AccountId: 011433970860
ContactId: 81040b59-0269-493b-9375-82c91c0af6dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 770320 ms
Total Talk Time (AGENT): 239278 ms
Total Talk Time (CUSTOMER): 363157 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/81040b59-0269-493b-9375-82c91c0af6dc_20241230T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, this is [PII], and I have some questions about some coins.
[AGENT][POSITIVE] OK, I'm happy to check on a claim for you today. Do you have a policy number?
[CUSTOMER][NEUTRAL] Uh yes, 252-520-6.
[AGENT][POSITIVE] All right, thank you so much. Let me pull this up here one moment.
[AGENT][NEUTRAL] All right, and then if I could get uh first name, last name on the policy and date of birth please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that [PII] and then can you verify your address on file please and email address we should have.
[CUSTOMER][NEUTRAL] Um, address is [PII]. Uh, email is [PII].
[AGENT][NEUTRAL] OK, thank you for that and was the recent claim submitted, was it for you?
[CUSTOMER][NEUTRAL] Well, I've just recently submitted, I submitted 3 claims yesterday and then 1 this morning. Um, my question is, you know, I have several questions, but the ones I submitted some in the past for my husband, where, you know, advanced financials said that I could go back and do that, you know, submit those from previous years.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so that's OK to do that.
[AGENT][POSITIVE] Yes, ma'am. Yeah, you can do that absolutely.
[CUSTOMER][NEUTRAL] OK, now and then on my question though, um, the only time that I've ever been paid for a claim was.
[CUSTOMER][POSITIVE] From [PII] and I was paid uh well.
[CUSTOMER][NEGATIVE] Not 100% sure of it.
[CUSTOMER][NEUTRAL] Let's say date completed [PII]. Um, but then I filed some claims that were, you know, I wasn't paid anything for in 23, you know, and my understanding is that it pays for one wellness.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Per year
[AGENT][POSITIVE] It does, yeah, it should, correct, yeah.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so, let's see.
[CUSTOMER][NEUTRAL] The date of service that I'm seeing is [PII] was whenever for that date of services whenever I was paid $100.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And probably I would say 100 because
[CUSTOMER][NEUTRAL] It's like I had a test and then I had to have a follow up test maybe.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But then.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] See, I submitted some for 23, but they were all denied.
[CUSTOMER][NEUTRAL] And then I had submitted one for 24.
[CUSTOMER][NEUTRAL] And that one was denied or well not paid on or whatever. Um, and my understanding is that how it works there at your company is like for a calendar year. um.
[CUSTOMER][NEUTRAL] But the way I pay for it is like I work at a school system and so it's from [PII].
[CUSTOMER][NEUTRAL] And I don't know if that created a problem somewhere along the line or exactly what happened.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. So.
[AGENT][NEUTRAL] 9123.
[CUSTOMER][NEUTRAL] Because you know, I had 3 different tests then and I mean, I don't know whenever I started to file the claims I saw all these reasons that you could file for and in my mind I thought, OK, well, I'm just gonna put it down or whatever. And then whenever I called Advanced Financial, they said just 11.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, wellness screening or whatever per year.
[CUSTOMER][NEUTRAL] So like,
[AGENT][NEUTRAL] That's correct, yeah, so most of these plans will only pay for one wellness, you know, benefit screening per year. So when I go into um because you know you were issued a new policy number there were some changes that were done in September so when I go.
[AGENT][NEUTRAL] Into the previous like policy number and look I was pulling up you were talking about some of these denials like one of them from 191 of 23, you know, it shows the reason it was denied it says that the uh max benefit had already been paid, but I would need to go and find that, you know, where it was paid at but that was the reason for that particular denial on that just stated that.
[AGENT][NEUTRAL] It had already been paid out for [PII].
[CUSTOMER][NEUTRAL] Right, well, I don't think, I don't think that I was paid anything for $23. I mean, the, the $100 was from what I'm seeing, I mean it was, you know, I didn't follow it until [PII], but, and then, you know, it was paid in [PII], but the date of service I'm showing is [PII].
[AGENT][NEUTRAL] OK. Well, let me pull up.
[AGENT][NEUTRAL] This claim and see what the because I see the benefit payment let me see what it shows is what the payment let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you were paid because the benefit payment for the the testing is $50 so you were paid $50 date of service [PII] and then there was an additional $50 and that was for a date of service of [PII].
[CUSTOMER][NEUTRAL] Oh, OK, well, I mean, I don't, that's a little confusing I guess how.
[CUSTOMER][NEUTRAL] How it looks on my screen when I'm trying to, to go from, you know what I'm saying? Um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because it just, I mean it has 3.
[CUSTOMER][NEUTRAL] I guess those are claim numbers. It has 3 claim numbers.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then you know it just has service from 72922 and then it just has $100 so that OK well that's if that's what happened then I mean I understand that.
[AGENT][NEUTRAL] Should be like a
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So, but then um.
[CUSTOMER][NEUTRAL] 2 1624 I.
[AGENT][NEUTRAL] 216
[CUSTOMER][NEGATIVE] You know, I didn't get anything for that.
[AGENT][NEUTRAL] OK. So let me.
[CUSTOMER][NEUTRAL] I mean, I don't know if that was something that's not covered, maybe.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] I needed to find that claim, so bear with me just a 2nd. 216-24.
[CUSTOMER][NEUTRAL] Do you need a claim number?
[CUSTOMER][NEUTRAL] Or confirmation number.
[AGENT][NEUTRAL] Does it
[AGENT][NEUTRAL] Does it end in 6102?
[AGENT][NEUTRAL] The claim number
[CUSTOMER][NEUTRAL] Um, I have OSC 81719.
[CUSTOMER][NEUTRAL] Oh wait, don't know that was the policy number, yeah, that's the, that's a confirmation number I guess that's what I got whenever I filed it.
[CUSTOMER][NEUTRAL] The OSC 81719
[AGENT][NEUTRAL] OK, let me see here.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I'm thinking maybe that that is something not covered because that was the CT scan of the chest.
[AGENT][NEUTRAL] 81709 hm.
[AGENT][NEUTRAL] Yeah, so I was having a hard time trying to match up the OSC numbers, but I do see a claim that was submitted for date of service [PII], and it does say it was the CT like imaging, um, let's see, and on this particular claim it states.
[AGENT][NEUTRAL] The medical imaging benefit will pay.
[AGENT][NEUTRAL] OK. So the information re it only pays, it looks like for MRI, CT scan, CAT scan, or PET scan, one performed due to the treatment of cancer.
[CUSTOMER][NEUTRAL] OK, got you. Alright, well then, so I saw yesterday. I just went ahead and saw the, the one for [PII] where I got my mammogram, so that should, that should work, right?
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Yes ma'am, because I don't see anything that we've looked at thus far that shows an indication for a payment for that $50 for the [PII] year. I don't see anything.
[CUSTOMER][NEUTRAL] OK. Well, so when I submitted yesterday, I submitted a claim for my husband for [PII] and then I submitted my uh my mammogram for [PII] and then.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I also submitted a claim for [PII] for my husband.
[CUSTOMER][NEUTRAL] And then this morning I submitted a claim for him for [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I mean I guess then that those should be OK. I mean I know you probably.
[AGENT][NEUTRAL] Yeah, I mean, as, as far as it being like [PII] or [PII] for him, yeah, definitely not a, not an issue, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, so, and like I said, yeah, you should still be eligible. I don't see anything on this new for. I just see your pending claims at this point. I don't, you know, I haven't seen any benefit payments, so yeah, you should definitely be fine on your mammogram and all that for this year.
[CUSTOMER][NEUTRAL] OK, so you see 4 pending claims?
[AGENT][NEUTRAL] Yes, ma'am, I do. Uh-huh.
[CUSTOMER][POSITIVE] Oh, OK, OK, perfect. OK, well, thank you so much. You've been very helpful.
[AGENT][POSITIVE] My pleasure. Thank you for calling APL. I hope you have a good rest of your day.
[CUSTOMER][NEUTRAL] Uh, you too. Goodbye.
[AGENT][NEUTRAL] All right, bye-bye.