AccountId: 011433970860
ContactId: df86dd3c-0a95-47a4-8818-bf1511e72138
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 778010 ms
Total Talk Time (AGENT): 237647 ms
Total Talk Time (CUSTOMER): 204543 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/df86dd3c-0a95-47a4-8818-bf1511e72138_20250102T14:11_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I am trying to find out about the last one I sent to you all. It was denied because I had exhausted my arm.
[CUSTOMER][NEUTRAL] My premium benefits for that year. I'm gonna give you the policy number 593-389.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you, Mr. [PII]. Let me have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And when I had talked to somebody before, they told me I could resubmit it in January of this year, but I didn't know which one it was.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maybe you can help me with that.
[AGENT][NEUTRAL] Sure. May I have your date of birth for security?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I need to verify the mailing address and email address on file.
[CUSTOMER][NEUTRAL] One, OK, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh [PII].
[AGENT][POSITIVE] Yeah, thank you.
[CUSTOMER][NEUTRAL] Yeah, I had talked to you. I, I have it written down this information given by [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so I see the last um claim that we processed.
[AGENT][NEUTRAL] Let's see what's on [PII], which it was the mammogram which we send the payment of $75.
[AGENT][NEUTRAL] For [PII], um, so it's for the year of [PII]. Um, let me check and see what else we have covered.
[AGENT][NEUTRAL] OK, and then we paid up to 2024. OK, so, um, I guess she was talking about the wellness benefit, which you have $75 per year. OK, yes, um, we paid 1920 21 22 23 $24. So you're due for $25 now.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so 25, what about this one for claim number 2,005,010?
[CUSTOMER][NEGATIVE] I did not get that one paid.
[AGENT][NEUTRAL] Let me put that one for.
[AGENT][NEUTRAL] OK, let me pull the image on that one because I don't see it on the list.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see what it stands for.
[AGENT][NEUTRAL] OK, let me have that claim number one more time.
[CUSTOMER][NEUTRAL] OK, 2,005,010.
[AGENT][NEUTRAL] I'm waiting on the image.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK, here's what it, the benefits said. This calendar year maximum for the year and this expense benefit has been met for for this year. This benefit will not be payable again until next year.
[CUSTOMER][NEUTRAL] If you disagree with your decision, uh, decisions made regarding your claim, you have the right to appeal the claim decision.
[AGENT][NEUTRAL] And it's coming from us, from ATL.
[CUSTOMER][NEUTRAL] And I didn't know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Explanation of benefits it says.
[CUSTOMER][NEUTRAL] And that was uh the one processed on for the 20.
[CUSTOMER][NEUTRAL] From [PII].
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me just pull the date of service.
[CUSTOMER][NEUTRAL] I can give you the claim number 3510654.
[AGENT][NEUTRAL] OK let me have that number one more time let me write that one down.
[CUSTOMER][NEUTRAL] 3351-0654
[AGENT][NEUTRAL] 54 OK.
[CUSTOMER][NEUTRAL] Yeah, y'all OK OK [PII], correct?
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] OK, I'm waiting on the image.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] OK, so this one was um
[AGENT][NEUTRAL] A wellness exam for [PII].
[AGENT][NEUTRAL] Yes, that was a wellness exam. We already paid the wellness exam for [PII] previously and that's why it denied with that denial reason.
[CUSTOMER][NEUTRAL] So it did not pay that one.
[AGENT][NEUTRAL] Yeah, it didn't I know that one because we already paid for that year.
[CUSTOMER][NEUTRAL] Co
[CUSTOMER][NEUTRAL] In [PII]. OK. Uh.
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Do you need to know which one we pay on 23?
[AGENT][NEUTRAL] Let's see, let me see if I can find it.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No y'all did pay it. I just, I'm looking at it right now. What about this one then? 351-066-4.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so 664.
[AGENT][NEUTRAL] OK, so that was the um the 664. We paid for that one, but it looks like you never got the check, so we went ahead and we issued that check.
[AGENT][NEUTRAL] So we pay under
[CUSTOMER][NEUTRAL] To where?
[AGENT][NEUTRAL] Um, we will issue the check on claim number 352-4875.
[CUSTOMER][NEUTRAL] And that was 352-487-5.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] I should, I'm sorry for taking up your time with this, but.
[AGENT][POSITIVE] No, it's fine. No, don't worry, it's fine, it's just fine.
[CUSTOMER][NEUTRAL] 352-487-5 you said right?
[AGENT][NEUTRAL] Mhm. 352-487-5.
[CUSTOMER][NEUTRAL] Was that bank sent to my bank to my uh checking account?
[AGENT][NEUTRAL] Let me see if it was direct deposit. Let me check.
[CUSTOMER][NEUTRAL] I don't see one like that.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so this one since it was a replacement, I'm not, I'm not sure if we send that yeah, we have to send the UOB if we send the check if it was a paper check.
[CUSTOMER][NEGATIVE] Cause I absolutely do not see that one.
[AGENT][NEUTRAL] Yeah, it was direct deposit. That one was direct deposit because I don't see a check number. So that was, uh, looks like one of the first direct deposit when that check got lost and we had to cancel and reiss.
[CUSTOMER][NEUTRAL] And where was in um when was that bank deposited?
[AGENT][NEUTRAL] November, um, around [PII], around that week, um, we don't know exactly when it deposit, but it's usually around those days, um, it was processed on the [PII], so let me see what um what day was the [PII]. The [PII] was Friday, so more than likely the [PII] or the [PII] was on your bank.
[CUSTOMER][NEUTRAL] See, I don't even have a copy of that.
[AGENT][NEUTRAL] I don't see that we send the EOB um unless we did and it's just not showing that here. um let's see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. I do have it. That was dated [PII] to [PII].
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Yeah. Mhm.
[CUSTOMER][NEUTRAL] OK, so yeah, I got everything I was supposed to get then. And so this year, so [PII], um.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] For this year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] would be um
[CUSTOMER][NEUTRAL] Now let me ask you a question. Do you all cover the uh what do you get for the colonoscopies?
[AGENT][NEUTRAL] The one
[AGENT][NEUTRAL] It's the same wellness benefit, um, so either it's either or, basically, um, you can do the mammogram and the colonoscopy or uh anything that to detect cancer, but it's just one test per year that we pay.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] So either or. OK, uh, perfect. I appreciate your help. Thank you, honey.
[AGENT][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] Uh, no, ma'am, you did a great job. Thank you. I appreciate it. Have a good new year. Thank you.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling APL. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.