AccountId: 011433970860
ContactId: 4a5d3585-f35b-46a2-bc8a-92434ca67b5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 774479 ms
Total Talk Time (AGENT): 418401 ms
Total Talk Time (CUSTOMER): 336139 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/4a5d3585-f35b-46a2-bc8a-92434ca67b5f_20250411T19:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], are you a claims adjuster?
[AGENT][NEUTRAL] Um, I am not, um, if you were needing to check on the status so I can check that for you.
[CUSTOMER][NEUTRAL] No, um, I have a claimantchester named [PII] that was.
[CUSTOMER][NEGATIVE] All of a sudden taking over my claims and
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] She, she's telling me information is completely opposite of the first person that took this over. And she's saying I don't qualify for all these things, even though I've been talking to people, I've been sending over these documents. I've been telling them I don't have cancer, but I have a cancer screening writer benefit. And I'm looking at the notes and literally it says this this is preventative measurements and um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I was wondering if somebody else could handle my claims and not her because I don't think she's understanding a word I'm saying and all these other people have had me submit all these documents and I'm clearly looking at my benefit deal and it has this on here clearly stated.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Regardless of cancer diagnosis. So I'm just wondering if somebody else like how to put in a request to have somebody else to, to take over that claim because this is not what I'm reading.
[AGENT][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I completely understand and I just apologize you're having to go through that. I'm very sorry um but let me, well, first, if you don't mind, um, what was your name please?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK and then uh can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII] and if I don't answer, please leave a voicemail or the way I can get back in touch with you because I'm teaching and um I'm not able to answer the phone sometimes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, I understand. OK, um, and this is, of course, just in case there is a disconnect, um, I'll try to get, get you taken care of as quickly as possible. Um, do you have your policy number?
[CUSTOMER][NEUTRAL] No, but I can give you my social security number.
[AGENT][NEUTRAL] Sure, OK.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I'm just gonna verify some information really quick. Uh, [PII], can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and my address is [PII].
[AGENT][NEUTRAL] Perfect, uh, last thing I need is the email address we've got on file for you please. It looks like it is through your employer.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that you've definitely been through this before. OK, um, give me just a moment, [PII]. I'm going to put you on a brief hold and I'm just going to reach out, um, and see what we can do, um, maybe get these reevaluated and, uh, who might be available to help you with this.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Right, because what's going on is that she kept saying all this stuff and I'm like, all I'm trying to do is I was given $50 but my, I had to do diagnostic testing, which was a follow up and says clearly right here one test per calendar year, it's $100 for a follow-up test.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] And I had a follow-up test. And that's the reason I'm getting confused as to why I was not paid. I was paid $50 and not $100 like I was supposed to.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, I see. OK, yeah, definitely. OK, uh, I appreciate you giving me all that information too so I can pass that along. Alrighty, I'm just gonna put you on a hold for just a moment, [PII]. um, if it, uh, hopefully it shouldn't take too awful long, um, but if it does, just know I've not gone anywhere. I'll get back to you as quickly as I can, OK?
[CUSTOMER][POSITIVE] OK thank you alright bye.
[AGENT][POSITIVE] All right thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi Miss. [PII], this is [PII] over on the care team. How are you today?
[CUSTOMER][POSITIVE] I'm good how are you [PII]?
[AGENT][NEUTRAL] Doing all right. It's Friday.
[CUSTOMER][POSITIVE] That's right
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, well, I've got a weird situation here. Um, I've got a member on the line, uh, she's got a cancer policy. I don't have a lot of background, but apparently she had one specific claims adjuster who was handling her claims. She said it got switched to [PII], which I'm not quite sure who that is, [PII], um, but she's, I guess having some serious problems with [PII] handling her claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, she said that the information she's getting is contradicting um what she was originally told and she believes contradicting what's in her policy regarding, uh, claims as well and so she asked if somebody else can look over them, make sure that they're correct, and if she can just get somebody else entirely to handle her claims.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah, I never run into that before.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Oh yeah, me either. Um, do you know who is right? Do you happen to know who was handling before? Did she know?
[AGENT][NEUTRAL] So I was like, oh, you know, I don't know.
[AGENT][NEUTRAL] I do not, uh, no, I don't think she remembers the name, um, and I'm not, I guess I could look at the older claims, but.
[CUSTOMER][NEUTRAL] OK, that's OK.
[AGENT][NEUTRAL] That's just the user names.
[CUSTOMER][NEUTRAL] Oh, that's OK, so she just wants someone to go through review, make sure everything that's being processed is correct and if so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] The only thing she gave me specifically, yeah, the only thing she gave me specifically was I guess she had, you know, her wellness benefit.
[CUSTOMER][NEUTRAL] What does she?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and she did the diagnostic test and it did require a follow up and so she's, you know, for her policy says that it's, you know, the $100 for the follow up diagnostic, um, and I guess we only paid her $50 and she said that [PII] had told her that that's, you know, it is only the $50 that she's arguing, so I think that's really the biggest thing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the main thing is gonna be double checking her wellness.
[AGENT][NEUTRAL] Right, and she, I, I think I've spoken with her before, um, because I think she had mentioned this, um, and I had just transferred her, but I guess maybe she went to [PII].
[CUSTOMER][NEUTRAL] That's the biggest thing that she's.
[CUSTOMER][NEUTRAL] OK, uh, what's that policy number?
[AGENT][NEUTRAL] Yeah, it's 252-861-9.
[CUSTOMER][NEUTRAL] OK, let's see, is she just wanting like a call back or what she wanting?
[AGENT][NEUTRAL] I'm honestly, I'm not quite sure. Um, I don't know what we can even do. Can we just assign this to somebody else or?
[CUSTOMER][NEUTRAL] Um, I mean, let's see, it looks like [PII] did her previous preventative.
[CUSTOMER][NEUTRAL] Um, exam
[CUSTOMER][NEUTRAL] I mean I can do the review since she's called in with this request for the review um and then as far I don't know if we can designate specifically someone to process her claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I didn't think so either.
[CUSTOMER][NEUTRAL] Um, it's kind of, you know, there's not a guarantee that [PII]'s gonna be here every time a client comes in and it could fall outside of.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I, I don't know that's something that I'll have to talk to this product supervisor about and let her know that there's been a very specific request, um, and then ultimately I think it's gonna be whatever the outcome of the review shows as well because if [PII] is correct then it could be that the information given to her previously regardless of who that was was incorrect um so it's gonna.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] It's correct, right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or and you know, really possibility is that maybe she just misunderstood and so, you know, but I think
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] That's one of those things.
[AGENT][NEUTRAL] OK, well I can just tell her that you, uh, y'all will I won't give her names, um, but I'll say that you know it will be reviewed, um, double checked by somebody else and then just that we'll get back with her.
[CUSTOMER][NEUTRAL] Exactly. So.
[AGENT][NEUTRAL] Do you want her to call back?
[CUSTOMER][NEGATIVE] Yeah, yeah, um, I can't.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, it's uh [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And she did specify that I know we always leave a voicemail but she said it will most likely go to voicemail um that to please leave a voicemail.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, um, I can't guarantee that it will be today. I will do my best. She doesn't have a whole lot of paid claims out there. It looks like she maybe has two, so if that's all the only two that we need to review, then obviously we can look at that and determine from there. um, it could be Monday though.
[AGENT][NEUTRAL] Sure. Oh yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] I'll kind of set that expectation, like, yeah, I'll kind of set that expectation. I'll probably even tell her Tuesday at the latest, but OK. Well, I sure appreciate your help, [PII]. I'll let her know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yeah, that sounds perfect.
[CUSTOMER][POSITIVE] You're welcome. Thank you, [PII].
[AGENT][NEUTRAL] Alright, bye bye.
[CUSTOMER][NEUTRAL] All right, bye.
[AGENT][POSITIVE] All right, [PII], I'm so sorry about that wait are you still with me?
[CUSTOMER][NEUTRAL] Yes, I was just reading over the policy bill again and highlighting, highlighting pieces of it that way if I need to I can send it back over.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Absolutely yeah that's not a bad idea at all. OK, so I did speak I just kind of called that department um and I explained the situation so first thing they're going to do is obviously review these claims, um, reprocess them if necessary.
[AGENT][NEUTRAL] And they did say that you know it can take obviously today's Friday it's afternoon um could be Monday or Tuesday but I did give them your callback number and I did tell them of course to leave a voicemail if they're unable to reach you uh once they have an update for you.
[CUSTOMER][NEUTRAL] Right. And like I'm looking at this, I'm looking at your APL policy deal, and it clearly states here says following up diagnostic testing does not have to have a positive cancer result in order to receive this benefit. And what she's doing is she's not looking right section. She's needs to be looking at the cancer screening benefit rider.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, and I feel like.
[AGENT][NEUTRAL] Yeah, I think that um.
[CUSTOMER][POSITIVE] That's what the benefit I'm trying to.
[AGENT][NEUTRAL] Either I've spoken with you before, I think I have actually, um, either that or somebody had a very similar situation, um, where, yeah, it was a diagnostic, one of the covered diagnostic tests and something came back, you know, just needing a follow up. Um, so I think that I spoke with you before. So I did pass all of that along, um, and they will review that, and then they will get back with you as soon as they're able to. It could very well be today, um, but I would at the very latest I would say Tuesday.
[CUSTOMER][NEGATIVE] Yeah, but they say you see with these, these claims, it takes 5 to 10 days and this thing's been going on for 3 weeks. And like I said, I was pretty frustrated. She's like, oh.
[AGENT][NEUTRAL] Oh no, so that's those that's for just processing claims in general obviously with something like this this information has already been processed and they're just simply going to check you know outside of um the original processor and just verify you know all of that.
[AGENT][POSITIVE] And they'll get back with you as soon as they can. I don't think it'll really take that long, um, especially if it's just this, this discrepancy between the diagnostic and the follow-up diagnostic test. I don't imagine it'll take long, but I always like to set that expectation because you never know something else might come up.
[CUSTOMER][NEGATIVE] Yeah, like I said, I mean, she kept saying, oh no, because it's not, it's not positive for cancer, not positive for cancer, but literally I'm, I'm looking at this deal and it says regardless of it says here twice.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And that's the reason the other girl that was originally working it kept saying, I need these documents. I need this document, and she knew all this. And I'm like, then somebody else gets a hold of it. And they're like, yeah, now, you don't qualify for anything. I'm like, then why have I been doing all these documents and stuff for over 3 weeks trying to get all this stuff in.
[AGENT][NEUTRAL] Right and typically that's that's the other thing I did want to address just so that you are aware um it's sometimes these members these claim adjusters or claim specialists um you know you could get the same one over and over, but typically you're not assigned to one per se uh so it's going to be depending on availability of who is working um but again I did pass all of that along so just as soon as they've got an answer for you they'll be giving you a call back.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] Yeah, was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] That's all appreciate it bye bye.
[AGENT][POSITIVE] All right, yeah, definitely thank you have a great weekend.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.