AccountId: 011433970860
ContactId: 9787a44b-bf72-4b34-a773-4ebc84fedb5c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604700 ms
Total Talk Time (AGENT): 161681 ms
Total Talk Time (CUSTOMER): 151256 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/9787a44b-bf72-4b34-a773-4ebc84fedb5c_20250520T21:16_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, [PII]. Um, I have a question. Um, um, did, uh, 23 wellness cancer, um, claims, um, for my husband, and they came back saying that it didn't show or didn't, didn't look like he had done any kind of cancer screening on his wellness.
[CUSTOMER][NEUTRAL] So we called the doctor's office just to ask and they said that on the wellness they do do a colon cancer screening. So I don't know if it didn't have the right thing for me to check or whatever, but what do I need to do to
[CUSTOMER][NEUTRAL] Refile that or send in the information so um they can see that they did do a um colon screening on his wellness.
[AGENT][POSITIVE] OK, um, well, I can definitely help you with your claims and what needs to be received so we can get it processed for you. Um, may I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes, it's [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am. Let's see. 00425102.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I have you here, Mrs. [PII], can you verify your date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] Yes ma'am, uh, [PII], and it's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And do you mind if I place you on just a brief hold while I look at these three claims?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, on the.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] No, thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, Ms. [PII], it's [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEUTRAL] I'm good. Um, I might not have to transfer this to you. If a wellness claim is being denied, um,
[AGENT][NEUTRAL] Saying that it wasn't a wellness, but it's a physical and they did a colon cancer screening too. How, what do they need to put on the claim form to let us know that
[AGENT][NEUTRAL] A cancer screening was done.
[AGENT][NEUTRAL] Like, do they need to just ride it in?
[CUSTOMER][NEUTRAL] What is the policy number?
[AGENT][NEUTRAL] It is 425102.
[CUSTOMER][NEUTRAL] 51
[AGENT][NEUTRAL] Um, this, yes, this is for part one.
[CUSTOMER][NEUTRAL] And was there a particular claim number? I know she got 5 of them.
[AGENT][NEUTRAL] Um, it's the, hold on, let me go back.
[CUSTOMER][NEUTRAL] I mean, I'm sorry, 33 or 4 to deny it.
[AGENT][NEGATIVE] It's all three that denied for the 201 reason.
[AGENT][NEUTRAL] Because on the claim, I looked on um on base on the claim form, she did check it's a physical or routine physical.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, that's
[AGENT][NEUTRAL] She didn't put anything about cancer, but she said she called the doctor and the doctor said, well, I do, um, the the colon cancer screenings which are physical.
[AGENT][NEUTRAL] Um, so she's trying to figure out how to
[AGENT][NEUTRAL] Let us know that.
[CUSTOMER][NEUTRAL] Mhm let's see.
[CUSTOMER][NEUTRAL] Let me see what was sending. Give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so it looks like they did not mark on the form that they have a cancer screening test done.
[AGENT][NEUTRAL] Right, that's my question.
[CUSTOMER][NEUTRAL] Uh, on the form they just.
[AGENT][NEUTRAL] She just my routine physical. Does she need to write in that a a colon cancer screening was done as well, or that's my question.
[CUSTOMER][NEUTRAL] Uh, yeah, that's the only way that we're gonna know that they had one done.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. I just never had that question before.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I didn't see any other documents except the claim form.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, on that claim form, all they gotta do is put it in, so she just got put on there that she had it done and the day she had it done.
[AGENT][POSITIVE] OK, I'll let her know. Thank you.
[CUSTOMER][NEUTRAL] So other other than that we won't know right.
[AGENT][NEUTRAL] Alright, bye bye.
[AGENT][NEUTRAL] Hello, Mrs. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So on the claim form there, um, I saw where you checked the, um, it was a routine physical. There's a section there that you can write in the testing that was done as well. If you want to, um, she said you can just write um that it was a colon cancer screening and the date on that section, um, because that's the only way they'll know.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so do I just need to refile those claims?
[AGENT][NEUTRAL] Yes, ma'am, and on the new claim form, um, just check the check the routine physical like you did and then just write in the cancer screening and the date.
[CUSTOMER][POSITIVE] Oh OK, well thank you [PII].
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, ma'am, that's all I needed.
[AGENT][POSITIVE] All right. Well, thank you so much for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] Bye bye.