AccountId: 011433970860
ContactId: 8c3ed462-c780-4130-b3b2-f160ba6d3816
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414040 ms
Total Talk Time (AGENT): 149607 ms
Total Talk Time (CUSTOMER): 116424 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/8c3ed462-c780-4130-b3b2-f160ba6d3816_20250117T19:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, [PII], uh, my name is [PII] or [PII].
[CUSTOMER][NEUTRAL] And I have a letter from you guys that just uh I sent them a claim and the claim number on this letter is 3546029.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I wanted to get some an explanation on some of this and see how.
[CUSTOMER][NEUTRAL] Where our claim is.
[AGENT][NEUTRAL] OK, let's take a look at it here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, give me just one second here, [PII].
[CUSTOMER][NEUTRAL] Pardon?
[AGENT][NEUTRAL] Just one moment, let me just pull up this uh claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. And then on the policy, I will need to verify for security your date of birth and address, please.
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII].
[CUSTOMER][NEUTRAL] And what you need address?
[AGENT][NEUTRAL] Um, address, uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] All right, so the last claim that I see that claim number that you gave me, [PII], it looks like the claim was processed, um, it looks like it was denied. It looks like this particular policy does not provide any benefit for office visits, and then it says the other denial reason was.
[AGENT][NEUTRAL] This policy only provides benefits for treatment of cancer and other specified diseases. Benefit is not payable for any other disease.
[CUSTOMER][NEUTRAL] Well, I didn't have any disease other than cancer. They removed a 2.5 pound tumor, cancerous tumor from my body.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I was in surgery for 7 hours.
[CUSTOMER][NEGATIVE] So this is saying declined the whole.
[CUSTOMER][NEUTRAL] The whole claim
[AGENT][NEUTRAL] Well this is yeah I mean the claim number that you gave me the one ending in 6029, that's the one that I'm looking at yeah it looks like.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Um, it's showing the entire claim as denied. Um.
[CUSTOMER][NEUTRAL] This is a cancer policy if you don't have, and you got cancer.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEGATIVE] I don't understand.
[AGENT][NEUTRAL] Right, let me see here.
[CUSTOMER][NEUTRAL] I've done a lot of leg work as far as going to get information from you guys for uh all the benefit all the claims from the hospital, all the charges, and you sent back some other information you need and I went back and got more information.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which was hospital charges or doctor charges, nothing else.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] And I got a probably a 25 inch scar on my stomach, my middle, show you they, they did do surgery.
[AGENT][NEUTRAL] OK, so what I'm gonna do [PII] is get somebody on the line um that actually processes these claims and have them look at what was submitted and um go over it with you because they're gonna be better equipped to explain to you exactly um this information so do you mind holding the line for me one moment?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Bring
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling Ael [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, this is [PII] in customer care. How are you this afternoon?
[CUSTOMER][NEUTRAL] I'm doing OK yourself?
[AGENT][NEUTRAL] I'm doing OK myself as well. Um, I have an insured on the line. He has a cancer policy and he has a denied claim, and he needs some more information on it. I was hoping maybe you could help him with that.
[CUSTOMER][NEUTRAL] OK, what's his callback number?
[AGENT][NEUTRAL] This call back is [PII] and we're speaking with [PII].
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] 6986664
[CUSTOMER][NEUTRAL] Uh, uh, and the claim was for him or for his wife?
[AGENT][NEUTRAL] Uh, yeah, it was for him. Yeah, it was the last one reported on [PII] ending in 6029.
[CUSTOMER][NEUTRAL] OK, OK, you can send them through.
[AGENT][POSITIVE] All right, thank you so much, here he comes.
[CUSTOMER][NEUTRAL] Look.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling AP it's [PII].