AccountId: 011433970860
ContactId: c465a3ce-6b14-410a-ae06-a6817ef7e31b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353829 ms
Total Talk Time (AGENT): 181874 ms
Total Talk Time (CUSTOMER): 75852 ms
Interruptions: 2
Overall Sentiment: AGENT=2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/c465a3ce-6b14-410a-ae06-a6817ef7e31b_20250122T15:16_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. This is [PII] in the care team. I've got, hi, good morning. I have Ms. [PII] on the phone.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Uh, and her policy number is 85615.
[CUSTOMER][NEUTRAL] I have verified her and the callback number is the number that's showing up on our screen. She, um, stated that her policy says that she should get paid $75 for mammograms once a year and she received a check for $17 and she wants to speak to somebody about that.
[AGENT][POSITIVE] OK, you can transfer her. Thank you.
[CUSTOMER][POSITIVE] You're welcome, Ms. [PII]. You have a blessed day.
[AGENT][POSITIVE] Mhm. Thank you.
[CUSTOMER][NEUTRAL] Mm bye-bye, ma'am.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] This is [PII], um.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] The, um, [PII] was explaining that you received the the check for $17.19 and the benefit is supposed to be $75 and you're you're calling in regards to that. Uh, give me just a few minutes while I pull up your claim and your policy and let me look and see how we arrived at the, the benefit.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a few minutes, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me a few more minutes. I'm looking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, I'm after reviewing your claim, um, you're correct, it is up to $75 per calendar year for any type of, um,
[AGENT][NEUTRAL] For any type of cancer checks, such as, you know, Pap smears, mammograms, skin cancer checks. And it looks like that, um, and it's up to what is charged. Um, if they charge $16 and that's what the benefit would be. Um, and then for that, but if you have a maximum of $75. Um, it looks like, um, it looks like you had some, um,
[AGENT][NEUTRAL] Like a check for some skin cancer, um, and we provided a partial wellness benefit for the day of service of [PII], and that was released in [PII], and that we paid $32.61 for a procedure that was, um, for, let me look at that procedure. Give me one minute.
[CUSTOMER][NEGATIVE] Uh, to destroy the can skin cancer, I'm sure.
[AGENT][NEUTRAL] Yeah, that, yes, yes, that's what it was, um, and then there was another benefit for $2525.20 for the destroyer of the skin cancer for that date of service of [PII]. So there were
[AGENT][NEUTRAL] The remainder of the um benefit that was due was for that, with that mammogram of $17.19. So that's the reason why your benefit was 1719 because we already paid part of that wellness benefit for [PII] with those skin cancer removal.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, I did not realize. I guess I didn't look at the uh EOB close enough, uh.
[AGENT][NEUTRAL] Yeah, that was, that was back in the, yeah, that was back in July, so it was a little while, so, and that's understandable.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, well, I mean, uh, yeah, and I know that I have um.
[CUSTOMER][NEUTRAL] As a matter of fact, I've got another one that I'm gonna have to go. I'm pretty sure that it's gonna be the same thing.
[AGENT][NEUTRAL] Yeah, well then just submit those bills and anytime you have that cancer check or removal of the skin cancer, go ahead and send that in to us and then, you know, for the calendar year of [PII].
[CUSTOMER][POSITIVE] OK. Well, thank you very much. You have a good day.
[AGENT][POSITIVE] Uh, my, uh, thank you, Mrs. [PII]. Is there anything I can help you out with today?
[CUSTOMER][POSITIVE] I know, I think that answers my question.
[AGENT][POSITIVE] OK, well, you have a wonderful day and thank you for calling American Public Life, Miss Miss [PII].
[CUSTOMER][POSITIVE] You too, thank you.
[AGENT][POSITIVE] Thank you. Goodbye.
[CUSTOMER][NEUTRAL] Mm mm bye bye.