AccountId: 011433970860
ContactId: 8b917532-9c20-4cf2-a7e0-fb928b43974e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 648450 ms
Total Talk Time (AGENT): 447462 ms
Total Talk Time (CUSTOMER): 315223 ms
Interruptions: 18
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/8b917532-9c20-4cf2-a7e0-fb928b43974e_20250214T22:40_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. You're speaking with [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Yes, uh-huh. Oh, hi, this is [PII]. Uh, I sent in a, a claim for my husband, uh, who has, um, uh, cancer, and I received a letter. I received a letter saying that they, that y'all might need some additional information, uh, that might be requested from me or the provider.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. OK, let me see, can I help you first give me your phone number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. OK. It's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, let me see if they gave me one here. I don't see the policy number here.
[AGENT][NEUTRAL] What do you have there? Do you have the explanation of benefit or do you just have a letter?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, no. Yeah, just a letter. Uh-huh.
[AGENT][NEUTRAL] Oh, that's how the generic letter that comes out, but I can make sure, uh, we, we send out a generic letter when we get a claim that the policy is in your name.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] It's in, uh, well, it, they sent it under my name here, but it's for my, I'm the one that's, yeah, yeah, yeah. OK. Yeah, sure. It's [PII].
[AGENT][NEUTRAL] Yeah, so it is in your name. It's in your name. So what's your social so I can bring up the policy.
[AGENT][NEUTRAL] OK, [PII]. OK. And what's your mailing address?
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] Uh-huh, it's [PII].
[AGENT][NEUTRAL] OK. Give me 1 2nd to see what I can find.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what's your date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh. [PII].
[AGENT][NEUTRAL] All right. And you said it's on your husband, correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's on my husband. Uh-huh.
[AGENT][NEUTRAL] And what's his name?
[CUSTOMER][NEUTRAL] [PII]. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Yes, ma'am. It looks like that's what it is, uh, that letter that goes out when we receive a claim, we received the claim on the [PII] and, uh, when any time we receive a new claim on uh a policy, you just get that generic letter. It's, it's in review. It has not been reviewed yet.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, OK, how long does it take to, to, to get reviewed?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] We have 7 to 15 working days, 7 to 15 working days. Yes, ma'am.
[CUSTOMER][NEUTRAL] Mm. Oh, OK.
[CUSTOMER][NEUTRAL] OK, OK, so, so, uh, y'all received it on the [PII]. 0, OK. It hasn't been 15 days yet. OK.
[AGENT][NEUTRAL] No, ma'am. No, ma'am.
[CUSTOMER][NEUTRAL] All right. OK. And then so if uh you need anything from me, then you will um uh contact me if if.
[AGENT][NEUTRAL] You, no, ma'am, we will not contact you by phone. You will get an explanation of benefit in the mail with the information that's needed. Yeah, you get correspondence. We don't call the insured, no, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, I see. OK, got you. So it'll be in the mail. OK. All right, well then, uh yeah.
[AGENT][POSITIVE] Yes, yes, ma'am. Yes.
[AGENT][NEUTRAL] Yeah, they'll come in the mail once once we process. Now do you have access to the internet because we got a website where you can always check claim status. You can, you do have it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yes, I do so I can just go into the um and and and under my uh claim or whatever and then and then check check there uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh, to check the status, yeah, but you can, but you can always call too. You can always call too. I was just making sure you did have the website, but you, you're welcome to call any time to check on your client, but it is in review and, you know, we have 7 to 15 working days to review and process a claim.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. Oh, OK, I see. OK. Are we, uh, eligible for, uh, the, they said something about, um,
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, like if we go to a doctor just to get, uh, a, a checkup. That, what do they call that, a well, well, wellness checkup?
[AGENT][NEUTRAL] A wellness, you're talking about a wellness benefit. Yeah, a wellness benefit. Yes, yes, ma'am. Let me see. Do you have that on your policy?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I'm not sure. I thought I saw it though.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, I'm sure it is, but I, I, yeah, before I just tell you, I wanna make sure I look at it and look at the benefit with you. But it does, if you got it, it's like a wellness like a colonoscopy.
[CUSTOMER][NEUTRAL] Cause I was reading my policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, PSA, Pap smith mammogram, chest X-ray, stool specimen, they're listed in your policy telling you which one I pay up for and I'm, I'm bringing, I'm getting it over. I'm trying to get over to that area if I can uh tell you the benefit amount, but if you have it one wellness per calendar year per person.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, oh, OK. Yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh-huh. So this, uh, so this is per year, uh-huh, yes, OK, and let me look at.
[CUSTOMER][NEUTRAL] Oh, OK. So one wellness, uh-huh.
[CUSTOMER][NEUTRAL] OK. OK. So does that count like if we go for blood, blood work? Like, um, like I went to my, yeah, no.
[AGENT][NEUTRAL] No, blood work is not covered. Uh uh. Blood work will not be covered on this policy. It has to be those specific that listed in your policy. Uh-huh. Yeah.
[CUSTOMER][NEUTRAL] OK. Just.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, got you, OK, I understand. OK.
[AGENT][NEUTRAL] Uh-huh, and out there on the website, there is a wellness claim form that you can get. All you do is fill it out, sign and date it, put the name of the doctor, uh, uh, facility where you went and choose like if it was a mammogram, you'll choose mammogram and put the date that you did it and that's all you have to send.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That claim from you, you don't have to send in any other information because if we have questions, we can, we can always call that facility or that doctor's office to verify that you, you had that wellness test done. So let me, um, I'm going to your benefits.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What do you know what it pays for the wellness?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] I'm gonna tell you now, yes, ma'am, I'm gonna tell you now. It pays $50 per calendar year per person, uh-huh, and let me go to, uh-huh, let me go to your other claim for the other policy you had before you got updated to this one and let me see that you have awareness on this one.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, that's good.
[CUSTOMER][NEUTRAL] Per person. OK. OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you did, uh, OK, 02541.
[CUSTOMER][NEUTRAL] Yeah. OK.
[AGENT][NEUTRAL] 394.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, I must put in the wrong number. Give me one second. Let me go back to this one because if you had an old one and you didn't file on your old policy, you can always, uh.
[CUSTOMER][NEUTRAL] OK. Uh-huh.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] 02541395. You can always uh use that one. So give me one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 23.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII] I thought I seen one you had before. OK, that was back then. OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 191898. Let me see when that one left.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 18149.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Mm.
[AGENT][NEUTRAL] Mhm. 181, 1918980191981.
[AGENT][NEUTRAL] OK. Oh, that back way back, way back in [PII]. So, OK. No, OK, so yeah, you do, you do have the awareness that you can file your claim form.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. OK, so I do have the wellness. Oh, OK. Um, does it have to be like so many days because, uh, I believe my, uh, our cancer policy that, that I, uh, started was, um, was it, I don't know, I don't remember when it started. Was it, did I have it last year, do you know?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh-huh. Mhm.
[AGENT][NEUTRAL] Mm well, I didn't only see two. You had one that was effective uh [PII] to into present and then you got one that the old policy that you had [PII], it lapsed.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, so, so, uh, to [PII]. So, and then I didn't get the cancer, uh, policy in between, uh, for [PII] then.
[AGENT][NEUTRAL] I, I didn't see anything. I mean, listen, y'all was with another company. I only seen these two policies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK, so what if if it lapse, then, then we can't, uh, file any claims is, is that for [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It, it lapsed [PII], but you can send any client for review.
[AGENT][NEUTRAL] And so you had two different policies. You have one that's 01918098, it's for [PII] and let me see that you have the wellness on there at that time.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm bringing that policy up. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm, yeah, and you did have a diagnostic testing of $50.01 wellness per calendar year.
[CUSTOMER][POSITIVE] Oh, OK. Good. OK.
[AGENT][NEUTRAL] Mhm. Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So then that was uh uh uh from [PII].
[AGENT][NEUTRAL] [PII] is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, the [PII]. 0, OK.
[AGENT][NEUTRAL] And, uh-huh, [PII]. And then your new policy affected [PII].
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Oh, OK. Yeah, yeah, that's a new one. Yeah, that's a new one. OK. So anything going back. Yeah, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, uh-huh. But even the old one, even, yeah, even the old one had a wellness on it. Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, even, OK, so that was from the old one is from [PII].
[AGENT][NEUTRAL] Uh-huh, to 101 of [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] To 101, uh-huh, of [PII]. OK, got you.
[AGENT][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, yeah, OK, of [PII]. OK. Alrighty, well, I better send my claims in.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And you did say your address, your address was [PII], right?
[CUSTOMER][NEUTRAL] And then if I guess so.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, yeah, that's the same one we had when you was, uh, had that old policy, that's the same address that we had also. Uh-huh. Yeah.
[CUSTOMER][NEUTRAL] OK. Yeah, that's, that's, yeah, cause I've been here for 25 years, yeah, living here for 25 years, so, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yeah, so if you're doing in the wellness, make sure you have the ones that can be paid between 91 of 20 to 101 of 22 on that policy, and then put your one that you can pay for 24 and 25 on your new policy, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] And the new policy, yeah, OK. All right. Well, thank you so much. Yeah, I appreciate it.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] You're welcome. All right.
[CUSTOMER][POSITIVE] Yeah, thank, uh-huh, thank you so much. Uh-huh. OK.
[AGENT][POSITIVE] All right, well, thank you for calling American Public Life, Miss [PII], and you have a great weekend. Bye, bye bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Uh-huh. You too. Thank you. Uh-huh. Bye-bye. Uh-huh. Bye-bye. Mhm.