGENT][NEGATIVE] Yes, we denied that the maximum benefit had been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you so much.
[AGENT][NEUTRAL] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, that was it.
[AGENT][NEUTRAL] OK. And you can also check any status on our secured portal as well. Do you have it?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Website
[CUSTOMER][POSITIVE] Yes, I, yeah, I have it there.
[AGENT][POSITIVE] OK, alright, well thank you so much for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] Alright thank you.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye.