AccountId: 011433970860
ContactId: 1b8f20e1-1f7e-4c37-b7c0-cb6d5dacfd61
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 565919 ms
Total Talk Time (AGENT): 238142 ms
Total Talk Time (CUSTOMER): 189581 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/1b8f20e1-1f7e-4c37-b7c0-cb6d5dacfd61_20250519T13:17_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] Uh, yes, I have a question about, uh, my policies cause I, I, um.
[CUSTOMER][NEUTRAL] I'm submitted a few things that have not been approved and I just don't I'm just trying to figure out why so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, tell me what you need from me first.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, sure, I can assist you with claims. May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have the policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] I'm trying to find out right now, so.
[CUSTOMER][NEUTRAL] Are there different policy numbers for every single thing that we have or?
[AGENT][NEUTRAL] If you have
[CUSTOMER][NEUTRAL] OK, let's just pick this one because this one did not get approved for some reason.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 224-422-1
[AGENT][NEUTRAL] OK. Thank you. Yeah, if you have more than one policy, you should have more than one policy number. Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I have a lot of accounts it looks like.
[AGENT][NEUTRAL] All right, um, for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] OK, what's the email address on file for verification?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The email address on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK, you said this one was not paid, um, let me check.
[CUSTOMER][NEUTRAL] OK, so what I did, I had a skin cancer, my yearly skin cancer scan, which I sent, and I had a mammogram.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Uh, I haven't sent that one yet, but I had a Pap smear and I sent that one. Now the Pap smear, they denied and then they sent me all this paperwork that they want me an accident claim form and all that. It's not an accident claim form, it's just my yearly preventative maintenance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't know why they, what they critical illness claim form. I don't need all this crap.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] These are just my yearly.
[CUSTOMER][NEUTRAL] Preventative maintenance.
[AGENT][NEUTRAL] OK, it's fine. They, yeah, they just probably just send you some claim forms, but um for this ones in particular, um, the benefit, I believe it's gonna be one per year. So let me just go ahead and pull your benefits and just make sure, OK?
[CUSTOMER][NEUTRAL] Appointments
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And then like the pap smear, I know it's been over a year. I only get one a year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, I'm waiting on the documents uh for the benefits to pull up, OK? It's gonna be a minute.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] OK. So this one in particular, and this is not a guarantee of payment, just a verification of coverage. So on this one, this is your accident policy. On this one, you have a screening test benefit of $50 and it says it's maximum of accident screening benefit, $2 per covered person up to $4 per family.
[AGENT][NEUTRAL] Um, it does have a list of the ones that is covered under the accident policy. So let me go ahead and pull that list.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Alright, screening. OK, so the accident screening test, um, will be the.
[AGENT][NEUTRAL] A routine physical exam, I think that's the one we covered. Uh, stress test, bone density.
[CUSTOMER][NEGATIVE] Correct, that was skin cancer, but then the Pap smear one they denied, which that's not right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that, that one, yeah, that one is not covered under the accident. So let me go ahead and pull the other policy and see what's covered under your other policy.
[CUSTOMER][NEUTRAL] Well, when I submitted it, I did it under all three because I don't know what.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] You know, I don't, I don't know what it would be under.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Yeah, that's, and that's perfectly fine. It's just gonna pay based on the policy, um, the benefits of each policy. So since you send all three, it's going to deny the two that it's not payable under this one and it's going to pay the one that is payable. So under the accident policy, we did pay the $50 for the screening. So that one is the other, yeah. It doesn't pay the other two, it doesn't have those two.
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] But it didn't
[CUSTOMER][NEGATIVE] It did not pay it.
[AGENT][NEUTRAL] If we did send a $50 payment.
[CUSTOMER][NEGATIVE] I understand, but for the Pap smear it did not pay anything and it should have.
[AGENT][NEUTRAL] No, no, no, no, no. No, the, the pass is not payable under the accident policy. You have more than one policy, OK? I have to go to the other policy to see if it paid on the other policy. Under the accident policy, it's not payable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] They did not because I'm looking at the screen.
[AGENT][NEUTRAL] OK, let me go to the other policy and look at it, OK? OK. So right now I'm just looking at the accident. Um, more than likely it's gonna be hospital indemnity, but I can check on that one, OK?
[CUSTOMER][NEUTRAL] I OK.
[CUSTOMER][POSITIVE] Perfect, which would it be under?
[AGENT][NEUTRAL] Yes. Yeah, it's 3 separate policies, so I had to pull each one separately.
[CUSTOMER][NEGATIVE] See, and for some reason it's not even showing under the the hospital didn't even.
[CUSTOMER][NEGATIVE] So maybe I need to submit it again under that because it's not even showing that it was submitted under that and I know I submitted it under all three so maybe that's the problem.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me look at the hospital indemnity. Let me pull that one and go through that one, OK?
[CUSTOMER][NEUTRAL] That's dermatologist, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEGATIVE] You know what? it's just, it's not in order.
[AGENT][NEUTRAL] Mhm. OK, this one is not covered. OK.
[AGENT][NEUTRAL] Yeah, let me go ahead and pull the next one, bear with me.
[AGENT][NEUTRAL] So the hospital indemnity doesn't have that benefit. Mhm.
[CUSTOMER][NEUTRAL] You know what, it, it, I hold on a moment, I apologize it looks like it they did pay him on Friday.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, on, on the [PII].
[CUSTOMER][NEUTRAL] It paid $50 and that's what it should have.
[AGENT][NEUTRAL] Mhm. Oh, OK. Yes.
[CUSTOMER][NEUTRAL] Yep, OK, see they're not, they're not in order and that's why they paid them OK.
[AGENT][NEUTRAL] OK, so you see.
[CUSTOMER][NEUTRAL] Because it shows the one they paid on the [PII] and then after that is the one on the [PII] and the [PII] so that's where that's what I did not see those so I apologize I wasn't looking that far down. I was just looking at the top so then the one for my son.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] It's
[CUSTOMER][NEUTRAL] That should be paid probably today cause he had his skin cancer, uh scan. So that should be done today.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, I can check and see if it's if they're working on it.
[AGENT][NEUTRAL] Oh yes, it's the online to be processed. So yeah, it will be processed uh in a few days. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome, OK, I apologize, thank you for your help.
[AGENT][NEUTRAL] OK, no problem. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] Nope you have a great day.
[AGENT][POSITIVE] You as well thank you for calling APL bye bye.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.