AccountId: 011433970860
ContactId: 4539006f-da4f-44d0-b377-098aeeffb160
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 528460 ms
Total Talk Time (AGENT): 145668 ms
Total Talk Time (CUSTOMER): 325137 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/4539006f-da4f-44d0-b377-098aeeffb160_20250325T19:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh yes, ma'am. Um, I'm a client of y'all's and I have a question concerning some claims. I'm not sure if I filed them or not and um, can someone go into my account and check for me please if I give them some dates?
[AGENT][NEUTRAL] Yes, ma'am, I can check claims for you. Can you please give me your name and your policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, my name is [PII]. My last name is [PII] Let me find my policy number. Here it is. 00596492.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] OK, that papers all over my desk. I don't know if I'm looking at the right things or not.
[AGENT][NEUTRAL] Yes, ma'am. OK, Ms. [PII], can you please um verify your policy for me? Can you give me your date of birth?
[CUSTOMER][NEUTRAL] Can you please um verify
[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] Yeah
[CUSTOMER][NEUTRAL] OK, my address is [PII]. Uh what else did you need? I'm sorry.
[AGENT][NEUTRAL] Your um email address and phone number.
[CUSTOMER][NEUTRAL] Oh, phone them.
[CUSTOMER][NEUTRAL] Phone number is [PII]. I've had to change an email, so I don't know if I updated it with you all or not, but what I've got right now is [PII].
[AGENT][NEUTRAL] OK, I am showing it looks like a work email address.
[CUSTOMER][NEUTRAL] You may have
[CUSTOMER][NEUTRAL] Yeah, it was, yes, it was a [PII].
[AGENT][NEUTRAL] Yes, so now it's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I've got that updated for you now, Ms. [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're very welcome. OK, so I'm showing that the last reported claim was reported on [PII].
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] And then it was paid also on [PII].
[CUSTOMER][NEUTRAL] OK, was the dates of service like in June? Or can you see that?
[AGENT][NEUTRAL] Yes, yes, it was [PII].
[CUSTOMER][NEUTRAL] There's
[CUSTOMER][NEUTRAL] OK, so I had another, uh, I think it was in uh December. I got some, yeah, yeah, [PII].
[CUSTOMER][NEUTRAL] Uh, OK, all right, um, I, the wellness I have to submit on a separate claim form from the cancer, is that correct?
[AGENT][POSITIVE] That's correct. There's a wellness form for that.
[CUSTOMER][NEUTRAL] OK, let me see. This is a well that's a well. I'm sorry to talk to myself, but if I don't do it, I'll.
[AGENT][NEUTRAL] That's OK. Sometimes we have to talk through it and I understand. I do the same thing.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] I've, I've looked at this a million times and I, I think it's just because I just don't wanna mess with it, but I got to, so, uh, OK, that, that one's been paid, that one has not. So has there been a wellness plan for [PII]? bless you, did you sneeze?
[AGENT][POSITIVE] Thank you, yes, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, for [PII], wellness, um, what was the date of service?
[CUSTOMER][NEUTRAL] I think I'm showing a wellness one was on [PII] for a mammogram. I don't know if I submitted that one or not.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] I do not show anything has been submitted for that date of service.
[CUSTOMER][NEUTRAL] OK, so I need to submit this.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] And we don't, you all don't pay on a mammogram and uh bone density, do you pay on either or or do you pay on both?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let me pull up your uh policy real quick and see if it says anything like that. I want to say it's either or.
[CUSTOMER][NEUTRAL] brought to you by.
[AGENT][NEUTRAL] But I wanna look and see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] a lot of
[CUSTOMER][NEGATIVE] like you forget about and who doesn't need to save more money.
[CUSTOMER][POSITIVE] and a whole world of grant people your destination for shopping, dining and entertainment.
[CUSTOMER][POSITIVE] Where you're busy and there's always something new to discover.
[AGENT][NEUTRAL] It's gonna be just a second while I scroll through and see your schedule of benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] for your gran today.
[CUSTOMER][NEUTRAL] Out here I can take that.
[CUSTOMER][NEUTRAL] Sure do. That's why I.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] It seems to be hard work but I was.
[CUSTOMER][NEUTRAL] Can help you.
[AGENT][NEUTRAL] Yes, ma'am, you're correct. It's either or.
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so I, and I'm not submitted a wellness for in [PII], so we, we got that.
[AGENT][NEUTRAL] Right, I did not see anything for [PII].
[CUSTOMER][NEUTRAL] OK. And then I have a cancer thing and
[CUSTOMER][NEUTRAL] [PII] and I don't think I submitted the December.
[CUSTOMER][NEUTRAL] Charges for that.
[CUSTOMER][NEUTRAL] Can you check the actual dates of service in [PII]?
[AGENT][NEUTRAL] OK, do you have the complete date of the service for December?
[CUSTOMER][NEUTRAL] I think, let, let me look at this.
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] It looks like
[CUSTOMER][NEUTRAL] Looks like there was pathology done on [PII] and uh office visit and biopsy on that date and then um
[CUSTOMER][NEUTRAL] On the [PII], uh, repair of wound and, and removal of cancer skin growth.
[AGENT][NEUTRAL] OK, so looking, I did not see anything that was submitted for the date of service for the [PII] or the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, and is there a stipulation because I did submit cancer thing in June, is there a stipulation that only one can be submitted per year? I don't.
[AGENT][NEUTRAL] No, there's not a stipulation.
[CUSTOMER][NEUTRAL] My husband
[CUSTOMER][NEUTRAL] OK, good, good. Uh, he took care of all this stuff and he's not here with us anymore, so I'm trying to wade through the waters to figure it out. So, um,
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, ma'am. Yes, ma'am.
[CUSTOMER][POSITIVE] Oh, you've been helpful. I appreciate it. Thank you so much.
[AGENT][POSITIVE] Well, you're very welcome. Is there anything else I can help you with before we go, Miss [PII]?
[CUSTOMER][NEUTRAL] No, I think.
[CUSTOMER][NEUTRAL] I think we've got it. I'll, I'll submit that information to you guys and uh I've got the, I guess it's uh.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] They're ELBs, but they're ELBs through Medicare. They're not, they're not, uh, ELBs from insurance, say, um.
[CUSTOMER][NEUTRAL] Do you, do you need ELBs from the insurance or do you need itemized receipts? Um,
[AGENT][NEUTRAL] It'd be itemized statements with the procedures and diagnosis codes and any EOBs that you may have from another insurance can be submitted. They'll just take those into consideration.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for your help. I really appreciate it.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful day and we thank you for calling APL.
[CUSTOMER][POSITIVE] You're quite welcome. Have a good day. Thank you.
[AGENT][POSITIVE] You too. Thank you.