AccountId: 011433970860
ContactId: d3b10bb9-2290-4b75-8ee7-5f17649515ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 527390 ms
Total Talk Time (AGENT): 237528 ms
Total Talk Time (CUSTOMER): 154350 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/d3b10bb9-2290-4b75-8ee7-5f17649515ec_20250404T17:07_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] Hi, uh, they said, I wanna talk about my claim.
[AGENT][POSITIVE] Well, I would be happy to assist you with that claim information. Do you have your policy number available?
[CUSTOMER][NEUTRAL] 782-299.
[AGENT][NEUTRAL] And what is your name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII], and can you get, what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and do you also mind verifying your Gmail address and current mailing address?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. [PII].
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And these were those two claims processed on [PII] for yourself?
[CUSTOMER][NEUTRAL] Um, what date did you say?
[AGENT][NEUTRAL] Well, they were processed on [PII].
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, yes.
[AGENT][NEUTRAL] Looks like they are needing additional information.
[AGENT][NEUTRAL] I'm checking both claims, bear with me just one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Have you received that EOB yet?
[CUSTOMER][NEUTRAL] I did and then they said that uh.
[CUSTOMER][NEUTRAL] Some reason, you know, my, I
[CUSTOMER][NEUTRAL] My, the insurance didn't cover that. I know.
[AGENT][NEUTRAL] OK, so I'm looking at everything.
[CUSTOMER][NEUTRAL] I can't put my hands on.
[AGENT][POSITIVE] You're fine. I'll help you, not a problem.
[AGENT][NEUTRAL] So it looks like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the surgery on [PII].
[AGENT][NEUTRAL] They're going to need an itemized bill from the surgeon, including the procedure codes and diagnosis codes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Wait a minute. On, on what day? I had surgery?
[AGENT][NEUTRAL] That was on [PII].
[CUSTOMER][NEUTRAL] No, I, I don't know. No.
[CUSTOMER][NEUTRAL] Mm, is that me?
[AGENT][NEUTRAL] According to the information, there was a surgical procedure on [PII].
[CUSTOMER][NEUTRAL] I'm showing I went [PII].
[CUSTOMER][NEUTRAL] And that's when I got my first chemo.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Was there a surgery?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I had my first surgery I had was on [PII].
[CUSTOMER][NEUTRAL] And I, they got, I sent a pathological report and everything else on that first.
[CUSTOMER][NEUTRAL] Uh, claim I'm.
[AGENT][NEUTRAL] For the first occurrence, yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Let me get this pulled up, bear with me.
[CUSTOMER][NEUTRAL] And then I, I.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we'll get the documents pulled up and see if.
[AGENT][POSITIVE] I can find that. If not, we're gonna get you to someone who can help you further.
[AGENT][NEUTRAL] I've got to look through it for just a minute, OK?
[CUSTOMER][NEUTRAL] Yeah, I'm saying it's a lot.
[AGENT][POSITIVE] Yes, ma'am. Are you doing pretty good?
[CUSTOMER][POSITIVE] So far I'm doing pretty good.
[AGENT][POSITIVE] That's good. I tell you, the things that they can do now is just, it's wonderful.
[CUSTOMER][POSITIVE] I, I'm just blessed that that, that they have changed since my mother had it way back when but um
[CUSTOMER][NEUTRAL] Everything has changed drastically because this
[AGENT][NEUTRAL] Oh, yeah, the treatment.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm. I mean, it's, it, it's, it's, look, I'm almost, almost [PII], so.
[CUSTOMER][NEUTRAL] I know my body can only take so much.
[AGENT][POSITIVE] I'm right there with you. I know what you're talking about.
[CUSTOMER][NEUTRAL] And it's like they were doing the way.
[CUSTOMER][NEUTRAL] If they were doing the same method they did did from the beginning, I don't know if I would be.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] I'll tell you what, I can, there's two options. I can get you to an adjuster that can look at this or I can send a request that they review the information and give you a call that way you don't have to wait on the phone.
[AGENT][NEUTRAL] Would you
[CUSTOMER][NEUTRAL] OK, that, that'll that'll be fine.
[AGENT][NEUTRAL] Would a call that be OK?
[CUSTOMER][POSITIVE] Yes, that'll be fine.
[AGENT][NEUTRAL] OK. And that number that you gave me?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That I verified, that's a good number for them to return your call.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] A return, yeah, so that's [PII].
[CUSTOMER][NEUTRAL] Yes, that's it.
[AGENT][NEUTRAL] I'm gonna put that request in right now and that will be um better they'll have a chance to review everything prior to calling you.
[AGENT][NEUTRAL] And is there a specific question or are you just wondering what.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Why some things were not covered or?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Right, right, why, why.
[AGENT][NEUTRAL] I know we need to talk about this.
[AGENT][NEUTRAL] 10:31 data service.
[CUSTOMER][NEUTRAL] Yeah, I don't know what that is, cause I didn't actually have any surgery.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On that date.
[AGENT][NEUTRAL] I know that's one thing we need to specifically list for them to review.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you should be receiving a call today.
[CUSTOMER][NEUTRAL] And I thought
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But in regards to, to the my policy, I mean they do pay for the chemo, right?
[AGENT][NEUTRAL] Yes, ma'am. Have, let's see, let me check something else for you.
[AGENT][NEUTRAL] Have you created an account on our we[PII]? Because you can view your policy benefits and claims. So if you have that online portal account, you can click on your policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your policy documents, yeah.
[CUSTOMER][NEUTRAL] Look on out wait a minute, let me go.
[CUSTOMER][NEUTRAL] OK. OK. I, I got it. I'll look at it.
[AGENT][NEUTRAL] So that is going to upload your policy, and there's a page called a schedule of benefits page.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it will have all your benefits listed.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] We're gonna ask that they call you back today.
[AGENT][NEUTRAL] And that has been sent to our claims department. Like I said, that will give them a chance just to review these two claim documents prior to calling you or they should, and then that way they can answer your questions quicker versus you having to stay on the phone while I hunt.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Appreciate that.
[AGENT][POSITIVE] My pleasure. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] Well, Ms. [PII], it's been such a pleasure to assist you, and if you need any further assistance, please don't hesitate to give us a call. We'll be happy to assist you any way we can.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] And thank you for calling ATL. Take care.
[CUSTOMER][POSITIVE] You too. Have a good day.
[AGENT][NEUTRAL] You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.