AccountId: 011433970860
ContactId: ce648918-a8e7-44c2-b37b-87640706772a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326489 ms
Total Talk Time (AGENT): 63869 ms
Total Talk Time (CUSTOMER): 89498 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/ce648918-a8e7-44c2-b37b-87640706772a_20250324T21:16_UTC.wav
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[AGENT][POSITIVE] Thanks for calling ATL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from the care team. I've got a patient or a policyholder on the line who is questioning a denial on a claim, and I tried to help her as much as I could, but I can't figure out exactly what what we're needing or why I saw the denial reason, but I couldn't quite figure it out, so.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Um, policy number is 667756.
[AGENT][NEUTRAL] In the patient's name?
[CUSTOMER][NEUTRAL] Uh, patient is [PII], and I have verified her information.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, you can send her on over.
[CUSTOMER][NEUTRAL] OK, and it was on that 358-0046.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um, it was on claim 3580046. You probably can see that though because it says denied.
[AGENT][POSITIVE] Oh yeah. Yeah, I did. I figured that was the one.
[CUSTOMER][POSITIVE] OK, here you go. OK, thank you so much. Thanks. Bye.
[AGENT][POSITIVE] All [PII]. Thank you. All right.
[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, my name's [PII]. I was checking on a wellness claim that I had submitted, um, and I was looking online and it doesn't show that it paid. I was just wanting to find out why.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, give me just one second to um.
[AGENT][NEUTRAL] To get that information, 1 2nd.
[AGENT][NEUTRAL] OK, it looks like uh they did not make a payment uh because there was no cancer screening test performed.
[CUSTOMER][NEUTRAL] I mean, has the policy changed because I file this every year and it's just for my um.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Physician and it's just to renew my medicine and he does a blood screening for uh cholesterol and um blood pressure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and it, and there's a wellness benefit for this under the policy?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, give me one second to pull your policy up.
[CUSTOMER][NEUTRAL] Yes ma'am. I, I.
[AGENT][NEUTRAL] OK. And so did he check anything other than your blood glucose levels? Did you have like a pap smear or anything like that before?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No ma'am.
[AGENT][NEUTRAL] Right, because it looks like on the previous claims that we paid on those, you had a mammogram performed, you did have a Pap smear.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so it only does like a well woman visit is that that's what it covers? OK, alright.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Thank you so much I appreciate your time.
[AGENT][NEUTRAL] OK, did you have any other questions for me?
[CUSTOMER][POSITIVE] No ma'am, that's all thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.