AccountId: 011433970860
ContactId: e2d40215-6e47-4762-9bea-d626271e80e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314140 ms
Total Talk Time (AGENT): 153213 ms
Total Talk Time (CUSTOMER): 91617 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/e2d40215-6e47-4762-9bea-d626271e80e9_20250508T20:06_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, I was trying to find the status of a claim please.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status. May I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] The policy number is.
[CUSTOMER][NEUTRAL] 00698664
[AGENT][NEUTRAL] OK. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm, OK, Mr. [PII], I need to verify your date of birth and address for security.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right, let's see.
[AGENT][NEUTRAL] OK, so it looks like the last claim that I got here um was the one that we processed on [PII].
[AGENT][NEUTRAL] Did you send another claim after that one?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I got a letter saying that after I got that.
[CUSTOMER][NEUTRAL] Last, uh, check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We received a uh another letter saying that they were reviewing our claim.
[CUSTOMER][NEUTRAL] So I didn't know if it was gonna be anything further.
[AGENT][NEUTRAL] Mm. No. It looks like that letter was probably received um after, but it should have been received before we process the claim. I'm not sure what happened when you received that letter after.
[CUSTOMER][NEUTRAL] We need more reviews upon.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] The claim has been paid in full?
[AGENT][NEUTRAL] Mhm. Yes, yes. Uh, the only thing I see here that it was not paid, it was the office visit, which is something that is not covered. So other than that, everything else got paid. The surgery, the anesthesia, the drugs.
[AGENT][NEUTRAL] The physician, all bills were paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have in [PII] I had surgery.
[CUSTOMER][NEGATIVE] When I had to have my kidney removed because it was uh it was cancer.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] It's virtually the same amount of money and you paid a lot more then than you have now. What is the difference?
[AGENT][NEUTRAL] OK. Uh, it really depends on how large the surgery was or what type of surgery they did. Um, but
[AGENT][NEUTRAL] Yeah, it's based on the surgery, how much they charge for the surgery, uh, how big was the surgery.
[CUSTOMER][NEUTRAL] Well they removed
[CUSTOMER][NEUTRAL] Well, they removed a 2.5 pound tumor.
[CUSTOMER][NEUTRAL] And it was
[CUSTOMER][NEUTRAL] 7 hour surgery.
[CUSTOMER][NEUTRAL] I had uh several doctors involved.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And that may be the difference because really it, it's, it's a lot more if it's a larger surgery because it goes by unit. So basically, the, the larger the surgery is more units, so it pays more. Um.
[AGENT][NEUTRAL] And if you spend like more time.
[AGENT][NEUTRAL] In the hospital, if you had um hospital stay or ICU which it looks like you did have um ICU um benefits pay on that in [PII].
[CUSTOMER][NEUTRAL] I was in there 6 days.
[AGENT][NEUTRAL] Mhm. Yes, so you had additional um
[AGENT][NEUTRAL] Charges that we pay for on [PII] that were not charged this, this other surgery and that's, that's all for um this past year.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that's that.
[AGENT][NEUTRAL] Really.
[AGENT][NEUTRAL] I'm just getting into what we pay. Yeah, the, the charges for [PII] was a little bit more because you, you stayed in ICU. So it looks like it was a more severe surgery and the one you had on [PII], it was just a regular surgery. You didn't have to be like hospitalized or put in ICU or anything like that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I'm gonna help you with today? Any other questions or concerns, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] You're welcome.