AccountId: 011433970860
ContactId: 45ff9f7f-246d-4d0b-bc3e-e482c04a0c48
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 550530 ms
Total Talk Time (AGENT): 175500 ms
Total Talk Time (CUSTOMER): 202227 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/45ff9f7f-246d-4d0b-bc3e-e482c04a0c48_20250509T15:02_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, yes, um, I was calling because on last Friday, I submitted a claim for, uh, uh, for my husband, um, the first date of his diagnostic with cancer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I had already made my portal checking the portal um it says that I uh that I, I guess either um hold on let me just open it up again because I, I don't what what is it because I'm at work now what's the um the website to to that portal?
[AGENT][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] Oh, it's [PII], and then you're gonna click on sign in.
[CUSTOMER][NEUTRAL] OK, hold on a.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII] OK.
[AGENT][NEUTRAL] And then when it comes up, you're gonna click on sign in or I think it says sign in or sign up to the top right.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, there's actually it was because I'm.
[CUSTOMER][NEUTRAL] I'm googling it and so it's got supplement insurance uh for brokers is that what it is? OK, here it is here [PII]. I should have added the W and then the sign in.
[CUSTOMER][NEUTRAL] Let me sign in.
[CUSTOMER][NEUTRAL] OK, so I'm in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um I submitted it, uh, the, the coverage type. I, I selected or it's the group cancel insurance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then when I first filed it it showed like um.
[CUSTOMER][NEGATIVE] Uh, received on the [PII] and then it has, no, on the [PII], sorry, and then it says amount paid 0 and then looking more into it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, it says something about I don't have the wellness claim or I don't, I don't, I don't know something like that. I'm, I'm pulling it up right now.
[AGENT][NEUTRAL] OK, let me take a look at it with you. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, so it's [PII].
[AGENT][NEUTRAL] And Ms. [PII], may I have a good contact number and then your policy number?
[CUSTOMER][NEUTRAL] Yes, so it is [PII].
[CUSTOMER][NEUTRAL] can I just put you on hold for just a moment?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] Yeah, there's one in the the yeah, like after the nurse between the nurse and the counselor.
[CUSTOMER][NEUTRAL] I'm so sorry, I'm receptionist, so I have to open the door.
[AGENT][NEUTRAL] Oh, it's OK, you're fine. Um, I just need your policy number.
[CUSTOMER][NEUTRAL] OK, the policy number is 01022965.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, what was the other one, my email?
[AGENT][NEUTRAL] Mhm, your email and mailing.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. OK, so I see the policy or the claim here for your husband. Let me take a look at it. Um, do you mind if I place you on just a brief hold? I'm just looking at the denial reasons.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Of course not.
[AGENT][NEUTRAL] OK, hold on one moment. You're welcome.
[CUSTOMER][POSITIVE] Yes ma'am thank you uh huh yes.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Alright, so we need the pathology report.
[AGENT][NEUTRAL] OK, what's this DC.
[AGENT][NEUTRAL] This wellness screening not covered on this policy, OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Just to make sure.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. Um, so just again for the call, all the information provided is a verification of benefits, not a guarantee of payment. So there's a few things. So, the one that you saw saying that the wellness benefits are not covered on this policy, um, that is correct. Um, so for that one, it was for that one code, it was denied. The other codes are requesting um the pathology report.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So anytime there's a positive diagnosis, um, if you're wanting to use the um first occurrence benefit, which is that lump sum payment, we'll need the pathology report. Um, so just a copy of the pathology report.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So, OK, um, the what I sent is the, uh, I guess from the desert imaging that's where they had it, um, how can you say it, uh, um, I guess diagnosed that that that that would be the wrong paper.
[AGENT][NEUTRAL] Let me see if I can.
[CUSTOMER][NEUTRAL] I guess that's what I'm trying to understand.
[CUSTOMER][NEUTRAL] Or do I get that pathology report from his uh cancer doctor?
[AGENT][NEUTRAL] Um, the pathology report is supposed to come from the um cancer doctor or whoever diagnosed, but let me see what was sent in. Hold on one second.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, yes, let me just get the door again one moment.
[AGENT][NEUTRAL] Sure, OK.
[AGENT][NEUTRAL] coming
[CUSTOMER][NEUTRAL] OK, I'm back.
[AGENT][NEUTRAL] OK. I don't know if my system just froze or
[AGENT][NEUTRAL] Why it's not letting me get to page 3. Hold on one moment.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold? I'm accessing the oh nope, it just popped up. Hold on one second.
[CUSTOMER][POSITIVE] Yeah yes ma'am, one moment, uh huh, yes, thank you.
[AGENT][NEUTRAL] OK. Mhm.
[CUSTOMER][POSITIVE] Thank you ma'am
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this here that's um been presented, that is your written report from the imaging um or the test that was taken. So yeah, we were gonna, we're gonna need the actual pathology report from the doctor.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, OK then, OK, I, I, I just, I'll, he has his appointment with him next Friday, so I'll go ahead and have him, have him handle that for us.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty, and I'm gonna go ahead and note the policy for you as well. And was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that, that was it.
[AGENT][POSITIVE] Alrighty, well, thank you so much for calling APL and as soon as we receive the pathology report, we'll go ahead and continue processing automatically.
[CUSTOMER][POSITIVE] Yes ma'am, thank you so much you have a good day.
[AGENT][POSITIVE] Thank you. Thanks for calling APL and I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.