AccountId: 011433970860
ContactId: 74fdc3b4-28cb-479d-abf6-65bde6277d93
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 998429 ms
Total Talk Time (AGENT): 301349 ms
Total Talk Time (CUSTOMER): 314884 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/74fdc3b4-28cb-479d-abf6-65bde6277d93_20250306T16:21_UTC.wav
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[AGENT][POSITIVE] Good morning thanks for calling APL this is speaking how may I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Your name is what, ma'am?
[AGENT][NEUTRAL] Uh, my name is [PII]
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, uh, I just, uh, my name is [PII]. I'm calling on behalf of my wife.
[CUSTOMER][NEUTRAL] Her claim number.
[CUSTOMER][NEUTRAL] Is uh, let me find it 532,280.
[AGENT][NEUTRAL] Is that the policy number?
[CUSTOMER][NEUTRAL] That is her account number policy number, yes, 00532280.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, give me one moment, please.
[AGENT][NEUTRAL] OK, and you say your name is [PII]. Uh verify your date of birth and the mailing address for me, please.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] OK. And you say you're calling about claim status for your wife?
[CUSTOMER][NEUTRAL] Yes ma'am, uh, I just received some uh.
[CUSTOMER][NEUTRAL] Some, uh, explanation of benefits. Well, uh, I just received some checks and some explanation on what they paid.
[CUSTOMER][NEUTRAL] And I've got some questions.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK. And is Ms. [PII] there with you?
[CUSTOMER][NEUTRAL] She's here, yes.
[AGENT][NEUTRAL] OK, and ma'am, uh, verify your date of birth for me and email address.
[CUSTOMER][NEUTRAL] Did you want her date of birth or my date of birth?
[AGENT][NEUTRAL] Uh, her date of birth. I need to speak with Ms. [PII]. Mhm.
[CUSTOMER][NEUTRAL] Her date
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][NEUTRAL] OK, is Ms. [PII] there with you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and may I speak with her so we can get permission?
[CUSTOMER][NEUTRAL] Alright, just a minute.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, Mr.
[CUSTOMER][NEUTRAL] Good morning. This is [PII].
[AGENT][NEUTRAL] Good morning, Ms. [PII]. Uh, verify your date of birth and email address for me, please.
[CUSTOMER][NEUTRAL] [PII]. My email is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback, a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, let's do [PII] and that is my cell.
[AGENT][NEUTRAL] OK, thank you, and you give us permission to speak to Mr. [PII] in regards to your claim status?
[CUSTOMER][POSITIVE] Yes, he's, he's taking care of it.
[AGENT][NEUTRAL] OK. And did you ever fill out a third-party authorization form? that way anytime he called, he, we wouldn't have to keep um asking you if it's OK to speak with him?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, would you like for me?
[CUSTOMER][NEUTRAL] No, we've never filled out that.
[AGENT][NEUTRAL] OK, um, since he's helping you.
[CUSTOMER][NEUTRAL] We've never been asked this before either.
[AGENT][NEUTRAL] Oh, I'm sorry. Uh, would you like me to email that form out to you and you can send it back to our office? That way it's given us permission to speak to Mr. [PII] in regards to your uh claims.
[CUSTOMER][NEUTRAL] Uh, if you want to do that, that's fine.
[AGENT][NEUTRAL] OK, and would you rather just email it?
[CUSTOMER][NEUTRAL] That'd be fine.
[AGENT][POSITIVE] OK, I'll email that to you and then once you get it, just complete it and send it back to our office, that way we'll have it in our system. But thank you so much. Thank you, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and Mr. [PII], you say you have a question about claims that were processed and you received several checks.
[CUSTOMER][NEUTRAL] Uh yes ma'am, I received several checks, uh.
[CUSTOMER][NEUTRAL] Do you, can you see my records? uh, are you in the office there in [PII]?
[AGENT][NEUTRAL] No, sir. um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you can't see what I'm fixing to ask you about.
[AGENT][NEUTRAL] Are you asking about claim information that was sent?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] I can view it. Um, do you have that claim number?
[CUSTOMER][NEUTRAL] OK, yes, the one in question, the main one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let me find it.
[CUSTOMER][NEUTRAL] Claim number is 3,566,020.
[AGENT][POSITIVE] OK, thank you, give me one moment.
[AGENT][NEUTRAL] OK, it looks like it paid $1,308.45.
[AGENT][NEUTRAL] Uh, looks like someone was paid for preventative and chemo treatment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh-huh, uh.
[CUSTOMER][NEUTRAL] Uh, it shows probably 4 chemos there, is, is that what I'm saying?
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Pay for 4 chemos.
[AGENT][NEUTRAL] It looks like we paid for 31 for [PII] or [PII], another for [PII] or [PII].
[AGENT][NEUTRAL] And another for [PII]. The rest of them looked like outpatient drugs that were given.
[CUSTOMER][NEUTRAL] OK, give me those dates again. May, uh, start again.
[AGENT][NEUTRAL] OK, give me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, [PII] at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] I'm looking for [PII].
[CUSTOMER][NEUTRAL] [PII] what?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I see that, OK.
[AGENT][NEUTRAL] And give me one moment.
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, on the back, uh, of this, it says in the notation, the, uh, remarks number 4.
[CUSTOMER][NEUTRAL] This is the maximum payable.
[CUSTOMER][NEUTRAL] For the chemotherapy, radiation therapy benefit has been met for this period.
[CUSTOMER][NEUTRAL] I have had to tell every person that I've talked to at APL I have an extra $10,000 rider on this policy.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And we have not, we have not exceeded.
[CUSTOMER][NEUTRAL] The $20,000 maximum.
[CUSTOMER][NEUTRAL] On this policy, do you, do you see that notation anywhere?
[AGENT][NEUTRAL] Uh, give me one moment.
[AGENT][NEUTRAL] September
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] I have talked to a [PII].
[CUSTOMER][NEUTRAL] [PII] [PII]
[CUSTOMER][NEUTRAL] And [PII] and [PII].
[CUSTOMER][NEUTRAL] And you are [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh K E K E.
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Yes sir. I'm just looking through our notes, give me one moment. I'm sorry.
[CUSTOMER][NEUTRAL] That's fine, that's fine.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you say you had spoke to someone about the cancer or the chemo and that it had not maxed?
[CUSTOMER][NEUTRAL] Uh, well,
[CUSTOMER][NEUTRAL] The, the notation on this says that the maximum payable for the chemotherapy, radiation therapy benefit has been met for this period. Well,
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] We have the extra $10,000 rider.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] We have not met that $20,000 maximum pay payable towards chemo and radiation.
[AGENT][NEUTRAL] And let me see what date this was for.
[AGENT][NEUTRAL] This looks like for [PII], um, let me double check one other screen.
[AGENT][NEUTRAL] OK, it looks like that was for [PII].
[AGENT][NEUTRAL] But I don't show any additional rider.
[CUSTOMER][NEUTRAL] It's, it's in my policy. I've got it.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Let me, uh, just a second, let me pull up the policy that was written to me.
[CUSTOMER][NEUTRAL] Let me pull it out.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] The policy that I have right here in my head.
[AGENT][NEUTRAL] Oh, I see what you're saying the initial.
[CUSTOMER][NEUTRAL] I had an additional $10,000 coverage.
[CUSTOMER][NEUTRAL] $10,000 is what the, the, the policy pays originally, but I took out an extra rider.
[CUSTOMER][NEUTRAL] For the additional $10,000.
[AGENT][NEUTRAL] Oh, I see what you're saying.
[CUSTOMER][NEUTRAL] So I have
[CUSTOMER][NEUTRAL] I have a $20,000 maximum in any calendar year.
[CUSTOMER][NEUTRAL] To be paid for chemo.
[AGENT][NEUTRAL] OK, I do see that. Give me one moment.
[AGENT][NEUTRAL] OK, I see what you're saying.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I see what you're saying. Let me, um, see if I can get an examiner and explain this to him, if you don't mind holding for a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, uh thank you so much. Give me one moment, Mr. [PII].
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Sing.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[AGENT][POSITIVE] Hey [PII], it looks like I'm just getting you today, lady.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Uh, this is a cancer policy and I have an insurance husband on the phone and I did get permission from her and I'm going to email the third-party authorization form.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] It's 532-280.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Yes, ma'am, and it's on the claim number 3,566,020.
[AGENT][NEUTRAL] And he's inquiring about the chemo benefit for [PII] where it says that Max the benefit for the year, and he's explaining that they have an extra chemo uh rider which pays an additional 10,000. He was saying that they hadn't met the
[AGENT][NEUTRAL] Uh, benefit since it's actually 20,000 instead of 10,000 as far as chemo.
[CUSTOMER][NEUTRAL] OK, let me check real quick.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Sorry.
[AGENT][NEGATIVE] That's one thing I hate about when it gets warm, all these dang bugs.
[CUSTOMER][NEUTRAL] Yeah, they do have the writer. Let me see let me let me process this one.
[CUSTOMER][NEUTRAL] Yeah, this is um the same on this one as well. We'll have to send a request to the examiner to reprocess the claim.
[CUSTOMER][NEUTRAL] So, uh,
[AGENT][NEUTRAL] OK, so, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] I can speak with him or you can let him know that um we do show that he does have the additional rider benefit and we'll send a request to have the claim reprocessed.
[AGENT][NEUTRAL] OK, if you would explain that to him, um, because he, he, he said he has let everyone know he has a list of people he spoke to about it and um it still hadn't been taken care of, so.
[CUSTOMER][NEUTRAL] OK, let me check notes real quick. Let me see who.
[AGENT][POSITIVE] Because he'll spell out the names and he got mine on there.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Huh, I don't see anything in regards to the additional.
[CUSTOMER][NEUTRAL] Benefit ride or disgust.
[CUSTOMER][NEUTRAL] Yeah, I don't see.
[AGENT][NEUTRAL] Yeah, I looked and I didn't see anything either.
[CUSTOMER][NEUTRAL] I see, OK.
[CUSTOMER][NEUTRAL] You can send them to me.
[AGENT][POSITIVE] Awesome and um like I said, I spoke to his wife and she gave us permission. I'm gonna send out a third party for him, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Awesome. Thank you, ma'am. Have a great one. Bye.
[CUSTOMER][POSITIVE] Thanks you too.