AccountId: 011433970860
ContactId: a3578aa7-92a6-44cf-a6d4-7b7d16ea9953
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 309920 ms
Total Talk Time (AGENT): 151433 ms
Total Talk Time (CUSTOMER): 79438 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/a3578aa7-92a6-44cf-a6d4-7b7d16ea9953_20250502T12:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in [PII]. How are you doing?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] Doing doing great sorry I was trying to take you off speakerphone, um.
[CUSTOMER][NEUTRAL] I'm a broker and basically just calling to check on a claim for one of our customers.
[AGENT][NEUTRAL] OK, yeah, happy to check on the claim. Do we have their policy number?
[CUSTOMER][NEUTRAL] Yes, let me get that for you, sorry, we're in the middle of.
[AGENT][NEUTRAL] OK. No.
[CUSTOMER][NEUTRAL] Two enrollments at once and we're in between here let's see OK, policy number is.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK, 248-67004.
[AGENT][POSITIVE] Alright, [PII], thank you for that. Give me just a second here.
[AGENT][NEUTRAL] And then insured's name and date of birth.
[CUSTOMER][NEUTRAL] It is uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Alright, so looks like most recent claim filed for 28. Let me pull this up.
[CUSTOMER][NEUTRAL] I think he had 2 different claims under his hospital.
[AGENT][NEUTRAL] Yeah, it looks
[CUSTOMER][NEUTRAL] And I don't know if anything fell under the heat.
[AGENT][NEUTRAL] It looks like there were multiple, yeah, reports on 426428 excuse me. OK, uh, looks like claim was paid. There was a benefit sent in the amount of $600. Claim was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that was yesterday. Uh, I feel like, looks like the insured has direct deposit, so they may see it today, uh, maybe Monday or, you know, at the latest.
[CUSTOMER][NEUTRAL] OK, so it wasn't a uh paper check it was direct deposit?
[AGENT][POSITIVE] Mhm. Correct, yeah, it was a direct deposit, yeah.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK, so we got, so I think it was two different claims, um, so was it 600 for one and something for another, or was it broken up differently?
[AGENT][NEUTRAL] Um, it looks like that was the amount paid for the full thing. Um, there were some, let's see.
[AGENT][NEUTRAL] It looks like there was some diagnostic testing that was submitted that was not a covered benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, so, and then there was a couple looks like procedure codes saying benefits not payable for condition other than sickness or injury.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Can you see under the cancer plan?
[CUSTOMER][NEUTRAL] Was there anything processed on there?
[AGENT][NEUTRAL] Um, let me take a look here one second.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] No, you're totally fine. Yeah, let me go to the other policy here. That was our hospital one.
[CUSTOMER][NEUTRAL] People are uh
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] There was a claim processed on this one for 30. Let me pull this one up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this claim under this policy looks like paid out $100. It was also direct deposit. Um, it was a preventative benefit that was paid at $100. It looks like uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] One of the denials was policy does not provide benefit for treatment of a benign or pre-malignant lesion.
[AGENT][NEUTRAL] And then it looks like the
[CUSTOMER][NEUTRAL] OK, so they said it's a
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] I'm sorry, you said they paid the $100 benefit, but then they said they couldn't pay for anything to do with the skin cancer, is that right?
[CUSTOMER][NEUTRAL] I'm sorry, are you still there?
[AGENT][NEUTRAL] Yeah, it says the policy doesn't provide any treatment for benign or pre-malignant lesions.
[CUSTOMER][POSITIVE] OK, OK, no worries.
[AGENT][NEUTRAL] So that was the surgery part it looks like on that.
[CUSTOMER][POSITIVE] OK awesome thank you so much for your help. I appreciate you um hope you have a great day.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You too, [PII]. Take care.
[CUSTOMER][POSITIVE] Thank you all right bye bye.
[AGENT][NEUTRAL] Mhm. Bye bye.