AccountId: 011433970860
ContactId: 1da20c9f-8fcb-4b97-813a-be257a39f1d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376600 ms
Total Talk Time (AGENT): 241463 ms
Total Talk Time (CUSTOMER): 85000 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/1da20c9f-8fcb-4b97-813a-be257a39f1d7_20250507T22:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Well hi [PII], my name is [PII]. My policy number is 755,880.
[AGENT][NEUTRAL] OK, let me look up your policy.
[AGENT][NEUTRAL] And then what is your callback number just in case the call gets dropped I'll be able to call you back.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My email is [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] I don't know what your other question was.
[AGENT][NEUTRAL] Uh, the phone number that you gave me to call you back on if we're disconnected, is that your cell phone number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] OK. How can I help you today?
[CUSTOMER][NEUTRAL] Well, I, um, I submitted a lot of paperwork and I got a text today saying that my claim is ready. My claim number is 359.
[CUSTOMER][NEUTRAL] 6115
[CUSTOMER][NEUTRAL] And I go into the portal.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEGATIVE] And it doesn't, it doesn't allow me to put in a claim number to look at it. It, it just shows me old claims. Anyway, I don't, I don't know how.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I, I need to know what's the status.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me pull up the claim. So I'm looking at the claim. It's got several remarks on it, some things we're probably gonna need, um, one of the, um, and I'm gonna, there's a long list of remarks, so I'm gonna read them to you. Um, the first one is the above reference claim is a duplicate of a previous submitted expense, so we had a duplicate claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, in order for processing of this claim to continue, we will need the pathology report with the first diagnosis of cancer.
[AGENT][NEUTRAL] This information has not yet been received upon receipt of this information, we will receive, we will give further consideration to the claim. So that's something that's needed is the pathology report needs to be sent in.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Lab tests are not, are not a covered benefit under this policy.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] This policy does not provide benefits for office visits.
[AGENT][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] The radiation
[CUSTOMER][NEUTRAL] What does it cover?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Go ahead. You're telling me it doesn't cover radiation? It's, it's
[AGENT][NEUTRAL] Are
[AGENT][NEUTRAL] No, the radiation therapy, chemotherapy, or immunotherapy benefit does not cover other procedures related to radiation, chemotherapy or immunotherapy treatment, such as treatment.
[AGENT][NEUTRAL] Oh my, I lost my line. Treatment planning, treatment management or consultation, design and construction of treatment devices, radiation.
[AGENT][NEUTRAL] Do dosimetry.
[AGENT][NEUTRAL] Cal calculation, lab tests, rays, scans, medical supplies, and equipment used in the administration of IV solutions, needles, dressings, pumps, and catheters.
[AGENT][NEUTRAL] So it looks like it's.
[CUSTOMER][NEUTRAL] He didn't cover any of that.
[AGENT][NEUTRAL] It doesn't cover any of that stuff. It looks like, looks like it's just the radiation.
[CUSTOMER][NEUTRAL] The set policy.
[AGENT][NEUTRAL] Um, the medicine itself. The charges for this listed treatment dates are not covered under this policy, and that was, um,
[AGENT][NEUTRAL] One of the
[AGENT][NEUTRAL] OK, let me see if I got any, uh, yes.
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] You know what I'm gonna do? We've got so many lines here of um remarks.
[AGENT][NEUTRAL] I'm gonna go ahead and transfer you on over to a claims specialist so that they can go over it with you, yes ma'am, and they can go over it with you um how they process the claim and any additional information that you might need to send in, OK?
[CUSTOMER][POSITIVE] Yeah, I think that would probably be good.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, it's gonna be a brief hold while I transfer you on over, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for calling APL. Somebody will be with you shortly. You're very welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, Ms. [PII], it's [PII] in the care team. I've got an insured on the phone. Her name is [PII]. Um, her policy number is 755,880. She has verified all of her information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She is calling about claim number, the 1st 1, 359-6115.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim has many remarks on it and she just needs to speak to somebody so that she can get a good understanding of what all she still needs to send in.
[AGENT][NEUTRAL] And how the claim was processed.
[CUSTOMER][NEUTRAL] OK, send it on over.
[AGENT][POSITIVE] All right, thank you, Ms. [PII]. Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] OK, you're welcome. Uh huh.