AccountId: 011433970860
ContactId: 00058c5f-85c1-400b-bbdc-3d9f501ae6a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 690760 ms
Total Talk Time (AGENT): 385195 ms
Total Talk Time (CUSTOMER): 248151 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/00058c5f-85c1-400b-bbdc-3d9f501ae6a6_20250117T15:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII], how are you? This is [PII].
[AGENT][NEUTRAL] Hi sir.
[CUSTOMER][NEUTRAL] Hey, um, um, I try not to transfer, but today is one of those days that everything is like, OK, I have a member on the line that, uh, he's calling about the wife, um, policy. He, he's authorized. He does have the paperwork here, he's authorized, um, and he is calling because we sent the payment and he believes it's too low and he.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] OK. Policy number is 2533255.
[AGENT][NEUTRAL] Uh, this is a cancel policy, and it's on the first mail that first, uh, what claim number is it?
[CUSTOMER][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] The most recent one that we sent out, um, yeah, the 286.
[AGENT][NEUTRAL] OK, let's see. DHB, OK, OK, and this is, um, uh, [PII] did this and this to be audited, so I know it's correct because, uh, uh, [PII], uh, audited them. OK, you can let me speak to him if you, you wanna know what's going on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, he just wanna know why we pay so little that um it should have been a little bit more than that, and I did advise him that we needed the itemized bills that we're still missing some itemized bills for the surgery, but um he, he just, he just wanna know why he needs to send more paper that he already all the paper he had. So let me put him in, OK? OK, thank you. Have a good day. Here he comes.
[AGENT][NEUTRAL] OK, I can tell.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's his name?
[CUSTOMER][NEUTRAL] His name is Mr. [PII] [PII].
[AGENT][POSITIVE] OK, OK, thank you.
[CUSTOMER][NEUTRAL] OK, you're welcome. uh, do you need the uh the phone number, the callback number?
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] If you, if they need me to call them back, what's the number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] OK. You're welcome. Thank you for holding and being patient for me, Mr. [PII]. I got Miss [PII] on the line. She's in our claims department and she's gonna assist you from here.
[AGENT][NEUTRAL] At
[CUSTOMER][POSITIVE] OK, thank you. You're welcome, have a good day.
[AGENT][NEUTRAL] Uh, Mr. [PII], my name is [PII]. I'm in the claims department and you're calling in reference to the latest claim that was processed on Mrs. [PII], uh, cancer policy. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, tell me what, what, uh, question that you have about it.
[CUSTOMER][NEGATIVE] Same questions I've had every time I've called. I don't understand why she's only been paying out $3900.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On her cancer policy.
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] The last 4 weeks that we've been here.
[CUSTOMER][NEGATIVE] And you guys are only paying out $3900 in our hospital bills so far with this cancer crap is already I don't know one statement shows $1.5 million.
[AGENT][NEUTRAL] OK, and I.
[CUSTOMER][NEUTRAL] But yeah she's only being paid.
[CUSTOMER][NEUTRAL] $3900 it's insane.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK. OK. Well, let me tell you about the policy and I can go over the policy benefits with you. If she's in the hospital, her daily hospital benefit is a $200 benefit per day. She was in the 13 days and we paid her $2600. So if you take that $200 and multiplied times 13.
[AGENT][NEUTRAL] You come up with $2600. So that's how it came out to be for the hospital stay for those 13 days.
[AGENT][NEUTRAL] You have any
[CUSTOMER][NEUTRAL] OK, I've, I've already.
[CUSTOMER][NEUTRAL] Yeah, I have a lot of questions. That's not, I don't answer my questions.
[AGENT][NEUTRAL] OK, I'm, well, I'm answering it the best I know how is to just go over the benefits with you to tell you what the benefit amount is for hospitals for DHB.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead, Mr. [PII].
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, that's what the benefit for the hospital benefit for the hospital stay, and the hospital stay from [PII], 13 days, the amount is $2600. But being in the hospital.
[CUSTOMER][NEUTRAL] But where's the 30, where's the.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Go ahead, go ahead and then I'll.
[AGENT][NEUTRAL] OK. Then she have a drug-in benefit for being in the hospital. We'll pay a benefit of 150 for drugs for which she was given in the hospital. That is the drug in a benefit amount.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] She has an image benefit and it paid a benefit of $500. Her image benefit is a benefit like for a CAT scan, PET scan, uh, MRI. Those are for image and that benefit is $500 and that's what we pay for that benefit for the image for data service [PII].
[AGENT][NEUTRAL] OK. Her surgery that she had on [PII], we need the itemized surgery bill for that date of service for [PII]. They are asking for the itemized surgery bill from the surgeon in order to review that benefit for that date of service.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Come on man, you've got all of that.
[AGENT][NEUTRAL] OK, would they, they evidently they don't have.
[CUSTOMER][NEUTRAL] I've sent you every.
[CUSTOMER][NEUTRAL] Man, I've sent y'all every, yes, I've sent y'all every statement. I'm looking at all the stuff that I've sent y'all.
[AGENT][NEUTRAL] We don't have it.
[AGENT][NEUTRAL] We need to itemize surgery bill from the surgeon, which was the facility bill. We cannot pay the surgery bill from the facility. We have to have the surgeon bill for that date of service and that's what we're requesting.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And anything that you don't agree with that we, uh, done, you can always do an appeal and you just write them down.
[CUSTOMER][NEGATIVE] Sure, but she's gonna be dead by then. That's what I'm trying to explain to y'all.
[AGENT][NEUTRAL] Uh, uh, we can do it.
[CUSTOMER][NEUTRAL] What else, what else, what, what about my airfare?
[AGENT][NEUTRAL] Uh, we can do is
[AGENT][NEUTRAL] Match of what?
[CUSTOMER][NEUTRAL] How come that hasn't been paid?
[AGENT][NEUTRAL] What, what?
[CUSTOMER][NEUTRAL] Her airfare, that was sent back in December.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let
[CUSTOMER][NEGATIVE] And y'all still haven't paid that. That was on the first claim. Y'all denied that one.
[AGENT][NEUTRAL] The transportation, someone on the transportation from 12:20 to 12:20, they're asking for the itemized bill for that.
[CUSTOMER][NEUTRAL] I sent it. It's a credit card statement where it says Southwest Airlines on there. What else do you, what else, what other kind of automis bill do y'all need for that?
[AGENT][NEUTRAL] They need
[AGENT][NEUTRAL] They are asking for the itemized bill for that data service for [PII] for that airline, so you, you can't send in a credit card receipt because we don't know what's that for. You need the itemized bill for that. So you need to submit that itemized bill. And like I say, Mr. [PII], anything that you don't agree with, do an appeal, send it in and tell why you're appealing it, and they will review that. But I can just go over the.
[CUSTOMER][NEUTRAL] Ma'am,
[CUSTOMER][NEUTRAL] Y'all make it so hard. How come this is not easier for.
[AGENT][NEUTRAL] I, I can only go over what we're needing.
[CUSTOMER][NEUTRAL] Ma'am, I don't guess I don't think y'all are understanding my.
[CUSTOMER][NEGATIVE] Frustration here. I've sent in everything.
[AGENT][NEUTRAL] Yes sir, yes sir. I understand, but they can't pay with it we don't get the right information that we need in order to process those claims that we are asking for additional information.
[CUSTOMER][NEUTRAL] I've sent in ma'am if you look at the files that I've sent in.
[CUSTOMER][NEUTRAL] It has a breakdown of every down to every pill.
[CUSTOMER][NEUTRAL] That they gave her for her surgery for the $2000.
[AGENT][NEUTRAL] OK, now what, what I can do, what I can do what I can do, Mr. [PII], the adjusted that process this claim, I can get her to review the claim going over what you're saying that you are concerned about, and she can give you a call back. Your number is [PII]. Is that correct, Mr. [PII]?
[CUSTOMER][NEUTRAL] The other one for the $52,200.
[CUSTOMER][NEUTRAL] It is, yes, is she not available where I can talk to her now?
[AGENT][NEUTRAL] OK. Well,
[AGENT][NEUTRAL] Uh, no, she's not available.
[CUSTOMER][NEUTRAL] She's [PII], my wife's fixing to go in. Of course not. My wife's fixing to go in for chemo treatment, chemo treatment.
[AGENT][NEUTRAL] I can send, I can.
[AGENT][NEUTRAL] I would give her the information, Mr. [PII], and I would have her to give you a call back.
[CUSTOMER][NEUTRAL] Oh dang.
[CUSTOMER][NEGATIVE] That's unacceptable. Is there a is there somebody, a supervisor there that I can talk to?
[AGENT][NEUTRAL] Uh, let me see. Can I get a supervisor? Let me see one available. Let me see if [PII] available.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] OK, hold on one moment let me see, can I transfer you?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Give me one second, I'm trying to get her and see. I'm IMing her, see if she's available.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, it doesn't look like she's available. I can send the supervisor and uh just uh an uh email or to have them to call you back. And so I would do that, Mr. [PII], have them to call you back at [PII]. Is that correct?
[CUSTOMER][NEUTRAL] That is correct, but what I'm saying, I'm fixing to go into a 6 hour chemo treatment therapy for my wife.
[AGENT][NEUTRAL] Well, all I can do is try to get someone to call you back. I, all I can do is get someone to call you back, Mr. [PII]. Uh, the, the adjuster, I would have to get with her for her to be able to give you a call back.
[CUSTOMER][NEUTRAL] That's why I'm calling.
[CUSTOMER][NEUTRAL] OK, will they be able to talk to my attorney?
[CUSTOMER][NEUTRAL] If they call?
[AGENT][NEUTRAL] Uh, yeah, I just, you want to.
[CUSTOMER][NEUTRAL] Or can I have my attorney call y'all?
[AGENT][NEUTRAL] Yes, you can have the attorney to call our office. Yes, sir. What's your attorney name so I can put it in uh in the mail saying, I mean in the note telling that's who you're gonna have.
[CUSTOMER][NEUTRAL] He'll be calling.
[AGENT][NEUTRAL] What's his name?
[CUSTOMER][NEUTRAL] He'll be calling. It doesn't matter to you. I'll have him call because I've got other.
[AGENT][NEUTRAL] OK. All right. OK.
[AGENT][NEUTRAL] OK. OK. Oh.
[CUSTOMER][NEUTRAL] He's dealing with other issues too.
[AGENT][NEUTRAL] OK. All right then. Well, I have someone to give you a call back or your attorney can call our office, Mr. [PII]. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] I need to talk to a supervisor and I'll hold for however long.
[AGENT][POSITIVE] Um, I'm gonna make sure, I'm gonna make.
[AGENT][NEUTRAL] Uh, uh, uh, uh, Mr. [PII], I'm gonna have to have someone to give you a call back. They are not available. So as soon as I get off the phone, I'm gonna try to get someone to call you right back, Mr. [PII].
[CUSTOMER][NEUTRAL] Alright, I'll wait for 5 minutes and I'm gonna call back.
[AGENT][NEUTRAL] That's fine, Mr. [PII]. OK. Thank you, Mr. [PII].
[AGENT][NEUTRAL] All right. Bye-bye.