AccountId: 011433970860
ContactId: 35b21247-5ea2-4d4f-bb32-1f6b168a7f3b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 396130 ms
Total Talk Time (AGENT): 173675 ms
Total Talk Time (CUSTOMER): 197881 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/35b21247-5ea2-4d4f-bb32-1f6b168a7f3b_20250218T17:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, um, my name is [PII], and, uh, I have a claim in, uh, a cancer claim, and, uh, I'd like some, uh, information, more information on the benefits that's being paid.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, my, all right, can you help me?
[AGENT][POSITIVE] Sure, I can help you with that, Mr. [PII]. What's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Area code [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and what's the policy number?
[CUSTOMER][NEUTRAL] OK, the policy number, I don't know. I've got the, let's see, I don't think.
[CUSTOMER][NEUTRAL] I've got the claim number.
[AGENT][NEUTRAL] OK, what's the claim number?
[CUSTOMER][NEUTRAL] Oh, OK, I've got the policy number. I'm sorry, uh, 0, the policy number is 00.
[CUSTOMER][NEUTRAL] 56.
[CUSTOMER][NEUTRAL] 4038
[AGENT][NEUTRAL] OK, thank you and verify.
[CUSTOMER][NEUTRAL] And the
[AGENT][NEUTRAL] Verify your address and date of birth.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Uh, my date of birth is uh [PII].
[CUSTOMER][NEUTRAL] Uh, the address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you and verify your email address.
[CUSTOMER][NEUTRAL] Uh email address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying your information and you're calling in regards to a claim, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And would that be for claim number 3561781?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] All right, what question did you have?
[CUSTOMER][NEUTRAL] OK, uh, I sent in some, uh, bills and, uh.
[CUSTOMER][NEGATIVE] I'm not uh clear on what they have paid out uh I received the payment.
[CUSTOMER][NEUTRAL] Of uh
[CUSTOMER][NEUTRAL] $720 and uh I'm not uh sure um it looks like uh.
[CUSTOMER][NEGATIVE] I sent in some that were not covered.
[CUSTOMER][NEUTRAL] Uh, and I understand that, I think, but, uh.
[CUSTOMER][NEGATIVE] The surgical benefits, I don't understand because uh the sur the surgery was around $2000 and uh they only sent $720.
[CUSTOMER][NEUTRAL] And I'm not
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't know why that is. Did I not send the correct.
[CUSTOMER][NEUTRAL] Information.
[AGENT][NEUTRAL] No, I don't show where we are requesting additional information. I see that we paid a benefit for two of the surgery codes. One was for the mole surgery.
[AGENT][NEUTRAL] And the other was for the repair um of that surgery. So the, the surgical benefit, it pays based on the surgery code that is submitted. It's not based on what your um provider billed, but each surgical code has a value in which once we receive that code, that benefit is paid based on that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So for the mole surgery,
[AGENT][NEUTRAL] We paid $456 which is the value for that surgery code. And for the repair, we paid $264.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, is that uh the uh maximum that you pay on those situations?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Is that what you're saying? Yeah.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, you have a in, in other words, you have a limit on what you pay on for each surgery and
[AGENT][NEGATIVE] Well, not so much a length.
[CUSTOMER][NEUTRAL] Uh, for each benefit.
[AGENT][NEUTRAL] Yeah, it's not so much of a limit. It's just that those codes, um, there's a value associated with the code. So when we receive the surgical code, which is the type of uh surgery that is performed, there's a dollar amount associated with that code. And in this case, for the most surgery, that value is $456.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, I didn't, you know, I I never done this before, so I didn't understand that. I guess I was expecting them to pay the full benefit or the full, uh.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, charge, OK.
[AGENT][NEUTRAL] Understood. Yeah. The surgeries are paid based on the value um of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, because I have another one coming up, so, uh, I wanted to make sure that, uh.
[CUSTOMER][NEUTRAL] I, I knew something about it. So, uh,
[AGENT][NEUTRAL] Yeah, understood. So, yeah, and also because it is um skin cancer. With skin cancer, only the surgery itself is covered. So um those benefits would look different if it was for internal cancer.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's, uh, if it's not skin cancer, then you have other benefits available to you, such as the anesthesia and um the facility charges and so on and so forth. But because it's skin cancer, this policy only covers the actual surgery.
[CUSTOMER][POSITIVE] OK. Uh, uh, that makes sense. So, uh, thank you very much for your help.
[AGENT][POSITIVE] No problem, Mr. [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Not at this time. Thank you.
[AGENT][POSITIVE] Alright, well thank you for calling APL. You're welcome have a great day.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Thank you, bye.
[AGENT][NEUTRAL] Mhm bye bye.