AccountId: 011433970860
ContactId: 3a3d1cd0-9036-45ef-b09e-026f8756a0b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 465649 ms
Total Talk Time (AGENT): 177049 ms
Total Talk Time (CUSTOMER): 131676 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/3a3d1cd0-9036-45ef-b09e-026f8756a0b4_20250310T20:04_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] I had a question about uh my benefits. Um, I just, I just received the check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, but gosh, I can't find it now. On the check it says that it says something about.
[CUSTOMER][NEUTRAL] Um, the
[CUSTOMER][NEUTRAL] The uh the calendar year maximum for this benefit has been exhausted and I just wanted to check with that.
[AGENT][NEUTRAL] OK, alright, I can check your benefits for you. Can I please get your name and your call back number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, it's [PII], [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, let me look that up real quick, Ms. [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Give me just a second, let me pull it in.
[AGENT][NEUTRAL] OK, that is not pulling in for me. Can I please get your social security number? It looks like there's too many digits.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] To my phone number?
[AGENT][NEUTRAL] No, for the, um, policy number.
[CUSTOMER][NEUTRAL] Oh, I haven't given you my policy. Um, my social security number is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me pull it up that way.
[AGENT][NEUTRAL] I apologize.
[AGENT][NEUTRAL] OK, [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Um, address is [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I forgot what else you asked me.
[AGENT][NEUTRAL] Your email address and a good callback number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Email address is [PII].
[CUSTOMER][NEUTRAL] And phone number is [PII].
[AGENT][POSITIVE] OK, thank you so much, Ms. [PII]. I appreciate you verifying that for me.
[AGENT][NEUTRAL] Alright, let me look, um, do you have the claim number that's on the letter that you received or on the check that you received?
[CUSTOMER][NEUTRAL] Yeah, um, let me just walk around and get it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, claim number is 35.
[CUSTOMER][NEUTRAL] 69.
[CUSTOMER][NEUTRAL] 387.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, so what it's what it's saying is after paying that payment that um amount that once that amount was paid, that the calendar year maximum for that benefit was exhausted.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, so the radiation, so any other claims like I have.
[CUSTOMER][NEUTRAL] Um, I just finished radiation. I can't claim that.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, let me look real quick at your benefits.
[AGENT][NEUTRAL] That was for imaging.
[CUSTOMER][NEUTRAL] OK, so radiation be a whole desk one.
[AGENT][NEUTRAL] For imaging and.
[AGENT][NEUTRAL] Right, for preventative it exhausted your benefits for imaging and preventive.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so probably the other thing will go through.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Right, and looking at your looking at this, if you, you did get a remark on the surgery, it says in order to give consideration to your claim, we will need a fully itemized surgery bill that includes the procedure code and diagnosis code and please submit this information at your earliest convenience. So if you submit that information they'll look over that part of the claim again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, has there, are you, so I noticed that my provider was not sending in claims, so I did it myself on your website. Can you tell if they started sending?
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The only thing that I see that was sent in was this claim that we were discussing now. I, I don't see anything before or after.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or after. OK, I will have to give them a call.
[AGENT][NEUTRAL] OK. All right. Was there anything else that I can help you with, Miss [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] All right. Well, you have a, a, well, wait a minute, you've got a different policy number.
[AGENT][NEUTRAL] Uh, let me check on that other policy number and see if anything's been submitted on that one because it switched to a different plan.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, it's the same situation so yes that is the last claim that was sent in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you so much.
[AGENT][POSITIVE] All right. You're so welcome. Anything else I can help you with before we go, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, you have a good day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you so much bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.