AccountId: 011433970860
ContactId: b3f19feb-eebc-4ce3-a09b-9fec3d292eeb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 554099 ms
Total Talk Time (AGENT): 101191 ms
Total Talk Time (CUSTOMER): 211523 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/b3f19feb-eebc-4ce3-a09b-9fec3d292eeb_20250327T17:03_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] Doing all right, thank you. I've got a member on the line, um, so long story short, she had, um, gone in on her cancer policy. Uh, she had a pap smear in November and she had to have a follow up, um, because I guess they found something.
[CUSTOMER][NEUTRAL] And that was in February. She filed both of those claims. um, the follow up was, uh, we paid the $50 benefit and she was expecting that $100 benefit or the $150 benefit for that since it was a follow up um I'm not, I've not really run into anything like this before, so I'm not sure if that's because the calendar year had reset and maybe that was why.
[AGENT][NEUTRAL] Can I get the policy number?
[CUSTOMER][NEUTRAL] Of course, um, that was 02528619.
[AGENT][NEUTRAL] OK, [PII] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, give me 1 2nd.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Give me
[AGENT][POSITIVE] Good
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Come on on base.
[AGENT][NEUTRAL] See what she sent in before I have you transfer over.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK good because it doesn't say follow up.
[AGENT][NEUTRAL] But you can send her on over.
[CUSTOMER][POSITIVE] OK, I sure appreciate your help thank you.
[AGENT][POSITIVE] No problem have a great rest of your day.
[CUSTOMER][NEUTRAL] OK. Bye-bye. You too. Bye.
[AGENT][NEUTRAL] Right
[AGENT][POSITIVE] Good afternoon. Thanks for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I was just talking to a um claims person about some of my claims that were filed, and she put me on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, so she uh transferred you over to me so to see if I can help you with your question.
[AGENT][NEUTRAL] Uh, she stated that I guess that, go ahead.
[CUSTOMER][NEUTRAL] OK, so my
[CUSTOMER][NEUTRAL] So, um, I filed several different claims, and one of the claims that I filed was for an appointment that was on [PII], and I have a benefit that says it pays $100 for a follow-up appointment.
[CUSTOMER][NEUTRAL] And I had a, this was a follow-up appointment where I was um transferred from my regular doctor to a um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] gynecologist over in [PII], where they did um biopsies, they removed cells and did different procedures. My first question is, I'm trying to figure out why my claim only paid 50 and not 100 since it was a follow-up procedure. And according to my claim still, it's supposed to be 100 for a follow-up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, uh let's see.
[AGENT][NEUTRAL] So they probably did not know it was a follow up because I'm looking at the information that was on here and I don't see anything that states this is a follow up appointment to the original path that you had [PII].
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] OK, um, I could have swore that I mean I sent them the information and stated it while we were discussing the claim, so what can I do to correct this or because I mean I've got the information from the other appointment as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] 48
[AGENT][NEUTRAL] One second, I'm pulling up the previous claim to see if it states follow up. Give me one second.
[AGENT][NEUTRAL] I'm still here just reviewing your clients one second.
[AGENT][NEUTRAL] OK, um, is there any way that I can get a callback number and I can see what we would need to uh to consider this a follow up appointment being that there was nothing here to tell us that this was a follow up?
[CUSTOMER][NEUTRAL] OK, it's
[CUSTOMER][NEUTRAL] Yeah, I think there's some miscommunication because when I talked to the representative on the phone, there, the document I sent over had a deal that said the reason for the appointment was a consistent medical condition I had. And then the file they had November.
[CUSTOMER][NEUTRAL] said that, you know, it was that type of procedure and it was, that was there too. So I mean, I can, um, numbers [PII].
[CUSTOMER][NEUTRAL] And I can make sure to just let me know which document you need, and I can get it to y'all. But also, I've got you on the phone, I'm trying to figure out, originally, I was told to submit a form because I was there, they did the coloscopy and they did the biopsy. And they said that the results didn't matter, but um to file it under a surgical deal, because that is considered a surgical procedure with my insurance company.
[CUSTOMER][NEUTRAL] And then they came back and denied it and said because they denied it because of a negative result. So which is the truth on that?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it not covered because it was negative?
[AGENT][NEUTRAL] Uh, I think it wasn't covered under the surgical procedure, so because it was negative. And so that's why they gave you the preventive benefit.
[CUSTOMER][POSITIVE] Yeah, the preventative benefit.
[CUSTOMER][POSITIVE] But I should have also received a follow up but a benefit as well because I did have a follow up procedure, um, so if you would look into that, I greatly appreciate it.
[AGENT][NEUTRAL] Mm yes ma'am that's what I was gonna look into how what you would need to, you know, they indicated that this is just a follow up.
[CUSTOMER][NEUTRAL] Yeah, yeah, cause I didn't.
[CUSTOMER][NEUTRAL] And originally I was told that the uh procedure itself that they did was considered a um an imaging thing and they didn't cover that one either. So if you look into those, I'd appreciate it. If you'll just holler back. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you said [PII], is that correct?
[CUSTOMER][NEUTRAL] Alright bye.