AccountId: 011433970860
ContactId: 8b6f8f0a-4cf6-458d-8685-52ae00f5b3a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 510619 ms
Total Talk Time (AGENT): 207955 ms
Total Talk Time (CUSTOMER): 113615 ms
Interruptions: 5
Overall Sentiment: AGENT=1.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/8b6f8f0a-4cf6-458d-8685-52ae00f5b3a7_20250310T19:42_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi there I am um a customer and I'm just wondering why my claim continues to get um.
[CUSTOMER][NEGATIVE] Not, not played, so declined.
[AGENT][NEUTRAL] OK, I can help you with the claim and you said you're a customer of ours. Can you please give me your name and your policy number?
[CUSTOMER][NEUTRAL] Uh my name is [PII], and last name is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And my policy number is 015989993.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, Miss [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then can you also give me your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Sure, [PII]. My email is [PII] and my phone number is [PII].
[AGENT][NEUTRAL] Thank you ma'am and then if we get disconnected is that a good number to call you back on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK thank you I appreciate it so I'm showing that the last um report for your claim was done.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was for.
[AGENT][NEUTRAL] Uh, Texas oncology, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the date of service for this claim is [PII]. Is that right?
[CUSTOMER][NEUTRAL] Well, actually, it's a year, it was a, a year of um.
[CUSTOMER][NEUTRAL] Of cancer treatment. So I'm not sure which date we're going with, but the surge, the surgery was [PII], but the diagnosis was back in February and then
[AGENT][NEUTRAL] Oh, so you're not sure what date of service?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The surgery and then chemo and then radiation.
[AGENT][NEUTRAL] So you've got multiple dates of service, OK, all right, so let me look and see what the remarks are on the claim, why it was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the first remark that I see.
[AGENT][NEUTRAL] Is the diagnostic and prevention benefit has been exhausted for the calendar year.
[AGENT][NEUTRAL] Then
[AGENT][NEUTRAL] The next remark I see.
[AGENT][NEUTRAL] In order for processing of this claim to continue, we will need the pathology report first diagnosed with cancer. Um, it has not yet been received upon receipt of this information, we will give further consideration to the claim.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Yeah, you guys received a um a packet after that you had a hard copy packet of that hopefully that's somewhere in a file somewhere.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then we then I have a, a non-covered, um, the charges for the listed treatment dates are not covered under this policy.
[AGENT][NEUTRAL] And those were the 3 remarks that were on the most recent.
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That means
[CUSTOMER][NEUTRAL] What does that mean they're not covered on this policy.
[AGENT][NEUTRAL] Uh, the charges.
[AGENT][NEUTRAL] The charges for the listed treatment dates.
[AGENT][NEUTRAL] So part of the claim that had a treatment date, they're not covered under this policy.
[AGENT][NEUTRAL] So what I'm going to do to get you.
[CUSTOMER][NEUTRAL] But I've always had the same policy.
[AGENT][POSITIVE] What I'm going to do to get you further help is
[CUSTOMER][NEGATIVE] I'm sorry, you're breaking up.
[AGENT][POSITIVE] I'm sorry. I'm so sorry. Um, I'm going to get you further help.
[CUSTOMER][NEUTRAL] No, I'm sure it's because I'm at school.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Oh no, oh no, OK, but I'm gonna get you further help. I'm gonna send in a hub request and and that's a request for somebody from the claims department to give you a call an examiner that can go over every little thing with you so we can make sure that we get this claim in right and that you have everything that you need, OK?
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] You're welcome. I'm gonna put you on a quick hold while I get that request.
[CUSTOMER][POSITIVE] And, and they'll just give me a call back? Oh, OK, super, thanks.
[AGENT][NEUTRAL] Yes, yes, I'm gonna put you on a quick hold while I put this um request together for you and I'll be right back, Miss [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding Miss [PII]. I've got that request in for somebody to give you a call back so that they can go over the claim with you and you guys can discuss exactly what needs to be sent in and they can go over the review with you in detail, OK? And you should be getting a call back within 24 hours.
[CUSTOMER][NEUTRAL] Come.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] OK, perfect. Thank you.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful day.
[AGENT][POSITIVE] You're welcome. Anything else I can help you with before we go?
[CUSTOMER][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] I'll buy this [PII].