AccountId: 011433970860
ContactId: 39355cf2-2977-4e28-883f-369d824d44cf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 633059 ms
Total Talk Time (AGENT): 376221 ms
Total Talk Time (CUSTOMER): 141205 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/39355cf2-2977-4e28-883f-369d824d44cf_20250602T14:17_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII].
[AGENT][NEUTRAL] Hey, [PII].
[CUSTOMER][NEUTRAL] Can you hear me OK? Hey, darling. Look, I
[AGENT][NEUTRAL] Yeah, there's just an echo. It sounds like you're a long way from here.
[CUSTOMER][NEUTRAL] And I'm not, it's like I'm right up at my computer. I don't know. Is that better? Let me just lean forward. Is that better?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Are you on a head, do you have a headset on or are you just talking through your?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, I have my headset on. I don't know. Some days it's like this, and I've been don't go to 3 headsets, and I'm sitting right outside my Wi Fi and everything. I don't know. I'm sorry. Are you able to hear me?
[AGENT][NEUTRAL] I don't know.
[AGENT][NEUTRAL] That's OK. Yeah, I can hear you. It's just like I said, it's got an echo and.
[CUSTOMER][NEUTRAL] OK so.
[CUSTOMER][NEGATIVE] It's aggravating. Oh gosh.
[AGENT][NEUTRAL] Uh, that's OK. How can I help you?
[CUSTOMER][NEUTRAL] Look, I've got it. I've got it, well, I've got an insured on the line, and she wants to know about some claim status, do you guys do that or do I need to send that to claims? I haven't had one of these calls.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No. Yeah, no, I can help him and um mm I can help him with claim status and what's the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It's 734389 [PII], and I've verified all of her information.
[AGENT][NEUTRAL] Alright, let me see here.
[CUSTOMER][NEUTRAL] And I've got a callback number if you need it.
[AGENT][NEUTRAL] Is it the same as what's in the system?
[CUSTOMER][NEUTRAL] It is, it is, it's [PII]. Well, hold on, I'm looking at what she's calling from. Hold on.
[AGENT][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] Yeah, it's the same, [PII]. Yeah, it's the same.
[AGENT][NEUTRAL] It is. OK. And so this is [PII] on the line?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, ma'am.
[AGENT][POSITIVE] OK. Well, I can help her, [PII]. Thank you.
[CUSTOMER][POSITIVE] All right. I appreciate it, [PII]. Thank you. Have a good day.
[AGENT][POSITIVE] You're very welcome. Yes, ma'am. You too. Talk to you later.
[CUSTOMER][NEUTRAL] All right, dear. Bye-bye.
[AGENT][NEUTRAL] All right, bye-bye.
[CUSTOMER][NEUTRAL] Well, I actually
[AGENT][NEUTRAL] Hi, Ms. [PII].
[CUSTOMER][NEUTRAL] That should be like.
[CUSTOMER][NEUTRAL] OK. Yes, ma'am.
[AGENT][NEUTRAL] Hi, this is [PII]. How are you today?
[CUSTOMER][NEUTRAL] I'm good, [PII]. How are you?
[AGENT][NEUTRAL] I'm doing fine, thank you. So [PII] was telling me that you're wanting to check claim status for yourself, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, yes, ma'am. Well, I can help you with that, and Ms. [PII], any information that I provide for you will be a verification of benefits and not a guarantee of payment. Uh, [PII] said that she had already verified all of your information with you as well. So what is the date of service, Ms. [PII], that you're checking claim status on?
[CUSTOMER][NEUTRAL] I don't know their wellness and it's 3 of them that I had submitted.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Alright, uh, so let me just.
[CUSTOMER][NEUTRAL] Since I can't get back to the website, I can't see them, so.
[AGENT][NEUTRAL] OK, so now, Ms. [PII], um, as far as the portal goes, you, you are set up on the online service center, is that correct?
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Right, but over the weekend you all changed everything, so I just need to know if they've been processed.
[AGENT][NEUTRAL] Yes, so you.
[AGENT][NEUTRAL] Right, so I can help you with that now you will just need to re-register for your portal, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you should be able to sign back in.
[AGENT][NEUTRAL] So I do see that there have been um.
[AGENT][NEUTRAL] OK, so there's 51, 1 moment.
[CUSTOMER][NEUTRAL] 3, I think it's 3 with 3 attachments.
[AGENT][NEUTRAL] OK, so there's a total of 6 different claim numbers assigned and it looks like all of the information you uploaded was on [PII].
[AGENT][NEUTRAL] So, on one of the claims,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For claim number 3607993.
[AGENT][NEUTRAL] This was for data service at 331. There is scheduled to go through our nightly processing tonight, a benefits payment in the amount of $90.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On that one.
[AGENT][NEUTRAL] Uh, and that states along on the remark, the calendar year maximum for this benefit has been exhausted with the payment of this claim.
[AGENT][NEUTRAL] Just a moment to get the other one pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and so the next piece of information that was uploaded on that.
[AGENT][NEUTRAL] Uh, also, again, you have the 6 that were uploaded the same day. Now this one is for.
[AGENT][NEUTRAL] Um, multiple dates of service.
[AGENT][NEUTRAL] So let me, and I can see that there was not.
[AGENT][NEUTRAL] That was for 2 things on [PII] and 2 on [PII].
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] OK, so for the uh for the [PII], Ms. [PII], it states that the, it was denied and one of the reasons is the diagnostic and prevention benefit has been exhausted for this calendar year. No further benefits are available for this screening.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the other remarks, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For that same data service for the [PII] states the diagnostic and prevention benefit will pay an indemnity amount for each other person who receives a screening test that's generally medically recognized to detect internal cancer.
[AGENT][NEUTRAL] Based upon this documentation received, it appears the cancer screening test was not performed for the service dates, please refer to your policy for additional information.
[AGENT][NEUTRAL] And it states with that laboratory tests are not a covered benefit under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the other data service that was on that upload was for 331, which also it's the same remarks regarding the laboratory test.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] It shows that this above reference claim is a duplicate of a previously submitted expense for the 331.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's fine. The lady that I spoke to said that nothing had been solved for 23, 24, or 25. So that's why they were submitted.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] OK, now give me just a moment because there were other, so just a second, that's, that's not all of them. There was another benefit that is being paid on the next set of uploaded information.
[AGENT][NEUTRAL] That was for [PII], and there is a $90 benefit for a mammogram.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then,
[AGENT][NEUTRAL] It looks like maybe the mammogram was submitted twice.
[AGENT][NEGATIVE] For [PII], so that next upload was just denied as, as a duplicate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] um.
[CUSTOMER][NEUTRAL] 153.
[AGENT][NEUTRAL] Because we processed it under that other upload and then um.
[AGENT][NEUTRAL] Then there was another benefit paid in the amount of $90 for [PII].
[AGENT][NEUTRAL] For a mammogram.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Right, that's what she told me.
[AGENT][NEUTRAL] Yes. So it's like some of the information was duplicates, so we pay but then had to deny the other as, you know, a duplicate or already processed. And then the [PII], that's, that's a mammogram again, and that's showing as a duplicate. So that's, that's what happened. It's just some of the things.
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] Why?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the same dates of service was uploaded more than once and we'll review everything, you know, that is submitted.
[CUSTOMER][NEUTRAL] OK, and so all that's being processed in tonight's work.
[AGENT][NEUTRAL] Yes, ma'am. It should be going through the nightly processing um tonight. And I do, uh, let me look at one more thing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I see that you have opted in for the direct deposit, so these, these benefits should go for direct deposit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Thank you very much.
[AGENT][POSITIVE] OK. Well, you are certainly welcome and if you need any help in setting up your new profile, just let us know, give us a call back and we'll be more than happy to help you with that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK. Yes, ma'am. Well, you're welcome. And is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] OK, well thank you again for calling APL and I hope you have a very nice day.
[CUSTOMER][NEUTRAL] All right. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] [PII], this is [PII] with Unic Bank. How you doing?
[CUSTOMER][POSITIVE] Good, I need to