AccountId: 011433970860
ContactId: a10e5185-cf68-4d73-93f8-f67d6b3993b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 507320 ms
Total Talk Time (AGENT): 224691 ms
Total Talk Time (CUSTOMER): 280194 ms
Interruptions: 5
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/a10e5185-cf68-4d73-93f8-f67d6b3993b4_20250521T16:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh yes, let me get you off speakerphone quick. OK, I was, it says it sent me a deal that said my claim was complete, um, but I'm figuring there might be something wrong with that. Uh, how do I figure out the, it says they sent $50 on one, I guess where do I need to start to get you where I am.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, I can help you with the claim status. First, let me get your name and your callback number just in case the call is disconnected.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] And then what is your name?
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is your policy number?
[CUSTOMER][NEUTRAL] Can
[CUSTOMER][NEUTRAL] Uh, this has 3 listed. I don't know why on the claim thing.
[AGENT][NEUTRAL] You can just give me one of them.
[CUSTOMER][NEUTRAL] OK, uh, because it's just for me, so I don't know why it's got the other name, so let's just do 252-2406.
[AGENT][NEUTRAL] OK, let me look up that policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, Ms. [PII].
[AGENT][NEUTRAL] Uh, I don't believe that's a policy number because it's not pulling up your name, 522406.
[CUSTOMER][NEUTRAL] You get.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] 252-240-6. OK, let me look that number sounds better.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, Ms. [PII].
[AGENT][NEUTRAL] And the claim is for yourself, is that correct?
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I'm only showing one claim that's been filed for you and it was reported on [PII] and then it um was processed on [PII].
[CUSTOMER][NEUTRAL] I'm like
[AGENT][NEUTRAL] is that um do you have the claim number?
[CUSTOMER][NEUTRAL] What does that show?
[CUSTOMER][NEUTRAL] [PII] I sent one thing in and it, it had three different things on there like it had some wellness and then it had where they just took cancer off my back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, and is the claim number that you're showing on that piece of paper, is it 3603382?
[CUSTOMER][NEUTRAL] That's what's on one of them, yes.
[AGENT][NEUTRAL] OK, let's look at that one first, we've got it pulled up.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and Miss [PII], can you please um verify your address, phone number and email address for me that we have on the policy?
[CUSTOMER][NEUTRAL] Uh, [PII], uh that might say Fort Worth too, um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What else? [PII]. My old number is [PII], which I did not have that home line anymore. And what else did you want? Oh, email [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, thank you, Ms. [PII]. I appreciate you verifying your policy for me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, let's look at this and see what the remarks are.
[CUSTOMER][NEUTRAL] That's not.
[AGENT][NEUTRAL] OK, so it's got several remarks on the claim, um, the first one is laboratory tests are not covered benefit under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and another one is in order for processing of this claim to continue, we will need the pathology report showing the first diagnosis of cancer.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I thought you
[CUSTOMER][NEUTRAL] OK, I thought they sent that pathology.
[AGENT][NEUTRAL] And, and.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then we've got another remark on here that um this is the same claim. This policy provides benefits for the treatment of cancer and specified disease only. Benefits are not paid for any other disease.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, it was cancer they took off.
[AGENT][NEUTRAL] OK. And then it also says this policy does not provide benefits for office visits.
[CUSTOMER][NEUTRAL] Because.
[CUSTOMER][NEUTRAL] OK, don't.
[AGENT][NEUTRAL] So that's the remark on that one.
[CUSTOMER][NEUTRAL] I don't understand if it says cancer. Let me see if I can find that, um.
[AGENT][NEUTRAL] Right, which the pathology report that you sent in.
[CUSTOMER][NEUTRAL] And they use their own pathology lab. Oh there it is, they use their own lab that.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, is that a problem?
[AGENT][NEUTRAL] So that pathology report will need to be sent in to show the first diagnosis of cancer. And that will clear up that remark on there, that it only covers for uh cancer.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Once we receive that.
[CUSTOMER][NEUTRAL] OK, so what pathology did you get? Because I know I sent, I asked her if they were both in, in this group of stuff and she said yes, but obviously not. I just went straight to.
[CUSTOMER][NEUTRAL] The doctor's office and had them print them.
[AGENT][NEUTRAL] Mhm. OK, I can't see the paperwork that was sent in myself because I'm not in the claims department. Now if you would like for a claims specialist to call you back, I can I'll send in a request for a call back for you if you would like for me to do that.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh well I've got.
[CUSTOMER][NEUTRAL] OK, tissue exam by pathologist.
[CUSTOMER][NEUTRAL] Um, oh, are you there? OK, I have one dated [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I'm trying to see uh they gave me so much paper, so I just sent because they didn't print individual stuff I just paid.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] $1900 for my last visit and.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And they just printed this whole bunch of stuff from every visit.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Oh goodness. If you want to upload the, the pathology report and then reference this claim number, the 3603382 and your policy number on that.
[CUSTOMER][NEUTRAL] But yeah, so.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's what they're asking for is the pathology report.
[CUSTOMER][NEUTRAL] OK, so I need to call these people back and say you must have two pathology reports. I have one dated 4/26. I did send that one, so they're looking for a second one of some sort, right?
[AGENT][NEUTRAL] The one that has the initial diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I'll just have to call him because I, I, yeah, I'm not.
[CUSTOMER][NEUTRAL] I'm a teacher of business and marketing now. I got out of the medical field, so I can't tell what all those codes are.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Well, bless your heart for being a teacher, right?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] Kudos to you.
[CUSTOMER][NEUTRAL] Thank you. It's a, it's a calling from the Lord. He's like, hello, you're supposed to do that. You better get to it. You're [PII], so I've done it for 21 years.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] That is awesome.
[CUSTOMER][NEUTRAL] OK, well I will thank you sweetie. OK, so I will call them and then I'm going to, how am I gonna get on I'm just gonna upload it and then reference that uh number I gave you or that we went over the 36 number.
[AGENT][NEUTRAL] That policy.
[AGENT][NEUTRAL] Yes, yes. The claim number is the 360.
[CUSTOMER][NEUTRAL] 0 252.
[CUSTOMER][NEUTRAL] 3603382
[AGENT][NEUTRAL] Yes, that's the claim number and then also reference your policy number, the 252-2406.
[CUSTOMER][NEUTRAL] Right yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For our expensive this is policy.
[CUSTOMER][POSITIVE] OK thank you sweetie. I'll figure it out I'll call them and see if we can't figure it out. I appreciate you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][POSITIVE] Yes, Ms. [PII]. You're so very welcome. I hope you have a blessed rest of your day and thank you for calling APL ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] See
[CUSTOMER][POSITIVE] You too, sweetie. God bless you.
[AGENT][POSITIVE] God bless you also, Miss. [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Alright bye bye.
[CUSTOMER][POSITIVE] Thank you.