AccountId: 011433970860
ContactId: 2cef283c-e672-412b-96a5-76d3616a2b44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400579 ms
Total Talk Time (AGENT): 169882 ms
Total Talk Time (CUSTOMER): 143643 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/2cef283c-e672-412b-96a5-76d3616a2b44_20250327T16:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII]. How are you doing? I'm a broker.
[AGENT][POSITIVE] Hi [PII], I'm doing good. How about you?
[CUSTOMER][NEUTRAL] I take
[CUSTOMER][NEUTRAL] Doing great sorry I took you off speaker. Um, I was multitasking here. um, I'm a broker and I'm just calling to check on a claim for, uh, two of our customers.
[AGENT][NEUTRAL] OK, perfect. Do you have their policy number?
[CUSTOMER][NEUTRAL] Yes, uh, policy number is 244-6176.
[CUSTOMER][NEUTRAL] And that's [PII] 1759.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And [PII], can you verify if you have a good callback number just in case I lose you?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then lastly, what's your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, great. Thank you.
[AGENT][NEUTRAL] What data service are we looking at for her?
[CUSTOMER][NEUTRAL] Um, I don't have a data service per se. I'm just trying to find out for on her cancer policy what she paid for her 2024 and 2025 wellness on herself, and I'm trying to find out was her husband paid for 2024 and 2025 for his wellness.
[AGENT][NEUTRAL] Um, it looks like 2025, we have a wellness for her. We paid out 100.
[AGENT][NEUTRAL] That was on it was 324 25.
[CUSTOMER][NEUTRAL] Was that recent?
[CUSTOMER][NEUTRAL] Was that ACH or paper check?
[AGENT][NEUTRAL] Paper check.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] We also looks like for 2024 we paid out paper check.
[AGENT][NEUTRAL] Um, also $100 to her, and that was on.
[AGENT][NEUTRAL] 2 1025.
[CUSTOMER][POSITIVE] Got it perfect.
[AGENT][NEUTRAL] And then let's see what we've got.
[CUSTOMER][NEUTRAL] Alright, so she's square.
[AGENT][NEUTRAL] For her spouse, we've got, looks like we've got a couple payments for him as well.
[AGENT][NEUTRAL] We paid out $100 that was on.
[AGENT][NEUTRAL] 3 13 2025.
[AGENT][NEUTRAL] That's for 2025 and then we also paid out $100 for 2024 and that was paid out on 2-10-2025.
[CUSTOMER][POSITIVE] Got it, so they're paid up, got it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Perfect, um, would you mind if I give you one more person?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, absolutely. Let me get back to that screen if you don't mind. Hold on one moment.
[AGENT][NEUTRAL] OK, what's that policy number?
[CUSTOMER][NEUTRAL] It is 247-866-2.
[AGENT][NEUTRAL] And patient name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] I know something was paid and something was declined.
[AGENT][NEUTRAL] It looks like we did decline something as it looks like it's an exclusion under the policy.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yes, basically he, he, he kind of had a weird, he kinda had a weird scenario. He
[CUSTOMER][NEUTRAL] They found a lump in one of his testicles, and he, they, he had a vasectomy, but I don't know that the vasectomy was tied to the lump, but he did have to have an ultrasound because they found a lump and thought it might be cancerous. Um,
[CUSTOMER][NEUTRAL] So it's kind of weird. He, he went in, he did go in for an elective surgery but they did find a lump that made them do some ultrasounds and some other stuff.
[AGENT][NEUTRAL] Very
[CUSTOMER][NEUTRAL] So we may have paid some of it.
[AGENT][NEUTRAL] Based on what we received from the what was submitted and like the diagnosis and procedure it it tied it to that exclusion under the policy.
[AGENT][NEUTRAL] So if they can kind of if the if you could get some clarification from the provider that it was not tied to an exclusion of sterilization or or anything related to um infertility that's really what we need.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, now I wanna say we sent out, uh, sure, I wanna say we sent him out a payment though, um, may have been like $50 or $100 or something like that.
[AGENT][NEUTRAL] Does that make sense?
[AGENT][NEUTRAL] Yeah, I'm looking at his claims history. I don't show any payments made. I just show those two denied claims for him. What could it possibly have been on another member of the family?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, possibly so. The only thing I'm showing on my screen is him though unless.
[CUSTOMER][NEUTRAL] Unless it was a situation where they put his name and it was for a child, you know what I mean? Do you show anything else mailed out to him from the hospital plan?
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Recently or in the last.
[CUSTOMER][NEUTRAL] Because sometimes I'll notice it'll say the employee's name instead of the the the claimant's name sometimes in here.
[AGENT][NEUTRAL] Yeah, let's see what we have I see anything else.
[CUSTOMER][NEUTRAL] On my side.
[AGENT][NEUTRAL] I'm not seeing anything else um for any other family members, so.
[AGENT][NEUTRAL] Not sure what would have yeah oh wait here hold on one moment let me see what this one is well this is from [PII] and we didn't pay that either. OK, that was for a defendant, but um, yeah, so on that one, you know, either have his provider contact us and we can kind of really get into the specifics of what we really need uh for an appeal um or you know he can contact us too and we can.
[CUSTOMER][NEUTRAL] OK, hm, OK.
[AGENT][NEUTRAL] Kind of explain in depth what we what we need because based on the procedure code diagnosis code, etc. filed, that's why it was denied so.
[CUSTOMER][POSITIVE] OK, so there's nothing been paid to him from the hospital plan. OK, that that that's the main thing I needed to know. OK, perfect. I appreciate your help and thank you for your time.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right. Thank you, [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] Thanks