AccountId: 011433970860
ContactId: 49561d56-7b82-4ca3-859c-795abc29a7b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 453950 ms
Total Talk Time (AGENT): 182531 ms
Total Talk Time (CUSTOMER): 140748 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/49561d56-7b82-4ca3-859c-795abc29a7b8_20250507T15:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], uh, I need to see if I can speak to the adjuster about my claim.
[AGENT][NEUTRAL] OK, yeah, we can definitely take a look at it. Do you have your policy number, claim number?
[CUSTOMER][NEUTRAL] Uh, I'm guessing this may be the policy number 252-2383.
[AGENT][NEUTRAL] OK, let me pull that up here one moment.
[AGENT][NEUTRAL] And if I could verify, please, your first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] 914, I'm sorry, [PII].
[AGENT][POSITIVE] Thank you so much. And then lastly, I just need to verify your address and email for security, please.
[CUSTOMER][NEUTRAL] My PO box is [PII] and what is it you're asking for my email?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The email, yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright, thank you so much.
[AGENT][NEUTRAL] OK. And was this a claim under your name?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So let me see, pull that claim number up here.
[AGENT][NEUTRAL] All right, [PII]. So the last one looks like it was an express scripts and it looks like showing tonight because the policy maximum's been met for the chemo radiation therapy. Is that what you had seen?
[CUSTOMER][NEUTRAL] Yes, I had already spoke with someone earlier. I just want to check with the adjuster to make sure when I need to submit the claim because they, she's saying that I, uh, I guess I submitted it too soon or the services I, my chemo services was before.
[CUSTOMER][NEGATIVE] Uh, the expiration date or before the benefits was exhaust exhausted.
[AGENT][NEUTRAL] OK, so what is the date when you should submit it? Let me see here.
[CUSTOMER][NEUTRAL] Um, it should have been [PII].
[CUSTOMER][NEUTRAL] After [PII] or after, but uh because I get the treatment before the [PII], um, she's guessing that's why they denied the claim. So I was just gonna check with the adjuster to make sure that is the reason so that when I submit the next claim this month, hopefully I won't have any problems.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, yeah, absolutely. So let me get somebody on the line for that. Um, give me just one moment, [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Ferring
[AGENT][NEUTRAL] Like new to me.
[AGENT][NEUTRAL] What the policy.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], this is [PII] over in customer care. How are you doing today?
[CUSTOMER][NEUTRAL] I'm fine thanks how are you?
[AGENT][NEUTRAL] I'm good. Um, I was just wondering if you could help me um answer a question on a claim if I give you the policy and claim number.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, policy number is 252-238-3.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the claim number, it should be for [PII]. Um, the claim number is 3597555.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I was reading in the notes that the benefit period on this, I guess is a calendar year or from [PII], 24 to 42525.
[AGENT][NEUTRAL] So I'm just wanting to make sure I tell her this correctly. She's understanding that the claim was denied because the chemo was done before, was done before the [PII]. So she's just wanting to know when I guess the benefits start over.
[CUSTOMER][NEUTRAL] Right, so it would be after the, the, um, the [PII], the [PII], so it's a 12 month.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, benefit period, it doesn't go by calendar year, um, and so that 12 months runs from [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and so starting on actually [PII], that's when the full amount will be available again. It will the benefit will renew.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, awesome. I just wanted to make sure I understood that correctly and was giving the right information, so I will pass that along. Thank you for helping me with that. I appreciate you.
[CUSTOMER][POSITIVE] Uh, sure, no problem. You're welcome.
[AGENT][POSITIVE] Have a good day.
[CUSTOMER][POSITIVE] Thanks. You too.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Thank you so much for your patience on that, [PII]. So I did verify with the claims um examiner department that your plan does run um from that year 425 24 to [PII]. So your benefits have restarted and so any claims going forward, then you would have that amount as of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. I just wanted to make sure before I submitted this claim in May.
[AGENT][NEUTRAL] Yes, yes, ma'am. So that 12 month period starts on [PII], and then you have that benefit amount of the 20,000 under that.
[CUSTOMER][NEUTRAL] OK. I, I just, when I submitted it, I wasn't thinking when I did the treatment, it needed to be after [PII] also. I, I wasn't, I wasn't thinking. I'm just trying to get my treatment done.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah. Yeah, no, totally understandable, but you're, you're absolutely correct on that date, so I'm glad we were able to clarify that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] My pleasure. Take care.
[CUSTOMER][POSITIVE] All right you too bye bye.
[AGENT][NEUTRAL] Bye-bye.