AccountId: 011433970860
ContactId: b61a0b56-718e-4d14-bf92-ff89c772fbef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 766400 ms
Total Talk Time (AGENT): 194002 ms
Total Talk Time (CUSTOMER): 122940 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/b61a0b56-718e-4d14-bf92-ff89c772fbef_20250311T15:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII]. Um, I was trying to, um, get an exam from my doctor, and she had ordered a mammogram ultrasound. Um, however, I was told by the provider, um, that they called, um, API and my policy does not cover, um, ultrasounds or mammograms, only high tech, um.
[CUSTOMER][NEUTRAL] Only high tech exams. Um, I just wanted to verify that and um if that's the case, could I need a letter um to fax it to my provider.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please give me your policy number and I can check on on your benefits for you.
[CUSTOMER][NEUTRAL] Sure it is, um, give me one moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It is 02596755.
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] Alright, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, and then what is your address, phone number and email address that we have on file for you?
[CUSTOMER][NEUTRAL] It is um [PII] and then my email address is um [PII].
[AGENT][POSITIVE] OK. Thank you so much for verifying your policy. And let me look real quick.
[AGENT][NEUTRAL] At it
[CUSTOMER][NEUTRAL] doing it.
[AGENT][NEUTRAL] OK and when did the provider call?
[CUSTOMER][NEUTRAL] Um, they called, um, I tried to make the appointment, what's the date today, um.
[CUSTOMER][NEUTRAL] Uh, last week, um, so it was last week.
[CUSTOMER][NEUTRAL] It was like last Wednesday.
[AGENT][NEUTRAL] OK. Right. And I do see that they called and uh mammogram and breast ultrasound are not covered under your policy?
[AGENT][NEUTRAL] Let me see if we even provide letters to the provider. That's not something I've been asked to do before. I don't know if that's in our um procedures, but let me check real quick, OK?
[CUSTOMER][NEUTRAL] OK, um, I just, I, they just. You are on hold.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, yeah, they just wanted um.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Um, uh, like a, a written copy, um, saying that so that, um, so I can like apply for, um, for financial assistance to get it covered.
[AGENT][NEUTRAL] OK, right, let me, let me, um, research that real quick.
[AGENT][NEUTRAL] Our next step is for that, OK, it's gonna be a brief hold that research real quick.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hi there Miss [PII]. I'm getting some answers now. I just wanna let you know I hadn't forgot about you.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[AGENT][POSITIVE] You're very welcome. I'm gonna put you on a quick hold again thank you so much for being patient with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you for holding for me, Ms. [PII].
[AGENT][NEUTRAL] OK, so I've um checked with several supervisors, two of them actually, and we do not provide those kinds of letters. What we do is if you, if the claim was filed and it was denied, then you can use the explanation of benefits to show that.
[AGENT][NEUTRAL] It's not covered. If not, then you can go into the online service center and get a copy of your policy and take it to them and show them that it's not covered.
[CUSTOMER][NEUTRAL] OK, um, and how do I go to the, uh, the online service center?
[AGENT][NEUTRAL] Uh, let me give you the um site. It's [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then when you get to that site you're gonna click on um new user on your first screen and on your second screen you're gonna choose I am an individual with an APL policy.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you're gonna sign up for the online service center you'll choose your username and your password, all that information and um it's a direct link to your to your uh policy it's a portal.
[AGENT][NEUTRAL] It's also a place in the future if you need to file claims you can do it through the online service center too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much. And so it should say in my explanation of benefits that it, that the mammograms and ultrasound not covered.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Correct. Um, if the claim was filed, it would be, would that part of it would be denied because it's not covered under your policy. So you can give them that or you can actually show them your policy certificate where it shows that it's not covered.
[CUSTOMER][POSITIVE] OK, all right, thank you so much for your help, [PII].
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Um, no, that's all for today.
[AGENT][POSITIVE] OK, well, you have a wonderful day and we thank you for calling APL.
[CUSTOMER][POSITIVE] OK thank you have a good day bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.