AccountId: 011433970860
ContactId: 49abec18-0580-4da2-b21a-bb7f7273145a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 670710 ms
Total Talk Time (AGENT): 352196 ms
Total Talk Time (CUSTOMER): 155297 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/49abec18-0580-4da2-b21a-bb7f7273145a_20250211T14:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] and we spoke last week.
[AGENT][NEUTRAL] Yes, Ms. [PII]. How are you today?
[CUSTOMER][NEUTRAL] Good, um, I wanted to let you know I never got a call back from anybody. Um, I got a call. I did get a call. I'm sorry, let me take that back. I got a call yesterday at like [PII], um, from a [PII] just saying that my check of $100 had been sent out again but um it wasn't anything about my claim or anything.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII], so, um, you're calling to just follow up on last week.
[CUSTOMER][NEUTRAL] Yes, um, and just to make sure that that $100 isn't the only thing that I'm gonna get out of the $3000 that was billed, um, because I know I spoke to [PII] and.
[AGENT][NEUTRAL] Mhm. Right. Yes, ma'am, I remember.
[CUSTOMER][NEUTRAL] She was gonna
[CUSTOMER][NEUTRAL] She was gonna send it on to someone to see what could be done and um she said she would call me back that day if not on Monday.
[AGENT][NEUTRAL] OK,
[CUSTOMER][NEUTRAL] And then I never heard anything.
[AGENT][NEUTRAL] OK, so Ms. Woman, first off, go ahead and give me a good callback number for you. I'll have to pull your policy back up and verify everything like we did last week.
[CUSTOMER][NEUTRAL] OK, um, cell phone is [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, I'm sorry. OK, and your policy number?
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] 682-888-527.
[AGENT][NEUTRAL] OK, we'll miss them, OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And that was your member ID number, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. So just a moment, please.
[CUSTOMER][NEUTRAL] Oh fine.
[AGENT][NEUTRAL] OK, so again, Ms. [PII], any information that I provide would be a verification of benefits and not a guarantee of payment. So if you could please verify your date of birth first for all for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, and, and lastly your email address please.
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you so much. So give me just one moment. I'm going to look at just a few things on here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do see um the note by [PII] where it was reprocessed and the benefit of the $100 was reissued because again, this is a limited benefit plan, Ms. [PII], that was the maximum benefit payable on this claim. It states, I can go over the remarks with you if you would like.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, so the benefit of the $100 was paid and it states the calendar year maximum for this benefit has been exhausted with the payment of this claim.
[AGENT][NEUTRAL] Under the next remark, it's
[AGENT][NEGATIVE] States the calendar year max for this benefit has been exhausted. Therefore, no benefits are payable for this calendar year and that is also the 3rd remark on here because it is a limited benefit plan.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The $100 benefit that was paid was the maximum benefit available under your benefits.
[CUSTOMER][NEUTRAL] So how do I go about like appealing that?
[AGENT][NEUTRAL] Sure, you can appeal that um you have 180 days to appeal that in writing, and you may, it will need to be um submitted to our claims mailing address which I will make sure that you have with any additional support and documentation that you want to include and it will be need to be addressed to attention appeals department.
[CUSTOMER][NEUTRAL] So I have to like mail it in.
[CUSTOMER][NEUTRAL] Like physical mail?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, you can mail it or fax it, but it has to be sent directly to our appeals department. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, now you're talking like you want me to write a letter or you just want me to.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, you need, well, you, you would need to request, make sure that it's acknowledged as an appeal and so that it's not mistaken as a duplicate claim and reviewed, you know, and potentially denied as a duplicate, you know, of of previously submitted expenses.
[CUSTOMER][NEUTRAL] OK, so when I send in the copy of my medical bills that I'm gonna send in I just write appeal on them?
[AGENT][NEUTRAL] Mhm. And you can.
[AGENT][NEUTRAL] Correct. And why, if you want to include as to why you would like it an appeal.
[AGENT][NEUTRAL] Reviewed, you may also include that. You may include anything, a letter, anything you want to in the appeal. It just must be submitted to us within 180 days from the date of the decision.
[CUSTOMER][NEUTRAL] Can you send me the address?
[AGENT][POSITIVE] I can provide it for you. Yes, ma'am. Just let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you ready?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And again, please put attention appeals department.
[CUSTOMER][NEUTRAL] So earlier you said attention claims department is it appeals department or claims department?
[AGENT][NEUTRAL] I'm so sorry. I meant to say not attention claims because that would just get reviewed and probably processed as a, you know, a duplicate of previously submitted. It needs to be, if I said that I'm very sorry, it needs to be addressed to attention appeals department.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am. I apologize.
[CUSTOMER][NEUTRAL] That's OK, um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So there's no form that you guys have for like an appeal that I need to fill out?
[AGENT][NEUTRAL] No, ma'am. No, ma'am. There's not a specific form for that. No, ma'am.
[CUSTOMER][NEUTRAL] So once I mail this in how long will it take to be processed?
[AGENT][NEUTRAL] An appeal can take 30 days, up to 30 days.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you mind letting me, well, do you mind holding because I did want to look at one additional piece um of information in here.
[AGENT][NEUTRAL] Just uh for my purpose. Do you mind holding? Do you have time?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh, no, not doing it.
[AGENT][POSITIVE] OK, I'm so sorry about that thank you very much for holding for me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But I, the check was reissued and that should be be mailed, that should be being mailed out to you today.
[CUSTOMER][NEUTRAL] OK, yeah, I'm not really worried about the $100 but um I will go ahead.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] I, I understand, but just.
[AGENT][NEUTRAL] Yes, ma'am. I know that's not the biggest fish for you, but I just.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So that you can, cause it does, you know, typically take about 10 business days like we discussed the other day so that you could just kind of be looking for it since it wasn't received that first time.
[AGENT][NEUTRAL] For whatever you know, whatever reason.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, well I will um get this appeal in the mail today.
[AGENT][NEUTRAL] OK, all right then.
[CUSTOMER][NEUTRAL] And then I will make a note to call back in 30 days.
[AGENT][POSITIVE] Yes, ma'am. OK. And again, I'm sorry about all of the confusion with this.
[AGENT][POSITIVE] For you. I really am.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Well, you're very welcome. So is there anything else, Ms. [PII] that I can help you with at the moment?
[CUSTOMER][NEUTRAL] With your very
[CUSTOMER][NEUTRAL] Nope, that's it at this time.
[AGENT][POSITIVE] OK. Well, thank you so much for calling APL and I hope that you do have a very nice day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] Yes, ma'am. I have. Thank you too. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah