AccountId: 011433970860
ContactId: 8963aace-6c2a-49dc-ba0f-85b43c377a8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 516250 ms
Total Talk Time (AGENT): 206524 ms
Total Talk Time (CUSTOMER): 328942 ms
Interruptions: 11
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/8963aace-6c2a-49dc-ba0f-85b43c377a8b_20250603T17:27_UTC.wav
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[CUSTOMER][NEUTRAL] They also agreed upon the exchange of prisoners.
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, yes ma'am, I was reading over the cancer policy and I have a couple of questions, uh, about it if you can help me with that.
[AGENT][NEUTRAL] Yes, ma'am. I can help you. Um, are you needing benefit questions? Is that correct?
[CUSTOMER][NEUTRAL] right
[CUSTOMER][NEUTRAL] Yes ma'am, yes ma'am. I was just reading uh one of the one of the questions it says there's an optional benefit riders.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it says the diagnostic testing maximum 1 test per covered person per calendar year and benefit amount of 150. What does that entail? What does that cover? or?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, I'll be able to help you with your benefit questions. Can I first get um your name and your callback number just in case the call is disconnected.
[CUSTOMER][NEUTRAL] And he wants to be at the negotiating table. The reason he is.
[CUSTOMER][NEUTRAL] Sure this is [PII].
[AGENT][NEUTRAL] And then your callback number, Ms. [PII]?
[CUSTOMER][NEGATIVE] being killed.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then may I also get your policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh let me see if I can.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah, because I filed the claim and I got to wondering uh if I should have even gotten paid for what I filed so OK uh where's my policy number 254-0682.
[AGENT][NEUTRAL] OK, and that's 2500682?
[CUSTOMER][NEUTRAL] 2540.
[CUSTOMER][NEUTRAL] 682.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then also, um, I'll need your address, phone number and email address to verify the policy for us, please.
[CUSTOMER][NEUTRAL] Uh, address [PII]. Email address [PII]. Phone number [PII].
[AGENT][POSITIVE] OK, thank you, Ms. [PII]. I appreciate you verifying that information. Let me pull up your
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Policy so I can look at what you're looking at.
[CUSTOMER][NEUTRAL] together
[CUSTOMER][NEUTRAL] Congressional budget office and.
[AGENT][NEUTRAL] And you said there was a diagnostic test writer and you just wanted to know what it meant.
[CUSTOMER][NEGATIVE] Well, because I filed a claim and I paid for it and then I start reading the policy and somewhere it said in there that thought it said you must have been incurred a charge.
[CUSTOMER][NEUTRAL] So I had, I had my uh PA done.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I submitted a claim for that and it paid me $50. My question was, was I supposed to have been.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Out of pocket myself for that.
[CUSTOMER][NEUTRAL] In order to get reimbursed from y'all or?
[AGENT][NEUTRAL] Uh, it depends on, um, the
[CUSTOMER][NEUTRAL] Because it came under a well women's visit.
[AGENT][NEUTRAL] It depends on if whether or not.
[AGENT][NEUTRAL] Right, so if the um
[CUSTOMER][NEGATIVE] You don't have anything for me.
[AGENT][NEUTRAL] Claim was filed by you, then yes you would have to pay out of pocket and you would be reimbursed your $50 for that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, but if my insurance covered and I was not out of pocket because it was a well woman's visit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then would I be eligible for the $50?
[AGENT][POSITIVE] Yes, ma'am. You would be eligible for the $50 because you get one a year for your diagnostic testing for your wellness benefit.
[CUSTOMER][NEUTRAL] OK, whether I'm out of pocket myself.
[AGENT][NEUTRAL] Right, so if you're out of pocket yourself.
[CUSTOMER][NEUTRAL] If I did not have to pay anything for it.
[AGENT][NEUTRAL] Right. You get that $50 diagnostic test.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, I just wanted to make sure because I was reading in and it says we must have incurred a charge. Well, uh, yeah, I'm sure there was a charge, but I was not charged because my insurance covered it is what I'm saying.
[AGENT][NEUTRAL] OK, has the claim been sent in already for you for your diagnostic testing? I can look and see what is the claim number?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, and it they already, they already paid it that's what I'm saying I, I just wanna make sure I'm due that money.
[AGENT][POSITIVE] Oh, good, good.
[AGENT][NEUTRAL] Yes ma'am, yes ma'am, um, as long as you file that wellness claim and it, it doesn't ask for the itemized statement or anything it just asks for the wellness you have that benefit every year.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] OK, OK, so every year I get a if I get my mammogram or a PA then I need to submit that.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, alright, I just wanted to make sure because I said I knew I used to have one of these policies long ago before they came out with uh the well women's visit where you didn't have to pay anything so yeah well we were out of pocket, yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right, right. And they may have just carried that over for you when you um when, when they changed the plan and got you your new plan, they probably just carried that over for you with your group.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK, alright, so that's my main thing is like I said I was concerned that I did not pay anything out of my pocket and I'm getting money for it, but you're saying because I'm having it done that that falls under that writer to get it done once a year. OK, alright, next question does this policy cover any skin cancer?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Oh, let me check.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] deals to be.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] OK, in the policy, I just typed in skin cancer and this is what popped up. The definition of cancer does not include skin cancer.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right, see that's what I read and I thought, and then it gets down there and then it gives you the definition of skin cancer, so I'm like, OK, OK, but so based on that cancer does not include skin cancer unless it's melanoma I think is what I read.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right. Unless you have a pathology report.
[AGENT][NEUTRAL] stating that you have cancer.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It can't be defined as cancer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, that answered that question. OK, and.
[CUSTOMER][NEUTRAL] So one more thing, the the PSA testing for the men, the pros prostate.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Is that also considered a diagnostic, so if my husband had that lab work and that was included, then I need to submit that as a wellness.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, alright, I'm gonna call the doctor and find out if he's had that done within the last year.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, OK, well I appreciate your help on this. I feel better now that that money is mine.
[AGENT][NEUTRAL] And um
[AGENT][NEUTRAL] Yes, it's yours, yes ma'am, and just know that on your policies you don't have a timely filing limits. There's no time frame of when you have to send in a claim as long as you're covered on the data service by your policy, you can send a claim in at any time, so don't feel like you have to be rushed to find out about him.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, well I'm gonna have him call his doctor and see if he can find out if they've done that, and if they haven't, I'm gonna find out why not.
[AGENT][NEUTRAL] You could, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Alright, I appreciate your help today, thank you.
[AGENT][POSITIVE] You're very welcome. I hope you have a blessed day, Ms. [PII]. Is that everything that I can help you with?
[CUSTOMER][POSITIVE] Have a good day.
[CUSTOMER][POSITIVE] Yes ma'am, thank you.
[CUSTOMER][POSITIVE] Yes ma'am appreciate it.
[AGENT][POSITIVE] OK. All right. Well, you take care and thank you for calling APL.
[CUSTOMER][POSITIVE] Uh huh thank you uh huh.
[AGENT][NEUTRAL] Bye-bye, ma'am.