AccountId: 011433970860
ContactId: 85daaaa7-d739-4f80-8d41-703c777e88ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 422049 ms
Total Talk Time (AGENT): 185293 ms
Total Talk Time (CUSTOMER): 143767 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/85daaaa7-d739-4f80-8d41-703c777e88ee_20250121T16:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I just have a couple of questions about um.
[CUSTOMER][NEUTRAL] Like I filed a claim this um at the end of last year because I had had my mammogram.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEGATIVE] Done and um it was it was declined because it says the maximum for the calendar year has been met but I mean I have my mammogram once a year like the last time I had it done was [PII] and then this last time I had it [PII], but it was declined so I'm, I guess I'm not sure how it works.
[AGENT][NEUTRAL] OK, alright, um, can you please give me, and I'll be able to help you with your claim if you can give me your name and your call back number.
[CUSTOMER][NEUTRAL] Mhm. My name is [PII].
[CUSTOMER][NEUTRAL] And my call back number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And then what is your policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh, policy number is 02247515.
[AGENT][POSITIVE] OK, thank you so much and let me pull that policy in.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, Ms. [PII], can you verify your date of birth for me?
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Address is [PII] phone number is [PII]. Email should be [PII].
[AGENT][POSITIVE] OK, thank you. I appreciate you verifying that information for me. All right, let me look, Ms. [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let me look at the claim.
[AGENT][NEUTRAL] OK, so on the claim, um, it looks like it was reported on [PII], is that correct?
[AGENT][NEUTRAL] Through the online service center.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] That seems to be the most recent and it was for um Center of Women's Health.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes, uh huh.
[AGENT][NEUTRAL] And it does say for mammogram.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I have a remark on the policy that says maximum for the calendar year has been met for the diagnostic testing benefit rider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if you had sent in.
[AGENT][NEGATIVE] Claims before this one for diagnostic testing and they got paid, then by the time you sent in this one, your benefit had exhausted.
[CUSTOMER][NEUTRAL] OK, so it only pays for a mammogram once in my whole life then is what that's saying.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Because I mean, I
[CUSTOMER][NEUTRAL] OK, well, I, I, I, yeah, that's what I'm confused because I mean I had my mammograms 368 days apart, so different years.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So I'm not sure why it paid one year and not.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, I understand what I'm going to do is I'm gonna go ahead and transfer you on over to the claims department. I'm gonna let you speak to an examiner about your claim and um that way they can go over.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK, just real quick, I mean, is what I'm saying makes sense though, or am I just not understanding?
[AGENT][NEUTRAL] The remarks with you.
[AGENT][NEUTRAL] No, what you're saying makes sense, but the way that the policy is, it's just, it's broke down for diagnostic testing. So if you had any diagnostic testing before.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] You had your mammogram and it was paid for by the time you sent in your mammogram, you had exhausted your benefits for diagnostic testing.
[CUSTOMER][NEUTRAL] Oh, so it could be a diagnostic testing on anything, not just like.
[AGENT][POSITIVE] On anything, right, right, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm trying to think of what else I had done, hey, and while you have my policy pulled up, are my children not covered under there this year because I don't know why I would have taken them off, but when I go in to file a claim.
[CUSTOMER][NEUTRAL] Um, they're not popping up anymore whereas they did last year.
[AGENT][NEUTRAL] Right. Um, actually, the policy.
[AGENT][NEUTRAL] Is no longer active. It lapsed on [PII].
[AGENT][NEGATIVE] Because your employer um stopped carrying this product.
[CUSTOMER][NEUTRAL] Oh, OK, well, they did not tell.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So if um let me look at the notes again real quick.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Why would they stop carrying that?
[AGENT][NEUTRAL] Yeah, it's, it's not active anymore as of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Well then you don't even have to transfer me to anybody because I don't even.
[AGENT][NEUTRAL] So they may have.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am. Now they may have a different cancer plan that they've switched our to another company maybe if you wanted to check with them and see if they have a different cancer plan available for you.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][POSITIVE] OK, all right, I'll check. All right, thank you.
[AGENT][POSITIVE] You're so very welcome, Ms. [PII]. I hope you have a wonderful day and we appreciate you calling APL. If you have any other questions or concerns, please pick up the phone and call us we'll help you all we can.
[CUSTOMER][POSITIVE] I sure will thank you.
[AGENT][POSITIVE] You're welcome, ma'am. You take care.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Mm. Bye-bye.