AccountId: 011433970860
ContactId: 934a4280-5935-4545-a9ea-d919c1eff363
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514700 ms
Total Talk Time (AGENT): 220796 ms
Total Talk Time (CUSTOMER): 242922 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/934a4280-5935-4545-a9ea-d919c1eff363_20250326T16:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII]. How are you today?
[AGENT][POSITIVE] I am doing well, Ms. [PII]. How are you doing?
[CUSTOMER][NEUTRAL] I'm OK. Uh, I talked to someone last Friday. I was checking on the progress of the claim that I had, and, uh, she had her name was [PII], which was my name, uh, but anyway, she, yeah, and so anyway she said well you can call back on Monday and I'd be able to tell you at that point in time how much um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The claim would pay because it was supposed to be coming out like in 3 to 5 days I think and I was just checking on it because I, I did not call Monday simply because I wanted to give it time to process or do whatever so I was just checking on the state of it and I believe it's supposed to be uh direct deposit so again it was something that was, it just shows on my uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Internet page of.
[CUSTOMER][NEUTRAL] On the app, it just shows that um
[CUSTOMER][NEUTRAL] It's in process from [PII] and I just like I told her Friday, I was just double checking to make sure if there was something else that was needed or and she said it looked like they had everything and it was supposed to be being processed so I'm just checking on it and uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] OK, well, I can help you with your claim, Ms. [PII]. Can you please give me your policy number?
[CUSTOMER][NEUTRAL] 252-508-3
[AGENT][POSITIVE] Thank you and let me pull that policy up real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [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] [PII].
[CUSTOMER][NEUTRAL] Uh, my phone number, it could be one of two. This one is my cell phone [PII] or it could be our landline.
[AGENT][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] I have the cell phone.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK. And then what is your email?
[CUSTOMER][NEUTRAL] And then you said email?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I think it's gonna be [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. I appreciate you verifying your policy.
[CUSTOMER][NEUTRAL] Yeah, that was our school.
[AGENT][NEUTRAL] And Ms. [PII], if our call gets disconnected, is this a good number to call you back on the one that you gave me the cell phone?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, thank you so much and let me look and see about that claim.
[AGENT][NEUTRAL] OK, so looking at
[CUSTOMER][NEUTRAL] And I may have called you before. I don't know.
[AGENT][POSITIVE] Yes ma'am, I understand. I'm looking at it right now and it you're correct it is in progress to be direct deposited um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like the amount is going to be $6,618.50 and that's just to verify your benefits. It's not a guarantee of payment, but it's $6,618.50 is what I'm looking at.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I know on that policy that it showed like there was a one time do you get like an itemized how how they broke it down and paid for it or do you not? I, I've never done this before. I don't know so like when they direct deposit, do they still send something that shows how they broke down what they paid or?
[AGENT][NEUTRAL] Yes, I'm looking at.
[CUSTOMER][NEUTRAL] Because like on the policy.
[AGENT][POSITIVE] Yes, I'm seeing the first occurrence benefit.
[AGENT][NEUTRAL] Of $5000.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] I see drugs, drugs were covered of $150.
[AGENT][NEUTRAL] And then I see um a surgery at Mother Francis's Hospital of $1100.40.
[AGENT][NEUTRAL] And then I see anesthesia at Mother Francis Hospital for $275.10.
[AGENT][NEUTRAL] Uh, there is one non
[CUSTOMER][NEUTRAL] What was that anesthesia? What was that for anesthesia?
[AGENT][NEUTRAL] $275275.10.
[AGENT][NEUTRAL] Uh, it looks like some labs were not covered. Let me see what the remarks are on that.
[AGENT][NEUTRAL] It just says that um laboratory tests are not a covered benefit under this policy.
[AGENT][NEUTRAL] And then there was a surgery denial to um this policy does not provide a benefit for the treatment of a benign or pre-malignant lesion.
[CUSTOMER][NEUTRAL] Oh, OK, OK, uh, that was what I was saying because when you don't know and you've never dealt with it, you're trying to figure out, you know, how that looks and so if the.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Like when they did the um biopsy, then if it was benign, they pay nothing towards the labs.
[AGENT][POSITIVE] Correct, correct.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] OK. I just appreciate the explanation, just, you know, cause you don't, you know, don't.
[AGENT][POSITIVE] Oh, you're so welcome.
[CUSTOMER][NEUTRAL] There's like a, like you said, there's a total figure, but you're still sitting there like, well, they want an itemized list of kinda like what does the itemized list look like when they come back and they pay, you know, that sort of thing. So but anyway, OK.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] And it also looks like you had $93 that was also paid for transportation.
[AGENT][NEUTRAL] So that's looking at everything, that was everything that was um that was paid for and the two things that were not paid for under the policy contract.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, well, God forbid something else occurs.
[AGENT][NEUTRAL] Well, we will pray that does not happen.
[CUSTOMER][NEGATIVE] God forbid.
[CUSTOMER][NEUTRAL] But what I was gonna say
[CUSTOMER][NEUTRAL] Right, that's 100% right, um, but then if it does come back and it, and something does happen, then you just treat it as a brand new claim it's nothing off of this claim.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, OK, that's why I was also checking with to see if anything ever falls, you know, into it. Does it stay under the same or so this would close out this claim.
[AGENT][NEUTRAL] I believe so, yes, ma'am. It's uh and it's the only claim that's on there so it's being paid so then that would that would finish it unless you send in more claims and then those would be processed as they come in.
[CUSTOMER][NEUTRAL] Got you. OK, well that's what I was checking on so with this there's nothing else you need from me.
[CUSTOMER][NEUTRAL] And then is this in the process of being sent out or I, I'm just wondering when to look for it or you know what I mean like kind of she said like Friday that you know it should be coming out maybe like 3 to 5 days and like I said this is probably the.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So you kind of think it'll fall this week?
[AGENT][NEUTRAL] Yes, ma'am. I'm, I'm thinking that it's going to fall this week. Just keep your eye out for it, um.
[AGENT][POSITIVE] But it's in, it's in progress right now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well, and that's why it kept showing on that page and I just was double checking. I thank you, Ms [PII]. I appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] You're so welcome, and my name is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, I apologize
[AGENT][NEUTRAL] That's OK. I was just telling you in case you needed to use my name for anything in the future, you have it, OK?
[CUSTOMER][POSITIVE] I apologize, thank you.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Yes ma'am thank you OK bye bye.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. I hope you have a blessed day and thanks for calling APL.
[CUSTOMER][POSITIVE] Yes ma'am you as well.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.