AccountId: 011433970860
ContactId: 936d0fb8-3c16-4f37-82a7-52d8a6a5bada
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 463420 ms
Total Talk Time (AGENT): 147766 ms
Total Talk Time (CUSTOMER): 125011 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/936d0fb8-3c16-4f37-82a7-52d8a6a5bada_20250428T17:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII], and I'm calling about confirmation number.
[CUSTOMER][NEUTRAL] 0 S.
[CUSTOMER][NEUTRAL] C 97032 I posted.
[CUSTOMER][NEGATIVE] These two bills twice, um.
[CUSTOMER][NEUTRAL] It was for a mammogram and for my rehabilitation and for some reason, it disappeared off of
[CUSTOMER][NEUTRAL] The screen twice.
[AGENT][NEUTRAL] Hm, OK.
[CUSTOMER][NEUTRAL] I'm not sure why.
[AGENT][NEUTRAL] Sorry to hear that, Miss [PII]. Let me look at your policy. Do you have your policy number?
[CUSTOMER][NEUTRAL] Um, one moment.
[CUSTOMER][NEUTRAL] 764299
[AGENT][POSITIVE] Thank you so much give me just one moment let me pull this up here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I sent in a mammogram bill from Emory.
[CUSTOMER][NEUTRAL] And my
[CUSTOMER][NEUTRAL] Physical therapy deal with the
[CUSTOMER][NEUTRAL] Coles on it.
[CUSTOMER][NEUTRAL] From Emory.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And I sent those in twice and some reason, the week of [PII], it disappeared.
[CUSTOMER][NEUTRAL] And I put them back up.
[CUSTOMER][NEGATIVE] And it's gone again.
[AGENT][NEUTRAL] All right, let me just verify.
[CUSTOMER][NEUTRAL] And I'm not sure why.
[AGENT][NEUTRAL] OK, let me just verify for security please your date of birth and address.
[CUSTOMER][NEUTRAL] [PII], my address is [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] So when I look under your name, it looks like the last thing I see was submitted on [PII].
[AGENT][NEUTRAL] So that would have been a few days after [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] And it was done before then.
[AGENT][NEUTRAL] There were 2 uploads on 4:17.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's the same bill.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEGATIVE] And for some reason they keep disappearing off the list.
[CUSTOMER][NEUTRAL] I just have the confirmation number on the last one.
[AGENT][NEUTRAL] So the claim from [PII], it looks like.
[AGENT][NEUTRAL] Was the physical therapy cause it shows Emery.
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] Rehabilitation.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] And then Emory University Hospital.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It looks like the physical therapy.
[CUSTOMER][NEUTRAL] And one is a mammogram.
[AGENT][NEGATIVE] The physical therapy, it looks like was denied. It's not covered underneath your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the mammogram.
[CUSTOMER][NEUTRAL] They asked for another deal.
[CUSTOMER][NEUTRAL] And the mammogram
[AGENT][NEUTRAL] Shows that your calendar maximum for your wellness benefit had already been paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's a one time payment per year so it was denied stating nothing additional payable for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I haven't gotten a mammogram. This is my first one this year.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] I've never submitted a bill for that.
[AGENT][NEUTRAL] Let me see what this other.
[AGENT][NEUTRAL] Let me search and see what I can find that they're referring to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With a MRI or CT scan count, is that?
[AGENT][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because when I send in the
[CUSTOMER][NEUTRAL] Rehabilitation, they asked for a bill that had diagnosis codes on it and that's why I resend it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so it looks like your policy list wellness exam or test benefit.
[AGENT][NEUTRAL] So if you know if you had
[AGENT][NEUTRAL] Any other testing, then it probably would have been that.
[CUSTOMER][NEUTRAL] It's probably the MRI or CT scan from when I had a stroke.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So we will pay the wellness or test benefit amount.
[AGENT][POSITIVE] this benefit.
[AGENT][NEGATIVE] Yeah, so it looks like it's an and or, um, so it looks like the test benefit was paid, but because it's all under kind of the same umbrella as wellness exam or test benefit, it looks like that's why it's showing the denial on the wellness.
[AGENT][NEUTRAL] Because it's an Andor.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need me to check on anything else for you today?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That's it, sorry.
[AGENT][POSITIVE] All right, not a problem, Ms. [PII]. Thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you. Bye
[AGENT][NEUTRAL] Uh-huh.