AccountId: 011433970860
ContactId: 025a40d4-2cd6-4845-b230-c904e842dff5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 935320 ms
Total Talk Time (AGENT): 303371 ms
Total Talk Time (CUSTOMER): 348856 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/025a40d4-2cd6-4845-b230-c904e842dff5_20250604T22:31_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Oh my gracious [PII].
[AGENT][NEUTRAL] What's going on [PII]?
[CUSTOMER][NEUTRAL] I'm burning up. It's hot.
[AGENT][NEUTRAL] Why are you burning up, girl?
[CUSTOMER][NEUTRAL] I need to
[CUSTOMER][NEUTRAL] Cause my office is in the garage. I need to hurry up, get my room situated so I can have a office in my room so I could be where the air conditioner is.
[AGENT][POSITIVE] Oh, bless your heart.
[CUSTOMER][POSITIVE] I want to be where the air is cause I have, and then, you know what's funny, I know I got answered on the phone. I'll tell you this real quick. I went to this I had Donuts and more. They sell like burgers which are delicious, and they have stir fry like fried rice and shrimp and chicken and everything.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] So I went there, ordered me some food. I had to wait because they didn't have it ready. And this chick told me I smelled good. I was thinking, oh, you're so sweet. It's like I'm sweating my booty off. I know I ain't. I took a shower earlier today, but I don't know, cause she's like, are you wearing um
[CUSTOMER][NEUTRAL] What you might call it, uh, something about, um, I, um.
[CUSTOMER][NEUTRAL] [PII]. I was like, no, I just have cocoa butter on.
[CUSTOMER][NEUTRAL] I don't know why they just cracked me up. I was like, uh, no, ma'am, I just got cocoa butter. I don't know what you're smelling, but thank you. Could be because you're in a donut shop. I don't know.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] But I just thought it was so, I thought it was sweet but funny. Anyway.
[CUSTOMER][NEUTRAL] Um, I have an intern on the phone. He's a hot one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's not a cancer policy.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I told him, he's calling about a recent claim. I told him his claim was processed and well claim paid $50 for wellness, and he said, wellness, I just had um prostate cancer and they put radiation in my, you know.
[CUSTOMER][NEUTRAL] But the other claim he had, the one that he called about, it shows benefits of Max further.
[CUSTOMER][NEUTRAL] Lifetime max for the first occurrence, but I'm trying to find it but I can't help this man. I can, but.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Um, 238-377-72.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] When did he start having prostate cancer?
[AGENT][NEUTRAL] So we did the wellness.
[CUSTOMER][NEUTRAL] It's so what does that sound?
[AGENT][NEUTRAL] So for the radiation therapy, we need, oh, that was probably me because I uh when I clicked on.
[AGENT][NEUTRAL] This remark code so we need the uh itemized bill showing the procedure codes and charge amounts for the radiation.
[AGENT][NEUTRAL] Hold on, let's see
[CUSTOMER][NEGATIVE] 58, no, that's not it. I'm gonna send the wrong number.
[CUSTOMER][NEGATIVE] So I better talk to somebody if y'all won't continue my business.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, well, policy already turned 24, sir.
[CUSTOMER][NEUTRAL] I don't know what business you're trying.
[AGENT][NEUTRAL] Yeah I I but I think that.
[CUSTOMER][NEUTRAL] Oh wait, he does have an accident policy. Oh well.
[AGENT][NEUTRAL] So did they use the wrong remark code for the one in uh.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] I have
[AGENT][NEUTRAL] In February, let me pull this claim up and see something because we haven't paid anything.
[CUSTOMER][NEUTRAL] 53.
[AGENT][NEUTRAL] When they say that he used the Lifetime max.
[AGENT][NEUTRAL] I think she used the wrong one.
[CUSTOMER][NEUTRAL] That's so weird. So all the.
[CUSTOMER][NEUTRAL] I have no idea.
[AGENT][NEUTRAL] Looks like we need to um
[CUSTOMER][NEUTRAL] Why am I taking this call anyway? It's time for me to go. I'm sorry. I have to say that loud.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] What did you say? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, I.
[CUSTOMER][NEGATIVE] Nothing, nothing.
[AGENT][NEUTRAL] Oh, I didn't hear what you said.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I said I just looked at the time and so it was time for me to go. I didn't even, well,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It can help I got a call before [PII]. 0 well.
[AGENT][NEUTRAL] Last time I really get.
[AGENT][NEUTRAL] Oh, I was like that with a guy last week. It somebody sent me a call at [PII]. I'm on the phone with him at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Come on
[AGENT][NEUTRAL] You can go ahead and send them over, but looks like we need the itemized billing and stuff for the radiation.
[CUSTOMER][POSITIVE] Alright, sweet peep, just let him know he's hot, so.
[AGENT][NEUTRAL] I'm, I'm sure if if he's thinking that his benefit is max and we haven't paid anything.
[CUSTOMER][POSITIVE] Yeah, well I appreciate you have a great day, great night.
[AGENT][POSITIVE] All right. No problem.
[CUSTOMER][NEUTRAL] Alright bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] One
[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. My name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I need to check on the frame I had, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I think she told me that she informed you that we have paid the $50 for the wellness and that you had a question about your radiation.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] I mean, I had prostate cancer.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And they went in and, and planted, uh, radioactive seeds in there.
[CUSTOMER][NEUTRAL] And I'm still paying on the bill. I owe them for about $3000. I think I still owe them. And so far I've gotten two checks out of y'all for $50 apiece.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And somebody told me last time I checked.
[CUSTOMER][NEGATIVE] That they were going to check it, you know, that was for something they said and they were going to check on what else they could give me and never have heard the word back. That was back in April that I cashed those checks.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so under this policy, your cancer policy, uh, for the radiation therapy, looks like they're needing the itemized billing.
[AGENT][NEUTRAL] Uh, from the provider's office showing the.
[CUSTOMER][NEUTRAL] He said, I
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] OK, that shows us the procedure code and the charge amounts for the radiation.
[CUSTOMER][NEUTRAL] Well that that was all. Yeah, that was all, so I sent all that paperwork. My doctor filled it out and signed it, and I mailed all that in.
[AGENT][NEUTRAL] OK, give me one second because I'm going through the information that you sent in to us.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] 52
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like the other information that we that you sent in was for the [PII] calendar year.
[AGENT][NEUTRAL] And so this is for the radiation that you had [PII].
[AGENT][NEUTRAL] So I don't see the.
[CUSTOMER][NEUTRAL] No, I had this, I had this, I had this done in, in [PII].
[AGENT][NEUTRAL] OK, let me see if I can find that information.
[CUSTOMER][NEUTRAL] Doctor [PII] at the Salmons Cancer Center is the one that did it.
[CUSTOMER][NEUTRAL] These nurses are the ones that sent you the information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just now, whatever I need.
[AGENT][NEUTRAL] Do you know when they sent the information in for [PII]?
[AGENT][NEUTRAL] OK, I see it now. [PII].
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEGATIVE] They, they, they sent it in. I didn't get, I didn't get those two checks till April.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I know that they received it because we talked to the lady last time and she found it.
[AGENT][NEUTRAL] OK, I just found that they didn't enter it on the, they didn't enter it on the information that they give me one second.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, but it doesn't have any codes, procedure codes, so we have to have a procedure code so that we'll know what was done.
[AGENT][NEUTRAL] So if you had any chemo or
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Uh, hey, this is my wife here. I'm gonna let her go. So did y'all request that from the doctor?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No ma'am, we requested that from you, from you all we sent a letter out to you all.
[CUSTOMER][NEGATIVE] No, ma'am, no ma'am, no ma'am, you didn't send us anything.
[CUSTOMER][NEGATIVE] We got nothing. We talked to a lady back in probably the beginning of April, end of March, beginning of April. We were, she did not request that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Um, I haven't received anything in the mail requesting any information because we, we filed that claim a long time before that and that's why we called because we hadn't heard nothing and then we get $250 checks in the mail. The only letters that we have received is that y'all have received the claim.
[CUSTOMER][NEUTRAL] Um, and in some cases additional information must be requested from you or your provider.
[CUSTOMER][NEUTRAL] Uh, for the claim to be processed, so I don't understand why y'all can't request that from the provider if you're needing additional information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, if whenever if you submit the information to us we usually will request it from you and so it looks like this claim was processed back in February and on that one.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] For the [PII], I guess he has a surgical procedure. Uh, there were no benefits for that one because the policy does not have a surgical benefit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It was not. Well, it's radiation. It was radiation. The radiation.
[AGENT][NEUTRAL] Was the was the radiation.
[AGENT][NEUTRAL] Was there radiation done on [PII]?
[CUSTOMER][NEUTRAL] It's, it's they're, they're radio, let me talk, they're radioactive seeds that are implanted into the prostate.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's the exact same outcome as if he had went every single day for 6 weeks for radiation.
[CUSTOMER][NEUTRAL] Therapy.
[AGENT][NEUTRAL] OK. All right. So, we do not have, we have to have the procedure code. So, on this surgery, the surgery, we have the notes from the surgery that he had on [PII], but it does not give us any procedure codes. So in order for us to pay for that, we would need the procedure codes and the charge amounts.
[AGENT][NEUTRAL] So that we would know how much he was charged for that, for the, for that procedure.
[AGENT][NEUTRAL] Or if they, if they
[CUSTOMER][NEUTRAL] And you're telling me you you cannot request that from the provider.
[AGENT][NEUTRAL] I can see if we can call to get that information from them uh but if they state that they can't give it to us because they don't have an authorization, let me see if we have an authorization on file so that we can request it.
[AGENT][NEUTRAL] And it may take some time, uh.
[CUSTOMER][NEUTRAL] Well, it took time to get $100 out of you. I've already made that back premium.
[AGENT][NEUTRAL] Yeah, so we do, we do have an authorization so I will see if we can kind of reach out to the provider tomorrow to see if they can send that information over to us.
[CUSTOMER][NEUTRAL] Did y'all give me a call back and let me know?
[AGENT][NEUTRAL] I can. Can I get the call back number for you?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And, and your name is [PII]?
[AGENT][POSITIVE] Yes ma'am, that's correct.
[CUSTOMER][NEUTRAL] Do you have a direct line that we can contact you if we don't hear something?
[AGENT][NEUTRAL] No ma'am, you can just always call back and um go through the um.
[AGENT][NEUTRAL] Go through the care team and they can uh help you or either they can transfer you to me.
[CUSTOMER][NEUTRAL] OK, do you have a last name [PII]?
[AGENT][NEUTRAL] We don't give out that information. I'm the only [PII] here.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and um
[AGENT][NEUTRAL] Uh, and can I get your wife's name? just in case?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and she's authorized to talk for me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, uh, we'll try to go ahead and get a phone call over to the providers on tomorrow. uh, I'm not sure how long it would take for us to contact them because sometimes, you know, you have to go through different channels to try to get to the department that you need, but I will try to make sure that I give you a call back tomorrow to let you know whether or not we were able to contact them or if we were not able to contact the provider.
[CUSTOMER][POSITIVE] I appreciate that. OK, thank you.
[AGENT][NEUTRAL] Alright, did you all have any other questions for me today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] No, ma'am, I don't.
[AGENT][POSITIVE] OK, well thank you guys for calling APL. You have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye.