AccountId: 011433970860
ContactId: ed0460c2-9cf8-4d40-bdac-2bc2d5a27bc7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311369 ms
Total Talk Time (AGENT): 144705 ms
Total Talk Time (CUSTOMER): 184839 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/ed0460c2-9cf8-4d40-bdac-2bc2d5a27bc7_20250411T19:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi Miss. [PII], this is [PII] over on the care team. How are you today?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][NEUTRAL] Doing all right. It's Friday.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, well I've got a weird situation here um I've got a member on the line uh she's got a cancer policy. I don't have a lot of background, but apparently she had one specific claims adjuster who was handling her claims. She said it got switched to [PII], which I'm not quite sure who that is, [PII], um, but she's, I guess having some serious problems with [PII] handling her claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, she said that the information she's getting is contradicting um what she was originally told and she believes contradicting what's in her policy regarding, uh, claims as well and so she asked if somebody else can look over them, make sure that they're correct, and if she can just get somebody else entirely to handle her claims.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Yeah, I never run into that before.
[AGENT][NEUTRAL] Oh yeah, me either. Um, do you know who was right? Do you happen to know who was handling before? Does she know?
[CUSTOMER][NEUTRAL] So I was like, oh, you know, I don't know.
[CUSTOMER][NEUTRAL] I do not, uh, no, I don't think she remembers the name, um, and I'm not, I guess I could look at the older claims, but.
[AGENT][NEUTRAL] OK, that's OK.
[AGENT][NEUTRAL] Oh, that's OK so she just wants someone to go through review, make sure everything that's being processed is correct and if so.
[CUSTOMER][NEUTRAL] That's just the user name.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] What does she?
[CUSTOMER][NEUTRAL] The only thing she gave me specifically, yeah, the only thing she gave me specifically was I guess she had, you know her wellness benefit, um, and she did the diagnostic test and it did require a follow up and so she's, you know, for her policy says that it's, you know, the $100 for the follow up diagnostic, um, and I guess we only paid her $50.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she said that [PII] had told her that that's, you know, it's only the $50 that she's arguing, so I think that's really the biggest thing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the main thing is gonna be double checking her wellness.
[CUSTOMER][NEUTRAL] Right, and she, I, I think I've spoken with her before, um, because I think she had mentioned this, um, and I had just transferred her, but I guess maybe she went to.
[AGENT][NEUTRAL] That's the biggest thing that she's.
[AGENT][NEUTRAL] OK. Uh, what's that policy number?
[CUSTOMER][NEUTRAL] Yeah it's 252-861-9.
[AGENT][NEUTRAL] OK, let's see, is she just wanting like a call back or what she wanting?
[CUSTOMER][NEUTRAL] I'm honestly I'm not quite sure um I don't know what we can even do can we just assign this to somebody else or?
[AGENT][NEUTRAL] Um, I mean, let's see, it looks like [PII] did her previous preventative.
[AGENT][NEUTRAL] Um, exam.
[AGENT][NEUTRAL] I mean I can do the review since she's called in with this request for the review um and then as far I don't know if we can designate specifically someone to process her claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I didn't think so either.
[AGENT][NEUTRAL] Um, it's kind of, you know, there's not a guarantee that [PII]'s gonna be here every time a client comes in and it could fall outside of.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I, I don't know that's something that I'll have to talk to this product supervisor about and let her know that there's been a very specific request, um, and then ultimately I think it's gonna be whatever the outcome of the review shows as well because if [PII] is correct then it could be that the information given to her previously regardless of who that was was incorrect um so it's gonna.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] It's correct, right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or and you know, real possibility is that maybe she just misunderstood and so, you know, but I think.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] That's one of those things.
[AGENT][NEUTRAL] Exactly, so.
[CUSTOMER][NEUTRAL] OK, well I can just tell her that you, uh, y'all will I won't give her name, um, but I'll say that you know it will be reviewed, um, double checked by somebody else, and then just that we'll get back with her.
[AGENT][NEGATIVE] Yeah, yeah, um, I can't.
[CUSTOMER][NEUTRAL] Do you want her to call back?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK, it's uh [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she did specify that I know we always leave a voicemail but she said it will most likely go to voicemail um that to please leave a voicemail.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, um, I can't guarantee that it will be today. I will do my best. She doesn't have a whole lot of paid claims out there. It looks like she maybe has two, so if that's all the only two that we need to review, then obviously we can look at that and determine from there um it could be Monday though.
[CUSTOMER][NEUTRAL] Sure. Oh yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I'll kind of set that expectation like, yeah, I'll kinda set that expectation. I'll probably even tell her Tuesday at the latest, but OK, well I sure appreciate your help, [PII]. I'll let her know.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, yeah, that sounds perfect.
[AGENT][POSITIVE] You're welcome. Thank you, [PII].
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] Alright, bye.