AccountId: 011433970860
ContactId: eae73df0-9a1d-46a4-84dc-833463c3705f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 466540 ms
Total Talk Time (AGENT): 137602 ms
Total Talk Time (CUSTOMER): 139671 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/eae73df0-9a1d-46a4-84dc-833463c3705f_20250221T17:29_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] What is your name, sweetheart?
[AGENT][NEUTRAL] My name is [PII] as well.
[CUSTOMER][NEUTRAL] And so, OK, darling, I'm calling. I had just talked with the lady about a claim that I had filed in there, uh, with y'all and uh, I guess I'll have to go through the process all over again and ask the question that I need to know. Um, I, I have my policy number. I can give you that.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Um, it's it's 00727573.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. May I have your name and date of birth for security?
[CUSTOMER][NEUTRAL] My name is [PII] and my date of birth is [PII].
[AGENT][POSITIVE] OK perfect, thank you.
[AGENT][NEUTRAL] And I need to verify the mailing address, email address, and a callback number.
[CUSTOMER][NEUTRAL] OK, my mailing address is [PII]. My callback number is area code [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect. Thank you, Ms. [PII]. All right. And so you need to know what you need to for the completion of your claim?
[CUSTOMER][NEUTRAL] Well, I had a claim. Yes, ma'am. I had a claim on the [PII] and the lady told me, she explained to me that uh uh the reason that they didn't pay for the lab work was because it said it was a just an office visit and it was, but I, I had an infusion that day for my bones because the cancer is in my bones also and I was just wondering.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It would that count toward a uh uh uh uh um she said it was a wellness, uh.
[CUSTOMER][NEUTRAL] Visit and uh I had the infusion and they do they show that on the paper, I mean on on the information they sent y'all.
[AGENT][NEUTRAL] OK, let me check on this because we did pay for the preventative wellness, the $60 and then um we did deny the office visit because it's not covered. So let me check on the other two charges there. mm let's see, and this is from some medical I'm sorry.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It was the Jama.
[CUSTOMER][NEUTRAL] Zamata was the medication that they gave me, you know, I have it and it, it's put in through an IV.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They don't have it on there?
[AGENT][NEUTRAL] Um, one moment, let me check and see.
[AGENT][NEUTRAL] I have to pull the documents. It's not in the system just OK one moment.
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes ma'am.
[CUSTOMER][NEUTRAL] It's all likely.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 89
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this one I'm not really sure what it is. Um, let me check and see um.
[AGENT][NEUTRAL] Let me check and see who processed this claim. OK, one moment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Do you mind holding for me?
[CUSTOMER][POSITIVE] No, ma'am, no problem.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for Ms. [PII].
[AGENT][NEUTRAL] OK, um, thank, thank you for holding. OK, so it looks like um I went ahead and reach out to clients and it was letting me know that they need to go through the new paperwork and see if all the information is there, but right now it's in line to be processed, um, so, um, we just need some more time to to review.
[CUSTOMER][NEUTRAL] Ma'am, yes.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] The one, the one.
[CUSTOMER][NEUTRAL] The one on the [PII]?
[AGENT][NEUTRAL] The one on the [PII], it was just um based on all the information I gathered, it looks like it was only a wellness claim office visit and lab work which um.
[AGENT][NEUTRAL] It is not covered and then we just go ahead and process and pay the wellness.
[CUSTOMER][NEUTRAL] So it, so why is the, I mean, if after I had the infusion, that still doesn't count?
[CUSTOMER][NEUTRAL] It doesn't show the infusion on there?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Uh, I don't see the infusion. It look, it doesn't look like there's an infusion, uh, charge there. On the new paperwork, they will have to check on that. So it has to be processed for them to see if it's there or not. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. I see.
[CUSTOMER][POSITIVE] I see you, [PII]. Well, thank you so much for your time, sweetie. I appreciate it. You have a good day. All right, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. You too. Thank you for calling ATM. Bye-bye.
[CUSTOMER][NEUTRAL] Yes ma'am. Bye-bye.
[AGENT][NEUTRAL] Mm