AccountId: 011433970860
ContactId: 2aee7d5d-17e9-48c8-98c1-4a3a4bab08b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 914419 ms
Total Talk Time (AGENT): 352454 ms
Total Talk Time (CUSTOMER): 245217 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/2aee7d5d-17e9-48c8-98c1-4a3a4bab08b7_20250303T22:25_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] You saying I was
[CUSTOMER][NEGATIVE] It was filed and it was processed but I don't, I can't I go click on it it won't give me um where it went to and all that good stuff.
[AGENT][NEUTRAL] Mm, like you're trying to find a doctor, is that what you're trying to do?
[CUSTOMER][NEUTRAL] No, ma'am, and I have a payment of a claim that went in.
[CUSTOMER][NEGATIVE] And it was paid and it doesn't, I went, I clicked on it on my app and it says we're having technical difficulty call the number and then also I was, you just like you could just tell me what it was.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Tell me what it is.
[CUSTOMER][NEUTRAL] That would be great where money went to if it was coming to me or was going to the doctor. It was the last claim that was processed for $300.
[AGENT][NEUTRAL] OK, let me check the claim history for your policy, OK? Um, may I have your name and a call back?
[CUSTOMER][NEUTRAL] And then I also have a question.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have another question when we finish, uh, [PII].
[AGENT][NEUTRAL] OK, and um do you have the policy number?
[CUSTOMER][NEUTRAL] No, on hand, no, I have my phone number, my social security. I don't, I can't get, I'm, I'm trying to type in the payment stuff right now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, what's the social?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII] no that's my phone number. Um
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Hopefully I got it correctly. Um, you said [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, um.
[AGENT][NEUTRAL] OK, let me pull this one.
[AGENT][NEUTRAL] Can you for security, may I have your date of birth and email address on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what's the email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] One moment, let me go through the uh claim history, OK?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so, uh, let's see.
[AGENT][NEUTRAL] Basically, the last claim uh that you send in and we did receive was today, the one you sent electronic.
[CUSTOMER][NEUTRAL] Yeah, that was the one I was into that. I mean, that needs to go to my cancer policy.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So you send it to the wrong policy?
[CUSTOMER][NEUTRAL] I don't know, did I send it? It was, uh, it was a colonoscopy and an endoscopy. So I don't know if I did the wrong policy or not so I'm asking.
[AGENT][NEUTRAL] Oh, OK, let me see.
[CUSTOMER][NEGATIVE] I can't be reloaded to the right place, that's wrong.
[AGENT][NEUTRAL] OK, let me see what benefits you have under this policy, OK?
[AGENT][NEUTRAL] Um, one moment.
[AGENT][NEUTRAL] So you said it was a colonoscopy and endoscopy, correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this was preventative testing or was it diagnostic testing?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Both
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is the one with a diagnostic testing benefit.
[AGENT][NEUTRAL] Yeah, um, you did send it to the hospital indemnity and you do have wellness and diagnostic testing on this one. so I think you did send it to the correct one. I can check the other policy and see if it has also benefits for it. Um, let me see.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] OK, but can you tell me where that last payment went to this claim number 35?
[AGENT][NEUTRAL] Oh, it looks
[AGENT][NEUTRAL] Mhm, go ahead.
[CUSTOMER][NEUTRAL] 356-834-2
[CUSTOMER][NEGATIVE] And every time I click on the little blue claim number and it pops up, it tells me the technical problem, I can't see it.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, that one went to.
[CUSTOMER][NEUTRAL] It's been doing this for everyone though.
[AGENT][NEUTRAL] OK, yeah, it looks like we're doing some updates in our system, so yeah, it is also um a little bit slow on our end, so it may they probably will fix it tonight um because yeah, um.
[CUSTOMER][NEUTRAL] I mean it's been like that the last month when I tried to use it.
[CUSTOMER][NEUTRAL] Not just today.
[AGENT][NEUTRAL] A whole month.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yes, ma'am. Every time I've gone into stuff, I get the same thing.
[AGENT][NEUTRAL] OK. Yeah, I'm not sure uh.
[AGENT][NEUTRAL] Um, so it looks like uh that payment went to Willis Kingdom per month, so it went to the provider.
[AGENT][NEUTRAL] The $300 went to the provider.
[CUSTOMER][NEUTRAL] OK, even though what.
[CUSTOMER][NEUTRAL] When was that? when what was service date was that?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Prob for emergency room.
[AGENT][NEUTRAL] Yes, emergency room and a diagnostic testing in the emergency room.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I know what that is. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK doke. So I don't have anything coming to me. Darn.
[AGENT][NEUTRAL] Mm, now that you submitted the claim, um, your claim, so you're submitting your own claim, then that will be processed and that one will be considered, um, to be paid to you because you're sending the claim in whenever we get a claim from the provider of service usually we process and pay the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] You're welcome, and the claim will be processed within 7 to 10 business days, OK?
[CUSTOMER][POSITIVE] I appreciate it, uh-huh.
[CUSTOMER][POSITIVE] Hey, thank you.
[AGENT][POSITIVE] You're welcome and I do apologize for any inconvenience. Thank you.
[CUSTOMER][NEUTRAL] And you'll check on the other plan too for me. You'll check on the other one too?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Let me check right now before I let you go. One moment.
[AGENT][NEUTRAL] And bear with me just a sec.
[AGENT][NEUTRAL] OK I'm waiting on the benefits.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, um, OK, I'm looking at the benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this one also has a cancer screening.
[AGENT][NEUTRAL] That benefit. um.
[AGENT][POSITIVE] So I will say um this one prevention benefit here we go.
[AGENT][NEUTRAL] If you can, because we cannot, whenever you send it electronically, we cannot move it into another policy. Um, if you can just go ahead and upload it into the cancer as well, we can go ahead and process that part in under the cancer too because you have benefits in both of them it looks like.
[CUSTOMER][NEUTRAL] OK, how do I, OK, let me I can go back to the app, figure out how to do that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like when I click on my coverage, I click the tent, I mean.
[CUSTOMER][NEUTRAL] I don't know how to click that I mean.
[AGENT][NEUTRAL] OK. Let me know when you're in your policy.
[CUSTOMER][NEUTRAL] Oh I see
[CUSTOMER][NEUTRAL] I don't know where they
[AGENT][NEUTRAL] Go ahead and go in. OK, go ahead and
[CUSTOMER][NEUTRAL] I'm in my policy. I mean, I'm in, I, I'm on the app so I quick policy number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, click the policy number for your cancer policy.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I clicked that
[AGENT][NEUTRAL] OK, so once you're in the cancer policy, OK. Has it taken you into the cancer policy?
[CUSTOMER][NEUTRAL] It is getting dark starting.
[CUSTOMER][NEUTRAL] Yes, it's 42 pages.
[AGENT][NEUTRAL] Oh, no, no, no, uh, we, we don't want the policy certificate, so close that one. do you see anywhere in the homepage?
[CUSTOMER][NEUTRAL] Upload a file.
[AGENT][NEUTRAL] No, do you see anywhere in the
[CUSTOMER][NEUTRAL] It just say upload files, just upload files and file wellness claim.
[AGENT][NEUTRAL] File a wellness claim.
[CUSTOMER][NEUTRAL] OK, let's get started. Who are you calling for myself?
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Continue.
[CUSTOMER][NEGATIVE] What data service it says like the wellness screening, this is the wellness one. This is not what I need.
[CUSTOMER][NEGATIVE] I can't. It doesn't give me an option to file for the cancel plan here.
[AGENT][NEUTRAL] wellness is gonna be preventative. It's the same as preventative, which um the colonoscopy they did, was it a part of the wellness or was it like a diagnostic?
[CUSTOMER][NEUTRAL] It was both. I mean, cause they're checking to make sure there's no cancer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so if it was both, then it's part of your wellness. So you're just gonna put the information of what test was it done, where did you do the test, your signature and send it in.
[AGENT][NEUTRAL] So, yes, that claim form is the correct one. Just go ahead and fill that out um with the information of the colonoscopy.
[CUSTOMER][NEUTRAL] OK, so let me go back to, I'm sorry, so give me a second. So go put file wellness claim.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Click that, so you're following for ourselves. OK, and then it tells me, continue.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It doesn't give me the name of the, it just gives me the doctor's name on the paperwork.
[CUSTOMER][NEUTRAL] What is your the their phone number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like the wellness exam, it was a colonoscopy, is that what I put in?
[AGENT][NEUTRAL] Mhm, yeah, yeah, that's the one you're gonna do colonoscopy.
[CUSTOMER][NEGATIVE] For one of them, cause I got damn separate.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You only get one benefit under the cancer plan. So it's just gonna pay for the um for only one diagnostic prevention benefit.
[CUSTOMER][NEGATIVE] And I click continue and it don't do anything.
[AGENT][NEUTRAL] Did you acknowledge, did you sign?
[CUSTOMER][NEGATIVE] It's not giving me that option.
[AGENT][NEUTRAL] You need to scroll down, it will give you that option. There's a little box in the bottom that you need to acknowledge.
[AGENT][NEUTRAL] So once you fill that information out, you put your information, you put the doctor's information, you put the type of test and the date of the test, and then um you scroll up and in the bottom, you should see something that says that you acknowledge the information that you're sending in, which is your signature, and then it will tell you to submit.
[CUSTOMER][NEUTRAL] I did it
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, I'm gonna try this again because I did it, it didn't show that box.
[AGENT][NEUTRAL] I have a question, Miss Miss [PII] are you using the phone?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] That may be the problem. It will not let you do it on the phone.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] You need to do it on a on a tablet or a computer desktop laptop.
[AGENT][NEUTRAL] Um, because it will not let you acknowledge it and it's a little bit harder to find that acknowledge button.
[CUSTOMER][NEUTRAL] I have to wait and do it at school tomorrow.
[CUSTOMER][NEUTRAL] OK, I have to do it at school.
[AGENT][NEUTRAL] Mhm. Yeah.
[CUSTOMER][NEUTRAL] Come on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, but all that's all you need to do for your wellness, OK? I just fill that out and send it in and we'll go ahead and process that part for you, OK?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I'm gonna help you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] That's about it.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good afternoon.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.