AccountId: 011433970860
ContactId: 5b55c75f-9ad9-4fa9-8410-4d3422009d9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 749799 ms
Total Talk Time (AGENT): 246219 ms
Total Talk Time (CUSTOMER): 223112 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/5b55c75f-9ad9-4fa9-8410-4d3422009d9b_20250306T14:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, uh, plumbing about my, I'm calling about my cancer policy.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] You need my number?
[AGENT][NEUTRAL] Yes, ma'am, if you've got that policy number, please, ma'am.
[CUSTOMER][NEUTRAL] OK, 00486564.
[AGENT][NEUTRAL] Thank you. And can you verify your name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you, Ms. [PII]. And also, do you mind verifying your email and phone uh phone number?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, Ms. [PII]. And how can I help you today?
[CUSTOMER][NEUTRAL] OK, I received uh.
[CUSTOMER][NEUTRAL] I don't know what date I received this.
[CUSTOMER][NEUTRAL] But I guess I called a couple of weeks ago. I had gotten this uh explanation of benefits.
[CUSTOMER][NEUTRAL] Uh, this is for this year and I have a $10,000.
[CUSTOMER][NEUTRAL] Chemo benefit. Then I have an additional chemo.
[CUSTOMER][NEUTRAL] Uh, rider for 10,000. So I get this.
[CUSTOMER][NEUTRAL] Showing I got 10,000 I received 10,000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the annual. OK. On the additional, I only received 790437.
[CUSTOMER][NEUTRAL] On the back of this, it said that I had met my maximum payment for the chemotherapy.
[CUSTOMER][NEUTRAL] For that period. OK. I spoke with [PII] on the day I called and she looked and she said, well, that was just that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I admitted on the 10,000.
[CUSTOMER][NEUTRAL] So I'm, I was still do, I don't know, 2000 and something on that other one.
[CUSTOMER][NEGATIVE] But I just got a thing this morning that showed it didn't, it didn't finish out that 7900.
[AGENT][NEUTRAL] OK, well, let's take a look real quick. Bear with me just one second.
[AGENT][NEUTRAL] I'm checking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I apologize, my computer is not moving as fast as I want it to, so bear with me, OK?
[CUSTOMER][NEUTRAL] Oh, excuse for the way it goes.
[CUSTOMER][NEUTRAL] Uh
[AGENT][MIXED] You know, computers are wonderful except for when they don't work as fast as I think they've got us spoiled or at least it has me spoiled.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] You know, because
[CUSTOMER][NEUTRAL] My husband says I don't give it time. I, I go to clicking before it has time.
[AGENT][NEUTRAL] I do too.
[CUSTOMER][NEUTRAL] I'm a clicker.
[AGENT][NEGATIVE] I'm a clicker too, and I have to fuss at my finger and tell it to stop clicking.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEGATIVE] For sure, it gets me in trouble.
[AGENT][NEUTRAL] Let's see, so let's pull your policy up. We're gonna look at the, I'm gonna look at those benefits real quick and see.
[AGENT][NEUTRAL] Which benefit their state was maxed out.
[AGENT][NEUTRAL] I think I am anyway.
[AGENT][NEUTRAL] There we go.
[AGENT][NEUTRAL] So we know you've got your $10,000.
[AGENT][NEUTRAL] Chemo benefit
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And the additional that I took was another 10,000.
[AGENT][NEUTRAL] OK, let me get that pulled up.
[AGENT][NEUTRAL] Just gonna locate that router.
[AGENT][NEUTRAL] And let me check here.
[AGENT][NEUTRAL] And this was for.
[AGENT][NEUTRAL] 2025.
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh yes. Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you mind holding just one moment? What we're gonna do, Miss [PII], let me get you to that department because I'm seeing the same thing that you're.
[AGENT][NEUTRAL] Suggesting. So let me see why.
[AGENT][NEUTRAL] That was maxed out if you don't mind, OK?
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] All right, if you'll just bear with me, we're gonna review this and see if we can get this taken care of for you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] Ms. [PII], no one is available right now. They're all on another call. What I can do.
[AGENT][NEUTRAL] Is I can put in a request that they review that and then call you back, would that be OK?
[CUSTOMER][NEUTRAL] Yes, if they won't wait a day or two to call me back.
[AGENT][NEUTRAL] And it could be within 24 hours, but you should receive a call within 24 hours. Would that be acceptable?
[CUSTOMER][NEUTRAL] Oh yeah, that, it will be. There's nothing I can do about it.
[AGENT][POSITIVE] Well, we can, I can call, you know, we can, I can try you again and see if someone's available. It just may take us a minute, but I'll happily do that as well.
[CUSTOMER][NEUTRAL] So
[AGENT][POSITIVE] If that's OK with you. All right. Well, let's do that then. All right. If you don't mind holding.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] That's OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thanks.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hi, [PII], it's [PII].
[AGENT][NEUTRAL] I have policy number 486.
[AGENT][NEUTRAL] 564.
[AGENT][NEUTRAL] [PII], I was trying to do a hub request and she wanted to talk to somebody. I was gonna send it in hub, but she wanted to talk.
[AGENT][NEUTRAL] It's [PII]. I've verified all of her information. She's calling regarding the denied claim 3558801. Now she has in the policy the $10,000 chemo benefit and also a $10,000 rider benefit for chemo.
[CUSTOMER][NEUTRAL] OK, what was that claim number again?
[AGENT][NEUTRAL] 35 that's the paid one. The denied one is 3571696.
[CUSTOMER][NEUTRAL] And the policy number you gave me was 486-564?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK, why am I not seeing that claim number? It's so oh wait, hold on. OK, there it is. I scroll down. OK, let me pull it up here.
[AGENT][NEUTRAL] [PII] for part one.
[CUSTOMER][NEUTRAL] I was like why am I not seeing that claim number?
[CUSTOMER][NEUTRAL] Let me pull it up here and see what we got.
[AGENT][NEUTRAL] I was thinking, hmm, did I give it wrong?
[CUSTOMER][NEUTRAL] Listen, I feel like it's a Monday today already.
[AGENT][NEUTRAL] Me too. I'm like, no, let's don't do that.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so it looks like she met her max chemo.
[AGENT][NEUTRAL] So, she's got 2 chemos.
[AGENT][NEUTRAL] Well, that's what it says.
[CUSTOMER][NEUTRAL] And radiation, let me see what we paid it last.
[AGENT][NEUTRAL] But we have not paid that the writer or
[CUSTOMER][NEUTRAL] So this was for February and we last paid on.
[AGENT][NEUTRAL] Isn't it a per calendar year benefit on this plan though?
[CUSTOMER][NEUTRAL] I have to pull up the policy. Let me take a look.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Says per calendar year.
[AGENT][NEUTRAL] Benefits begin after the above radiation chemo benefit of 10,000 has been paid.
[CUSTOMER][NEUTRAL] Looks like we paid January most recently.
[AGENT][NEUTRAL] Mhm. Yeah, she's talking about her 2025 chemo benefits.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Looks like we paid it out.
[CUSTOMER][NEUTRAL] We paid the one, the additional chemo was paid on 120.
[CUSTOMER][NEUTRAL] Let me see what all we paid on that one.
[CUSTOMER][NEUTRAL] Under the additional writer.
[CUSTOMER][NEUTRAL] So we only pay $7,904.37 on the additional rider.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, you can send her to me.
[AGENT][NEUTRAL] All right, and her callback number is the number in this in her in line.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] Alright, let me get Ms. [PII] on the line, and I hope you have a wonderful day. Girl, I hope this day and tomorrow goes quick so we can have our weekend.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] Hang on just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Miss [PII], I do have [PII] on the line and she's reviewing, reviewing that information and will assist you further, OK? I was explaining to her what the situation was, so you didn't have to do that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] It's been such a pleasure, Ms. [PII]. Thank you for calling APL and have a wonderful day.
[CUSTOMER][NEUTRAL] Thanks. Hi Miss, Miss [PII], this is [PII], and you have some questions in regards to your February chemo that you received?
[CUSTOMER][NEUTRAL] Yes, OK, I, I I received.