AccountId: 011433970860
ContactId: 957bc32b-86af-4829-8469-2c367770f17b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 682150 ms
Total Talk Time (AGENT): 153358 ms
Total Talk Time (CUSTOMER): 150051 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/957bc32b-86af-4829-8469-2c367770f17b_20250408T13:42_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEGATIVE] Um, hi, I just got the results back on my claim, and it shows that I was denied.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But um,
[CUSTOMER][NEUTRAL] I should have been, uh,
[CUSTOMER][NEUTRAL] Compensated for the, my chemo medication and also for my radiation.
[CUSTOMER][NEUTRAL] And I'm wondering why I wasn't.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I can check and see if we're missing information or what happened. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. My name is [PII].
[CUSTOMER][NEUTRAL] That's [PII]
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh, let me put you on speaker and, and I'll get it for you. Hang on.
[AGENT][NEUTRAL] OK. Sure. Mhm.
[CUSTOMER][NEUTRAL] OK. Let's see here.
[CUSTOMER][NEUTRAL] My policy number is 02549206.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And I have a claim number as well.
[AGENT][POSITIVE] Mm, it's OK. Thank you.
[AGENT][NEUTRAL] No, it's 02541286.
[CUSTOMER][NEUTRAL] 254-9206
[AGENT][NEUTRAL] 92. OK.
[AGENT][NEUTRAL] I'm not sure if I'm not hearing right, but um I didn't get that policy number correct again.
[AGENT][NEUTRAL] I got 02.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, 54.
[AGENT][NEUTRAL] 54
[CUSTOMER][NEUTRAL] 9, uh huh 92.
[CUSTOMER][NEUTRAL] 06.
[AGENT][NEUTRAL] 92.
[AGENT][NEUTRAL] 06. OK.
[AGENT][NEUTRAL] OK, here we go. All right, and for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] OK. Um, my date of birth is [PII]. My mailing address is [PII], and that's in [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][NEUTRAL] All right, thank you. OK, let me pull the details of this claim and see what happened. One moment.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is for the claim ending on 5734, correct?
[CUSTOMER][NEUTRAL] Um, it, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let's see.
[CUSTOMER][NEUTRAL] break
[CUSTOMER][NEUTRAL] Something specific on a football player, it might be too tight.
[CUSTOMER][NEUTRAL] Um, before you start cooking.
[CUSTOMER][NEUTRAL] Fill in the blank for blank 50.
[AGENT][NEUTRAL] I'm waiting on the information to pull up.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK. So we just need the copy of the explanation of benefits from the primary insurance to continue the processing of the chemotherapy or radiation therapy.
[CUSTOMER][NEUTRAL] OK, um, I provided.
[CUSTOMER][NEUTRAL] Uh, all the information I believe.
[CUSTOMER][NEUTRAL] it might be too.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] It will have to be reviewed again by an examiner um because that's the determination they did on yesterday when they processed the claim. It's indicating they were missing the EOB um.
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][NEUTRAL] What exactly is that?
[AGENT][NEUTRAL] Is, is the copy of the explanation of benefits from the primary insurance?
[CUSTOMER][NEUTRAL] Isn't that
[AGENT][NEUTRAL] Because we pay actual charges, we need that information.
[CUSTOMER][NEUTRAL] OK, don't y'all have all that information from the insurance?
[AGENT][NEUTRAL] OK, I will have to get an examiner to review again the paper that you send and see if she missed the explanation of benefits from the primary insurance.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, because, um, they, they're the ones that process the claim. I only have the information about what happened to the claim or what's their decision in which that is their decision, um, that they're missing the primary ELB, um, so I can go ahead and get a request for them to look into it again and give you a call back. Is that OK?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes, that'd be fine.
[AGENT][NEUTRAL] OK, so let me go ahead and send this request over. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Sure. Go ahead.
[AGENT][POSITIVE] Thank you. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for Ms. [PII]. OK, so I went ahead and send the request over to the claims, um, support team, and somebody should be reaching you within 24 hours, OK?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Thank you very much.
[AGENT][POSITIVE] You're welcome. Is there anything else I'm gonna help you with today, M?
[CUSTOMER][NEUTRAL] I think that, I think that was it.
[AGENT][POSITIVE] All right, well thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] You're welcome. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Uh-huh. Bye.