AccountId: 011433970860
ContactId: f754ed00-39ce-4eac-b8a1-fb1fdd0fde63
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259570 ms
Total Talk Time (AGENT): 110078 ms
Total Talk Time (CUSTOMER): 124638 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/f754ed00-39ce-4eac-b8a1-fb1fdd0fde63_20250228T18:36_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII]. I was trying to get in touch with claims and I pushed the wrong option on my phone. Is this claims for cancer?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Oh, OK. OK. Uh.
[CUSTOMER][NEUTRAL] My name is [PII]. I was the writing agent for a policyholder, and we've been, I've been helping her with claims for, gosh, almost a year. And so, um, I signed the paperwork so that I could get information on her to tell her with questions. What information do you need from me? a policy number, date of birth, or what?
[AGENT][NEUTRAL] Can I start off with getting um your callback number, please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] May I have the policy number, please?
[CUSTOMER][NEUTRAL] Yes, it is 728463.
[AGENT][NEUTRAL] All right, one moment please while I pull up the policy.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Could you verify the member's name and date of birth and address, please?
[CUSTOMER][NEUTRAL] Yes. Uh, well, her name is [PII] or [PII]. It's under the name [PII].
[CUSTOMER][NEUTRAL] Uh, her date of birth is.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Address [PII].
[AGENT][POSITIVE] Thank you so much for verifying that information. I have the policy pulled up. How can I assist you today?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Well, she, uh, texted me. I know she has received two checks, her last two claims.
[CUSTOMER][NEUTRAL] But my question is she said she had a letter or something that she had maxed out one of her benefits and so I said well let me call she didn't know if she'd maxed out entire policy or just one of the benefits.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] The only thing that um if she didn't read you the letter, she didn't send you the letter.
[CUSTOMER][NEUTRAL] No, she just texted me.
[AGENT][NEUTRAL] OK, that she might should have sent you the information that way you can know, you know what she's referring to. The only thing that I can assume that she's referring to is the prostheses is that she received um the benefits for the prostheses and it's one prosthesis per site per lifetime. Um, that is the only.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, 1
[CUSTOMER][NEUTRAL] One per site or per site.
[CUSTOMER][NEUTRAL] For a lifetime.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's the only thing that I'm assuming without her telling you what the letter states, um, but on the EOB it does tell you on the denial, it's not a denial, but it's a paid code and on the paid code, it lets you know that that's the um.
[CUSTOMER][NEUTRAL] Sure. OK.
[CUSTOMER][NEUTRAL] OK. Well,
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] This is the max payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's the only thing that I'm.
[CUSTOMER][NEUTRAL] Next payment.
[AGENT][NEUTRAL] Without knowing for sure, yeah, this is, that's the only thing I'm assuming that was on her last payment that she maxed out the prostheses benefit, which is a lifetime per site.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Was that in the $3000 something dollars check? Was that part of that or the $800 something dollar?
[AGENT][NEUTRAL] It was, it was part of the $3800 check.
[CUSTOMER][NEUTRAL] 3000.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, well, uh, that's, that's probably what she's talking about, but I'll also have her send it, take a picture of that and send it to you. Thank you so much.
[AGENT][NEUTRAL] OK, OK. Yeah, that's the, yeah, that's the only thing I can think of that she may be referring to. Is there anything else, [PII], I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, no, that's it. I'll call back if there is. Thank you so much.
[AGENT][POSITIVE] You're so welcome. Thank you for calling APL. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Sure. Sure. You too. Bye-bye.