AccountId: 011433970860
ContactId: dd01e1b7-f021-4902-b915-a56b6e6e8b9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426089 ms
Total Talk Time (AGENT): 152219 ms
Total Talk Time (CUSTOMER): 102687 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/dd01e1b7-f021-4902-b915-a56b6e6e8b9a_20250327T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. And I recently filed some claims, and they didn't get paid the way I thought they would. And I'm just trying to get some more information as to why they were paid. OK, so I filed one because I had a um procedure back in February.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And according to my insurance chart, if there's a follow-up Pap smear or follow-up procedure or appointment, I qualify for a $100 benefit.
[CUSTOMER][NEUTRAL] And they only gave me 50.
[AGENT][NEUTRAL] OK, OK, we can get those claims pulled up and I'll take a look at those, see if we can get some clarification on that, um, [PII], first, if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then did you have that policy number?
[CUSTOMER][NEUTRAL] I do not, but I can give you my social.
[AGENT][NEUTRAL] Um, do you have the claim number by chance?
[CUSTOMER][NEUTRAL] No, um, do you want me to see if I can pull it up real quick?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, that's OK we can use your social that's fine.
[CUSTOMER][NEUTRAL] OK. It's uh [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, there we are, um, and I'm just gonna verify some information really quick. Uh, [PII], can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and can I get your mailing address?
[CUSTOMER][NEUTRAL] Um, [PII]. OK, so, [PII].
[AGENT][NEUTRAL] Perfect. Last thing I need is the email address we've got on file for you. uh, looks like it might be through your employer.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Perfect thank you so much for verifying that information. OK, let's take a look here give me just a moment.
[CUSTOMER][NEUTRAL] Oh, or sorry.
[AGENT][NEUTRAL] What was the date that you said you went for this procedure? I'm sorry.
[CUSTOMER][NEUTRAL] Oh, can you repeat yourself? I'm sorry.
[AGENT][NEUTRAL] Oh, that's OK. Um, what was the date that you went for this procedure? I'm sorry.
[CUSTOMER][NEUTRAL] It would have been the one in February.
[AGENT][NEUTRAL] OK, OK, I do have one for [PII]. Alright, give me just a moment here.
[AGENT][NEUTRAL] OK, so just so that I understand correctly, um, I have one, the last one that I have previously was uh right before this one was [PII] for a Pap smear, and you had to go back for a follow up one because they, they found something, is that right?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] They refer, yes.
[CUSTOMER][NEUTRAL] Yes, and then they referred me to a doctor in [PII].
[CUSTOMER][NEUTRAL] For a colossy, yeah.
[AGENT][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I follow the deal too because.
[CUSTOMER][NEUTRAL] During that, they had to do a procedure to remove cells and then they also did um a biopsy during those procedures.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For the one in February?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, OK, alrighty, um, give me just a moment, [PII], if you don't mind. I'm gonna put you on a brief hold and uh reach out to our claims specialist to kind of touch base with them and see what's going on with this.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What it is that.
[CUSTOMER][NEUTRAL] Purring
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[CUSTOMER][POSITIVE] I'm good. How are you?
[AGENT][NEUTRAL] Doing all right, thank you. I've got a member on the line, um, so long story short, she had um gone in on her cancer policy. Uh, she had a Pap smear in November and she had to have a follow up um because I guess they found something, and that was in February. She filed both of those claims. Um, the follow up was, uh, we paid the $50 benefit and she was expecting that $100 benefit or the $150 benefit for that since it was a follow up.
[AGENT][NEUTRAL] Um, I'm not, I've not really run into anything like this before, so I'm not sure if that's because the calendar year had reset and maybe that was why.
[CUSTOMER][NEUTRAL] Can I get the policy number?
[AGENT][NEUTRAL] Of course, um, that was 02528619.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] Come on all these.
[CUSTOMER][NEUTRAL] See what she sent in before I have you transfer her over.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, good because it doesn't say follow up, but you can send her on over.
[AGENT][POSITIVE] OK, I sure appreciate your help thank you.
[CUSTOMER][POSITIVE] No problem have a great rest of your day.
[AGENT][NEUTRAL] Bye bye. You too, bye.