AccountId: 011433970860
ContactId: 56867cc2-f75d-4421-86d4-6c6dd99c3831
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 695809 ms
Total Talk Time (AGENT): 245305 ms
Total Talk Time (CUSTOMER): 166656 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/56867cc2-f75d-4421-86d4-6c6dd99c3831_20250528T12:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], good morning. This is [PII] in [PII].
[AGENT][POSITIVE] Hey [PII], good morning. How are you today?
[CUSTOMER][POSITIVE] Doing great, doing great. I'm just trying to check on the claim that was processed overnight for one of our customers.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so you're just needing claim status for a member, is that right, [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Sure, I can help you with that. And go ahead and give me your callback number, please.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number.
[CUSTOMER][NEUTRAL] Is 2579047.
[AGENT][NEUTRAL] All right, thank you. One moment.
[AGENT][NEUTRAL] And [PII], as you know, I do have to verify a few things with you and any information provided as a verification of benefits and not a guarantee of payment. So first off, if you'll just go ahead and verify your email address for me.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, so yes, I do see that a claim went through nightly processing last night and this shows that the benefit amount will be $30,000 exactly even.
[AGENT][NEUTRAL] And that is scheduled for a direct deposit.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] OK, perfect, so it was processed 30,000 and it is processed um for direct deposit.
[AGENT][POSITIVE] That is correct, yes. Yes, there it is.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Well, there, oh, you're welcome, [PII].
[CUSTOMER][POSITIVE] I appreciate all your help um.
[CUSTOMER][NEUTRAL] While, while I have you, would you mind, would you mind if you, um, if we close that one up, uh, you know, whenever you're ready we check one more.
[AGENT][POSITIVE] Oh, OK. Well, give me just a moment to open a couple of more things up cause I had exited out of one thing that I didn't need to yet. So give me just a moment I'm so sorry, I didn't realize you had more than one.
[CUSTOMER][POSITIVE] No, take your time. There's no rush.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Sorry about that.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Well, and now this, OK, now the system has come to.
[AGENT][NEUTRAL] A crawl. I'm sorry, just.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK, [PII], and what is the next member's policy number?
[CUSTOMER][NEUTRAL] OK, next one is let's see.
[CUSTOMER][NEUTRAL] I had clicked it then the screen went blank and then I clicked it again and it highlighted in blue.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Now isn't the system changing, um, is it even today or tomorrow? Did they say the system is about to change.
[AGENT][NEUTRAL] Yes, yes, there will be some updates, uh, today.
[CUSTOMER][NEUTRAL] So is it a whole new system or you just updating this one?
[AGENT][NEUTRAL] There are gonna be some new features um you should have received an email, [PII] I believe from.
[CUSTOMER][NEUTRAL] Yes, I did.
[AGENT][NEUTRAL] Broker resources regarding uh the changes and yesterday I'm a day off this week because of the holiday, the [PII] is supposed to be the roll out.
[AGENT][NEUTRAL] And I believe
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you able to sign in still, or did you have to set up a new?
[AGENT][NEUTRAL] Profile.
[CUSTOMER][NEUTRAL] Nope, I signed in as regular so it'll probably update it today or tomorrow probably.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, the person, it, it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] OK, and her date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the same with this one, as you know, any information provided is a verification of benefits and not a guarantee of payment. So on this one I see that there was a claim that yes it was processed last night.
[AGENT][NEUTRAL] And let me look at one thing.
[AGENT][NEUTRAL] And then you've uploaded something else this morning. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, that was just some direct deposit uh for future claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It was supposed to be sent to me quicker than that, but somehow I just got it.
[AGENT][NEUTRAL] All right, so on the claim that went through nightly processing last night, it's still trying to load it.
[AGENT][NEUTRAL] This shows that the benefit amount paid was 5000, exactly 5000 even.
[CUSTOMER][NEUTRAL] OK, and.
[AGENT][NEUTRAL] Like
[CUSTOMER][NEUTRAL] I guess they're for 5000 they're trying to.
[CUSTOMER][NEUTRAL] Say it's a noninvasive cancer because I think her benefit amount is like 20.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me look at her policy information.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I can say there are two different. There is a 20,000 and there is a 5000.
[AGENT][NEUTRAL] So let me see.
[CUSTOMER][NEUTRAL] I'm thinking that's what it is normally invasive cancer is one amount and then I think a 25% of the benefit is normally non-invasive and I'm probably what they're trying to do right there.
[AGENT][NEUTRAL] Because this does show.
[AGENT][NEUTRAL] A soft tissue cancer connective in soft tissue.
[AGENT][NEGATIVE] Doesn't show.
[AGENT][NEUTRAL] [PII] on that
[CUSTOMER][NEUTRAL] I'm looking at the claim form real quick too I don't know.
[AGENT][NEUTRAL] Yeah, I would, let's say, I'm still looking for some of this information.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] And I know sometimes when these people do these claim forms they go fast.
[CUSTOMER][NEGATIVE] And they'll skip something like I'm looking on here for the cancer.
[CUSTOMER][NEUTRAL] Infection. It tells what type of cancer it is. It tells that a biopsy was performed, it was surgically removed.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But for the spot where it says invasive, metastatic or in sight, there's no check mark.
[CUSTOMER][NEUTRAL] So I'm wondering if that affected it or did they feel like the diagnosis was an invasive cancer, you know what I mean?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Um, diagnosis.
[AGENT][NEUTRAL] I mean, I can, I can't really tell by that now [PII], I could transfer you over to one of the examiners who reviews the claims documents.
[AGENT][NEUTRAL] To
[AGENT][NEUTRAL] Try and better answer that question for you if you would like for me to do that.
[CUSTOMER][POSITIVE] That's, that's perfectly.
[CUSTOMER][NEUTRAL] It's no problem at all. I was just trying to get a.
[CUSTOMER][NEUTRAL] I actually gotta go pick up a [PII], so I will, uh, I'll check back again later.
[AGENT][POSITIVE] OK. Well, I understand that that's a big job in itself. So, um, yes, I'm so sorry. I can't, I can just see that it shows a neoplasm of the connective and soft tissue, but I can't see anything showing invasive.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Based on what I'm looking at.
[CUSTOMER][NEUTRAL] OK, for for that check.
[CUSTOMER][NEUTRAL] No problem for that check, is it, is it a paper check or direct deposit? I didn't know she had already had directed on deposit.
[AGENT][NEUTRAL] Actually, this
[AGENT][NEUTRAL] Yeah, it looks like she already has that information on file with us for direct deposit and it does appear that that is going to be a direct deposit, yes.
[CUSTOMER][POSITIVE] Awesome awesome I figured she already had it on file from something else that happened. OK, that'll work I appreciate your time today.
[AGENT][POSITIVE] Yeah, it does. Well, you are certainly welcome and is there anything else at the moment I can help you with?
[CUSTOMER][POSITIVE] That's it. I hope you have a great day. Thank you for your time.
[AGENT][POSITIVE] I hope, well, you are welcome, [PII]. It was my pleasure in talking to you as always, and I hope you have a great day as well.
[CUSTOMER][POSITIVE] You too, thank you, ma'am.
[AGENT][POSITIVE] OK. Yes, sir, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] All right, [PII], bye bye.