AccountId: 011433970860
ContactId: 5b27050c-eff6-4b25-98e7-55399b8b1ba5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 541099 ms
Total Talk Time (AGENT): 160027 ms
Total Talk Time (CUSTOMER): 126501 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/5b27050c-eff6-4b25-98e7-55399b8b1ba5_20250324T21:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes ma'am, I was calling well claim that I had submitted um on the [PII]. I'm online looking at that now, but it doesn't show any type payment submitted.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and it was a claim for yourself or your provider?
[CUSTOMER][NEUTRAL] It was for myself.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] I do. It is um 667-756.
[AGENT][NEUTRAL] And for that claim was that for yourself?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Just need to verify a few other pieces of information. What is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then what is your email address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And then lastly, do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh yes, [PII].
[AGENT][NEUTRAL] OK, thank you so much. Let's look at this claim um what date of service was that for?
[CUSTOMER][POSITIVE] Um, it was for the [PII], I think that's right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it looks like based on the information received, it did not indicate that a screening test to detect internal cancer took part or place, therefore it didn't pay any benefits.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, it was just a, a routine, um, exam so I could get my medicine refilled that I go for every February.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] I'm trying to see it looks like this so it has to be a routine visit that's for.
[AGENT][NEUTRAL] You know, like a mammogram or something that would diagnose potentially cancer. Let me make sure I'm not missing something on your plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] OK, let me place you on a brief hold if you don't mind, is that OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thanks for holding. Um, so it looks like the, the policy that you have, it, it doesn't have coverage for this benefit. So it looks like you have a daily hospital benefit that it covers.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then a benefit for radiation and chemo, um,
[AGENT][NEUTRAL] So let's see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I, I mean, I've done this before. I submitted wellness claims before and as long as the doctor office coded it as wellness, I mean it's always paid.
[AGENT][NEUTRAL] OK, um, let me see.
[AGENT][NEUTRAL] But you said you did submit this one yourself, is that correct?
[CUSTOMER][NEUTRAL] At the end
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull up what we received and see if that helps a little bit um.
[CUSTOMER][NEUTRAL] Yeah, because it because I did it um.
[CUSTOMER][NEUTRAL] On paper
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The first time I in and they sent me a um.
[CUSTOMER][NEUTRAL] A thing back saying that the date was wrong it's so that's I went back online and to fix it.
[CUSTOMER][NEUTRAL] And resubmitted it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Yeah, it was the date was wrong on this one so I, I resent it.
[AGENT][NEUTRAL] OK, let me see what we have.
[AGENT][NEUTRAL] Yeah, and I'm not understanding what what they were looking for, um.
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] OK, do you mind if I transfer you to our claims department? I'll explain what's going on. You won't have to reverify anything, but they actually do the research on these claims, um, why they're why they've been denied can help you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] OK, I'll get you over there. Hold on one moment.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Calling APL, this is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] from the care team. I've got a patient or a policyholder on the line who is questioning a denial on a claim, and I tried to help her as much as I could, but I can't figure out exactly what, what we're needing or why. I saw the denial reason, but I couldn't quite figure it out, so.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] Um, policy number is 667756.
[CUSTOMER][NEUTRAL] In the patient's name?
[AGENT][NEUTRAL] Uh, patient is [PII], and I have verified her information.
[CUSTOMER][NEUTRAL] OK, you can send her on over.
[AGENT][NEUTRAL] OK, and it was on that 358-0046.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Um, it was on claim 3580046. You probably can see that though because it says the night.
[CUSTOMER][POSITIVE] Oh yeah, yeah, I did. I figured that was the one.
[AGENT][POSITIVE] OK, here you go. OK, thank you so much. Thanks. Bye.
[CUSTOMER][POSITIVE] All righty. Thank you. All right.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, my name's [PII]. I was checking on.