AccountId: 011433970860
ContactId: 9b63c6bd-c188-451f-a5f0-f6c3ca9eebbd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 573150 ms
Total Talk Time (AGENT): 214546 ms
Total Talk Time (CUSTOMER): 108291 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/9b63c6bd-c188-451f-a5f0-f6c3ca9eebbd_20250224T18:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I received a check from APL and I was just um.
[CUSTOMER][NEUTRAL] Needing to.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I just had questions about it um why I received a check.
[AGENT][NEUTRAL] OK, I can help you with the check you received. Can you please give me your name and your policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I don't have a policy number, but my name is [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], uh, what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, is there a policy number on the check, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, hang on a second.
[AGENT][NEUTRAL] Or any kind of reference?
[CUSTOMER][NEUTRAL] Hang on just a second.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] There it is.
[CUSTOMER][NEUTRAL] Yes ma'am, let's see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 022 96,170.
[AGENT][NEUTRAL] OK, let me pull that policy up real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], this is, um,
[AGENT][NEUTRAL] Can you verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you so much and then also um for security reasons can you verify your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Excuse me, it's [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] OK, and then I do uh show that a different cell, a phone number different than the number that you're calling from, but it's the one, no? OK, can you verify that cell phone number for me please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] OK, thank you so much and let me look in the notes here real quick and see why you received that check.
[AGENT][NEUTRAL] Can you give me the check number please, Ms. [PII]?
[CUSTOMER][NEUTRAL] It is 202-4700.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, that looks like a payment.
[AGENT][NEUTRAL] Paid back to you for benefits on your policy for dermatology associates when you went to the dermatology associates.
[AGENT][NEUTRAL] It was a claim that was sent in and you received the payment for the claim.
[AGENT][NEUTRAL] Is the check amount 68,180?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. That's what that's for.
[AGENT][NEUTRAL] So it's a claim payment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Against the cancer policy?
[AGENT][NEUTRAL] Yes, this is the cancer policy.
[CUSTOMER][NEUTRAL] Or just
[CUSTOMER][NEUTRAL] OK, is it for?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You want me to tell you the date of service?
[AGENT][NEUTRAL] That you went and saw that it's for?
[CUSTOMER][NEUTRAL] Well, um, and then I wanted to see um.
[CUSTOMER][NEUTRAL] What I need to do if I need to send in, well, so one of them was not covered, do I need to send in something else?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I would call the facility.
[AGENT][NEUTRAL] Um, and see what's not covered, uh, let me look and see on this claim itself if, um.
[AGENT][NEUTRAL] There was any remarks.
[AGENT][NEUTRAL] On it to see if there's any.
[CUSTOMER][NEGATIVE] On the back of the on the check it says 924 24 it says not covered.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, I do have some remarks here. Laboratory tests are not covered benefit under this policy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And the surgery, it says in order to give consideration to your claim, we will need a fully itemized surgery bill that includes the procedure code and diagnosis code.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let me keep looking.
[AGENT][NEUTRAL] And it says this policy does not provide a benefit for the treatment of a benign or pre-malignant lesion.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, asking for the um.
[AGENT][NEUTRAL] Surgery bill, itemized bill with the diagnosis and procedure codes, and it says also that office visits are not covered by the policy.
[AGENT][NEUTRAL] And then after this, uh, check the calendar year maximum for this benefit was exhausted with the payment of the claim.
[AGENT][NEUTRAL] But that claim was for.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] It was for [PII].
[AGENT][NEUTRAL] So your benefits started over again in [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So basically if you can get that itemized statement.
[AGENT][NEUTRAL] With the procedure codes and diagnosis codes and send that in, they can further examine this claim further.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And we don't have a timely filing limit um so as long as you're covered under the data service your policy is active during the data service you can submit a claim at any time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] So the one which one is that that you said it needs to be resubmitted again the one the 924 24 or a different one?
[AGENT][NEUTRAL] But.
[AGENT][NEUTRAL] It's for the um 9:24 for the surgery part of the client.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Remit.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, well thank you.
[AGENT][POSITIVE] Oh, you're so very welcome. I hope you have a good rest of your day and we thank you for calling APL. All right, bye-bye, Miss [PII]. You're welcome.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye bye.