AccountId: 011433970860
ContactId: cc7d821d-27dc-4f52-8fdd-6f3972a763ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 439670 ms
Total Talk Time (AGENT): 182380 ms
Total Talk Time (CUSTOMER): 207722 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/cc7d821d-27dc-4f52-8fdd-6f3972a763ab_20250326T19:38_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, this is [PII]. I had sent in uh papers for a claim and I don't understand, um, I guess it was trying to tell me what you covered and what you didn't, but.
[CUSTOMER][NEUTRAL] If you could uh maybe give me some information on that.
[AGENT][POSITIVE] It would be my pleasure to assist you. And what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is your policy number? Do you have that available?
[CUSTOMER][NEUTRAL] I think it's 00639172.
[AGENT][NEUTRAL] Let me check that for you.
[AGENT][NEUTRAL] Yes, ma'am, Miss Miss. [PII], what is your date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your current mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I am seeing the claim that we received on the [PII] and paid on the [PII]. Is that what you're referring to?
[CUSTOMER][NEUTRAL] OK, because I got another um this one said um.
[CUSTOMER][NEUTRAL] Fair enough. Let's see.
[CUSTOMER][NEUTRAL] It says
[CUSTOMER][NEUTRAL] Um, total benefits pay 0. it's, um,
[CUSTOMER][NEUTRAL] I don't know why this is like.
[CUSTOMER][NEUTRAL] What was the date you have on that one?
[AGENT][NEGATIVE] It was for data service [PII] and this was processed on the [PII]. You may not have received this one yet.
[CUSTOMER][NEUTRAL] Mm, I don't know.
[AGENT][NEUTRAL] Because it's coming by check. Let me.
[AGENT][NEUTRAL] And this is on your cancer policy for a wellness claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What
[CUSTOMER][NEUTRAL] And it is uh excuse me, it says uh wellness, but and it says.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] It has POC for that at the top and it has lipid, so I don't know.
[CUSTOMER][NEUTRAL] But that's probably cause it says from [PII].
[CUSTOMER][NEUTRAL] To [PII], um.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] I had noticed today, but this says.
[CUSTOMER][NEUTRAL] It says the check date is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] No, you were fine. The springtime too, and all that stuff in the air.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, it's baby.
[AGENT][NEUTRAL] So if you look on the 2nd page, is that what you're referring to?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, down at the back, yeah.
[AGENT][NEUTRAL] The diagnostic
[AGENT][NEUTRAL] The diagnostic prevention.
[CUSTOMER][NEUTRAL] Uh-huh. What it says remarks. It says, uh, remark and remarks description and it's, I said, OK, I'm not sure what it's.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's just letting you know that only one test benefit our wellness benefit is allowed per calendar year. So on this claim,
[CUSTOMER][NEUTRAL] Talking about.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When we received that claim documents, there was one for a lipid test for 5124.
[AGENT][NEUTRAL] And then a mammogram for 11-19 24.
[AGENT][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is why they're just letting you know that only one has been.
[AGENT][NEUTRAL] Approved because there's only one benefit payable per calendar year.
[CUSTOMER][NEUTRAL] OK, cause, uh, uh, because probably because they, but the whole payment would have been just the $75 right?
[AGENT][NEUTRAL] That's right, and it's payable for one time and then for the lipid, um.
[AGENT][NEUTRAL] For the lipid panel, that's not generally a preventive.
[AGENT][NEUTRAL] Um, diagnose or test.
[CUSTOMER][NEUTRAL] OK, and it's probably because when I.
[CUSTOMER][NEUTRAL] Yeah, when I did it last time, I probably had it on there too, but it was on there with the mammogram too, I think. I, I don't.
[AGENT][NEUTRAL] That's right, that's right. And because, and we do address each line item that's submitted with a claim, so that's why they did address that lipid panel not normally being for a.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, wellness
[AGENT][NEUTRAL] Procedure
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And they're just letting you know that they were able to pay the mammogram but not the lipid panel.
[CUSTOMER][NEUTRAL] OK. All right. So that's the only thing that's really, I'm just trying to get paperwork so I, next time I will know. So, um, the only thing that's really covered is I need to send uh the receipts in for would be the mammogram and that's it.
[AGENT][NEUTRAL] Well, actually they have changed and all you need to submit is a wellness claim form. Now that claim form it you're just going to fill out that information just like you did. You don't have to send anything else in, just the claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And so we don't need a receipt or anything, but yes ma'am, I do see on that claim form you did put the lipid panel.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] On
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And as well as the mammogram.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but it would have, I, and that's probably the reason cause I really hadn't, um, I thought, OK, I, I need to send, so I just sent those, sent the papers because I had
[CUSTOMER][NEUTRAL] I've had quite a bit of things done this year, so, and I wasn't sure, but I know I've sent one with the liquid on before, so I didn't know the difference. OK. Well, now I know. I didn't.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I didn't know that. All right. All right, thank you so much for the information.
[AGENT][NEUTRAL] Does, does that answer your question?
[CUSTOMER][NEUTRAL] Yes, yes, I.
[AGENT][NEUTRAL] All right. Well, [PII]iss.
[CUSTOMER][NEUTRAL] So I don't have to, so I don't really have to have the doctor give me uh like all these little papers.
[AGENT][NEUTRAL] No, ma'am. We just need that claim form submitted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] Well, it's been such a pleasure to assist you, Ms. [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's all. Thank you a lot.
[AGENT][POSITIVE] And thank you for calling APL. Hope you have a wonderful day.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh