AccountId: 011433970860
ContactId: 7da3f527-9cad-465c-ab50-dde4c9e3647b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378899 ms
Total Talk Time (AGENT): 155584 ms
Total Talk Time (CUSTOMER): 108531 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/7da3f527-9cad-465c-ab50-dde4c9e3647b_20250218T20:31_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII], and I filed a claim and they denied it because it said it was missing a document. So then I sent in the document and they sent the thing saying something was being reviewed, but now I can't look at its progress or anything online.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, I can help you with that, Ms. [PII]. Do you have your policy number available?
[CUSTOMER][NEUTRAL] I do not, but I have my social security number.
[AGENT][NEUTRAL] Alright, let me get to that screen and I'll be happy to look up that policy. What is your social?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And is this on your cancer policy?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you mind verifying your date of birth?
[AGENT][NEUTRAL] Mailing address, email, and phone number?
[CUSTOMER][NEUTRAL] Um, [PII]. My email is [PII].
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] It looks like we received a claim document on the [PII]. Is that the one you're wanting to see the status on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that is in line to be processed. It's not been processed yet looks like they might be reviewing it.
[AGENT][NEUTRAL] So you once it's reviewed and completed, it'll have a claim number and you can click on that claim number to see the uh claim decision. It could take up to 24 hours if you receive text um notification that it was processed.
[CUSTOMER][NEUTRAL] OK, um, so right now I mean if it was to be processed, how much does that one usually pay out?
[AGENT][NEUTRAL] Well, unfortunately I wouldn't be able to tell you until.
[AGENT][NEUTRAL] The claim has been processed.
[AGENT][NEUTRAL] Um, what is the claim for?
[CUSTOMER][NEUTRAL] Um, I had a biopsy.
[AGENT][NEUTRAL] Is it for preventive? You had a biopsy. Have you viewed your policy benefits online?
[AGENT][NEUTRAL] If you click on your policy number, yeah.
[CUSTOMER][NEUTRAL] Yes, but the
[CUSTOMER][NEUTRAL] It's very, very confusing and I just wanna make sure, do they need additional documents for that visit or?
[AGENT][NEUTRAL] Let's see what, see what I can find out for you. Hang on just a second.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEGATIVE] I'm taking a look, can't help.
[AGENT][NEUTRAL] Do you mind holding just one moment? Let me get you to a cancer adjudicator.
[AGENT][NEUTRAL] And maybe they can look take a look at that document and.
[AGENT][POSITIVE] And give you further information. My pleasure one moment please.
[CUSTOMER][POSITIVE] Alright thank you.
[CUSTOMER][NEUTRAL] Sing.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Well hey [PII], it's [PII]. How are you doing?
[CUSTOMER][POSITIVE] I'm good [PII] how are you?
[AGENT][POSITIVE] I'm doing well, thank you for asking. I have an insured on the line um calling regarding your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Status, it's policy number 2528619.
[CUSTOMER][NEUTRAL] Alright [PII].
[AGENT][NEUTRAL] Yeah, I told her that we just received that on the [PII], and she's wanting to know, she said it is for a biopsy and she's wanting to know what the policy pays toward a biopsy.
[AGENT][NEUTRAL] And if we need any other information.
[AGENT][NEGATIVE] She's just going through a hard time right now I think and.
[CUSTOMER][NEUTRAL] OK, sure, you can send her over.
[AGENT][NEUTRAL] And I wasn't, I wasn't exactly sure on the surgical benefits if that's for.
[AGENT][POSITIVE] Biopsies or what, but I appreciate you helping her and I verified all of her information.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Let me get her on the line. Thank you, [PII]. Good to talk to you.
[CUSTOMER][NEUTRAL] Same.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] Ms. [PII], thank you for your patience. I have [PII] on the line and she's going to take a look at that for you and assist you further.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] in the claims department. How are you today?
[CUSTOMER][POSITIVE] I'm fine, thank you.
[CUSTOMER][NEUTRAL] I understand you have some questions about your claim.
[CUSTOMER][NEUTRAL] Yes, I was wondering, do y'all need any additional documentation for that claim?
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Alright, so I showed the most recent claim received on [PII]. Is that the claim in question?
[CUSTOMER][NEUTRAL] Yes ma'am, I sent additional documents to go with another claim that was filed on the [PII].
[CUSTOMER][NEUTRAL] OK, yeah, so, um, that claim is in line to be processed. It hasn't been reviewed just yet. It's, uh, typically 7 to 10 business days from the date of receipt for the claim information to be reviewed in a claim decision.