AccountId: 011433970860
ContactId: 71bd25fa-68f0-4c31-a58f-13ccf48c43e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354049 ms
Total Talk Time (AGENT): 124348 ms
Total Talk Time (CUSTOMER): 202591 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/71bd25fa-68f0-4c31-a58f-13ccf48c43e1_20250103T20:26_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I have a member on the line. She's asking for a claims specialist.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Um, her policy number is 2552188.
[AGENT][NEUTRAL] OK, what's the callback number?
[CUSTOMER][NEUTRAL] Um, it is, um, back [PII].
[AGENT][NEUTRAL] And her name?
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] Who?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK, let's see here, let me get it pulled up. Give me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, is there a question about a claim or?
[CUSTOMER][NEUTRAL] Yeah, well, she submitted a claim. I already told her that it's 7 to 10 business days. Um, we went over the documents of the policy and over the exclusion on the limitations of the policy and, um, the preexisting, and, uh, she, um, I guess she has questions still about the preexisting even though I went over it and I read everything that is under the preexisting. Um, she keeps asking me if diabetes is a preexisting condition which is not listed and that's what I told her, but she's still.
[CUSTOMER][NEUTRAL] Wants to ask that to a specialist.
[AGENT][NEUTRAL] OK, you can uh send her through.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, here she comes.
[AGENT][NEUTRAL] Uh, oh, [PII].
[CUSTOMER][POSITIVE] Thank you for holding. Yes.
[AGENT][NEUTRAL] OK, never mind, go ahead.
[CUSTOMER][POSITIVE] Yes ma'am, thank you for calling [PII]. I got you on the line and she's gonna assist you from here. She's in the claims department. I appreciate your help. Thank you. You're welcome.
[AGENT][NEUTRAL] Hey so, this is uh hey [PII], sorry, this is [PII]. How are you?
[CUSTOMER][POSITIVE] I'm good, [PII], how are you?
[AGENT][POSITIVE] Good, I understand you have questions.
[CUSTOMER][NEUTRAL] Yes, about the preexisting, she didn't have all the information, um, and I never received a policy, and she told me she couldn't send it because it was like a terminated policy. My, my employer had switched carriers for this typical pro this, uh, product, so I just needed to get some information, um, from you. I did submit a claim, but I'm trying to figure out like what exactly the pre preexisting conditions are since I never got like a physical paper. I can't see how it's worded or anything, um, and the limitation on them, I guess.
[AGENT][NEUTRAL] OK, um, she said that, so this will, let me just say that this will be a verification of benefits and not a guarantee of payment. So she said that you were wondering about the diabetes, is that correct?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, that's considered a preexisting because the way she read it to me it was like specified disease, cancer, heart attack, or like um a stroke.
[AGENT][NEUTRAL] OK, what now, could you please repeat that? I'm so sorry, the phone cut out.
[CUSTOMER][NEUTRAL] Yeah, she had specified it as to where it was like specified disease or cancer, heart attack or a stroke, like internal cancer, and something about that being like a ninety-day exclusion. Um, and then there was a pre-existing condition limitation, which I didn't really understand what that meant. And like I said, I don't have a copy of the policy to like put eyes on it myself to interpret it.
[AGENT][NEUTRAL] OK. Now, the diabetes would not be considered as a pre-existing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So when
[CUSTOMER][NEUTRAL] OK, that's what, that's what I was wondering, and that's basically like what my hospitalization stemmed from.
[AGENT][NEUTRAL] Yes, ma'am. Um,
[CUSTOMER][NEGATIVE] I'm like diabetic ketoacidosis and I just didn't know like if that's what it was, you know, um, because like I said, I never got a copy of the policy and then I understand you guys can't send them because it's slaps now.
[AGENT][NEUTRAL] Yes ma'am, um, so whenever we process the claim that would not be considered as a preexisting condition.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, OK, that's what I wanted to check, and I think she said the turnaround is like 7 to 10 days, so I sent the itemized bills and I, I just wanna confirm maybe that you guys got the claim. I had my mom send it to you guys through fax, so I just wanna confirm that you guys did at least receive it.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] Uh, let's see here. Yes, ma'am, we received it actually today, so the turnaround is 7 to 10 business days, so hopefully, you know, by the end of next week we should get this claim processed for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do y'all reach out to me to like to let me know the findings? Should I be like expecting a phone call or an email or do y'all just process everything like internally if you have all the documents?
[AGENT][NEUTRAL] Um, no, ma'am, we don't reach out by email or um phone call. You should receive something in the mail if benefits are payable, then let's see here.
[AGENT][NEUTRAL] Um, you don't have anything set up for direct deposit, so if the benefits are payable, you will receive a check in the mail or if benefits are not payable, you'll receive the denial of the EOB in the mail. Yes, ma'am.
[CUSTOMER][NEUTRAL] A letter. Now can I set up something for direct deposit?
[AGENT][NEUTRAL] Yes ma'am, um, you would get the direct deposit form from your bank.
[AGENT][NEUTRAL] And you would just, you could fax that in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yeah, that's not a problem I'll go ahead um.
[AGENT][NEUTRAL] The same way, um, the same way you've done your claim. Yes, ma'am. Yes, ma'am.
[CUSTOMER][NEUTRAL] The same number I sent it to?
[CUSTOMER][NEUTRAL] OK, OK, well then, yeah, I'll take care of that. I'm assuming that's probably a little bit quicker than having to rely on the postal mail.
[AGENT][NEUTRAL] Uh, yeah, because what we say is unfortunately we say to allow at least 30 days for everything to be received because of the way the postal service is nowadays because once we send it out it's honestly out of our control.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] OK, no problem, but y'all usually send it out within 7 to 10 days.
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][POSITIVE] OK, well then, yeah, I'll go ahead and get that taken care of today. I'll send it in. Thank you so much for your help. I appreciate it.
[AGENT][POSITIVE] Yes I am. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it you have a nice weekend.
[AGENT][NEUTRAL] OK, well thanks for calling APL and I hope you do the same bye bye.
[CUSTOMER][NEUTRAL] Alright bye bye.