AccountId: 011433970860
ContactId: 7169712e-4441-4c76-b3db-9dd97d5de41a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346579 ms
Total Talk Time (AGENT): 152548 ms
Total Talk Time (CUSTOMER): 87575 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/7169712e-4441-4c76-b3db-9dd97d5de41a_20250123T21:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with Skyline Green. I um work in HR and I am trying to help [PII], um, see if he has any missing documents that he needs to send you.
[AGENT][NEUTRAL] OK, so there's a claim out there and you're wanting to know if there's any missing documents for the claim?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, well, I can look into that for you and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, yeah, I'm calling off of my phone, but we can do, his phone is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 2521583
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] And um may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] The date of service.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] That, is it [PII]?
[CUSTOMER][NEUTRAL] Was that when it was received?
[AGENT][NEUTRAL] OK, um, and so I do see two claims. What's the name of your provider's office?
[CUSTOMER][NEUTRAL] Um, Skyline Green.
[AGENT][NEUTRAL] Hm, because I have two claims here. One was
[CUSTOMER][NEUTRAL] Or American.
[CUSTOMER][NEUTRAL] Sorry, go ahead.
[AGENT][NEUTRAL] Um, one was received on [PII], the other was received on [PII].
[AGENT][NEUTRAL] Um, what's your tax ID?
[AGENT][NEUTRAL] Oh, only one has it.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] With his tax ID the [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] Actually, that won't help.
[CUSTOMER][NEGATIVE] I'm not able to log in the portal.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And we tried while creating him an account and it said that it was down.
[AGENT][NEUTRAL] Hold on please.
[AGENT][NEUTRAL] OK. So it looks like, see, I don't know how to decipher.
[AGENT][NEUTRAL] OK, so we've processed 2 claims.
[AGENT][NEUTRAL] For him, um, one of the claims needed.
[AGENT][NEUTRAL] Hold on, let's see.
[AGENT][NEUTRAL] Let me read this reason. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so one of them, it was for the internal cancer um benefit rider, but it was determined that it was a pre-existing condition, so there wasn't a payout on that. Um, the other policy, uh, I'm sorry, the other claim.
[AGENT][NEUTRAL] Um, what was the reason for this?
[AGENT][NEUTRAL] Oh, well, it was asking for the pathology report. Um, let me see if this is the same.
[AGENT][NEUTRAL] Yeah, this first claim here is asking for the pathology report.
[AGENT][NEUTRAL] Um, showing the first diagnosis of cancer.
[AGENT][NEUTRAL] Are these the same date? Because if this is the same claim, then that second one.
[AGENT][NEUTRAL] Yeah, this is all the same day. OK. So we first processed the claim, we asked for the pathology report, we received the pathology report and the medical records and determined that it was pre-existing, so there could not be a payout on the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So he wouldn't get um
[CUSTOMER][NEUTRAL] He, he then wouldn't get like any, any um of those payments in correct like the initial, the I think it was like the 2500 or any of like the monthly and the chemo.
[AGENT][NEUTRAL] Right, because the, um, it was before the
[AGENT][NEUTRAL] The diagnosis was before the policy was effective. So had it, had the policy been effective during this time and then he received the diagnosis, then yes, it could pay out, but it was
[AGENT][NEUTRAL] The policy was not in effect when the diagnosis came out so it's preexisting.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] All righty. Well, I wish I had better news for you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] No, that's fine. Thank you, [PII].
[AGENT][POSITIVE] Well, you're very welcome. Was there anything else I could assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, I didn't believe that's it.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APL and I hope you have a good day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye.