AccountId: 011433970860
ContactId: 114a8884-c672-4715-9e04-35892a082ebf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1530780 ms
Total Talk Time (AGENT): 378214 ms
Total Talk Time (CUSTOMER): 671771 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/114a8884-c672-4715-9e04-35892a082ebf_20250509T20:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, [PII], my name is [PII], and my husband is [PII], and I have a cancer policy, and I talked, spoke with the person at this number last week, and she told me what my, um, the amount my claim was rewarded for, and she said I would probably have it by Wednesday, but
[CUSTOMER][NEGATIVE] It's Friday, and that was Friday of last week. And she said I should have it by today, but it still says in progress. But she told me the amount, so she sent me it was done, but I still don't see it on my online.
[AGENT][NEUTRAL] OK, do you have your policy number?
[CUSTOMER][NEUTRAL] I don't. I'm actually in my car coming back from somewhere and I realized it was Friday and I needed to call before it got too late and I'm in my car. He's, I can give you whatever information I can.
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] Uh, do you have your social?
[CUSTOMER][NEUTRAL] My social and it was through me it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK, and then can you verify your date of birth for me, please, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK. My date of birth is [PII].
[AGENT][NEUTRAL] And what is your address?
[CUSTOMER][NEUTRAL] My address is [PII].
[AGENT][NEUTRAL] And do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK, I'm at [PII].
[AGENT][NEUTRAL] And then lastly, what is your email address?
[CUSTOMER][NEUTRAL] It's my first name [PII].
[AGENT][NEUTRAL] OK, let's see
[AGENT][NEUTRAL] And this is claim for your spouse, is that right?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEGATIVE] And it's on my cancer it's my cancer policy. I have to my cancer policy.
[AGENT][NEUTRAL] Uh, do you know what date of service that was for? I see one for.
[AGENT][NEUTRAL] Um, we paid out on [PII] direct deposited. Did you receive that payment?
[CUSTOMER][NEUTRAL] That it was 4000 some odd dollars.
[AGENT][POSITIVE] Yes, that's right.
[CUSTOMER][NEUTRAL] I, I, I received that one. It's, it's the one that has 3, they're almost identical right there together.
[CUSTOMER][NEUTRAL] I can't remember the date and I'm not looking online. I just did on my phone.
[AGENT][NEUTRAL] OK, um, let's take.
[CUSTOMER][NEUTRAL] And it says in progress.
[AGENT][NEUTRAL] Um, we have one for
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, that one we
[CUSTOMER][NEUTRAL] And that was 260.
[AGENT][NEUTRAL] Yeah that one
[CUSTOMER][NEUTRAL] It was a wellness, I think.
[AGENT][NEUTRAL] And that was a radiation claim, uh, claim for radiation.
[CUSTOMER][NEUTRAL] Probably so. I haven't gotten, uh, we got the first one we got was uh for wellness, and it was 260, I think, something like that. And then we, we received the one for 4000, which I think is the cancer plan. I'm not real sure. I've sent so many I've forgotten. And then I sent the three that say in progress are the same file.
[CUSTOMER][NEUTRAL] It's the same file. It's just, I, it would not go so I tried it 3 times, but the girl I talked to on Friday said yes it was received.
[CUSTOMER][NEUTRAL] And she even told me what they, what they were gonna pay was $11,000 some odd dollars. And she said you should have it by Wednesday. Well, when it's Friday, so.
[CUSTOMER][NEUTRAL] I thought, well, maybe I need to call. Maybe there's something else I need to send.
[AGENT][NEUTRAL] Yeah, I'm trying to see it, it said that.
[CUSTOMER][NEUTRAL] I did not
[AGENT][NEUTRAL] Um, it said the maximum was met for the policy, but that's what I'm trying to figure out is how it was met, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me pull up the policy and look at what's covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like under this policy, and this is not a guarantee of payment, it's a basic outline. So the actual, so this policy, the payout is is um determined by the actual charges.
[AGENT][NEUTRAL] So once, once you've submitted actual charges of 15,000.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] We've, it's been met. So it looks like
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That that one satisfied that $15,000 benefit because it's not a $15,000 benefit payable, it's when you submit charges totaling $15,000.
[AGENT][NEUTRAL] We will pay out up to that point.
[CUSTOMER][NEUTRAL] OK, so you're saying everything's paid up?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] In a 12 month period.
[CUSTOMER][NEUTRAL] So far, because
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so is
[CUSTOMER][NEUTRAL] OK, well then why would she tell me I was to get $11,000 some dollars by Wednesday?
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEGATIVE] That I can't figure out.
[CUSTOMER][NEUTRAL] She said it had just been completed.
[CUSTOMER][NEGATIVE] Because I don't think they've actually paid the last, the last one I sent was 20 pages long.
[CUSTOMER][NEGATIVE] And I don't think they, you've paid, they paid anything on it. It was for the actual radiation treatments and
[CUSTOMER][NEGATIVE] There should have been the only ones I got the itemized thing that I got from y'all and from online, it didn't pay for all the treatments. We had 28 treatments altogether and that was not for 28 treatments.
[CUSTOMER][NEUTRAL] That was a, a piece of it.
[AGENT][NEUTRAL] Let me pull up the claim itself and see what we received.
[CUSTOMER][NEUTRAL] OK, see if it's the 20 page one because I've sent several like I said, as they came in to me, I just sent them.
[CUSTOMER][NEUTRAL] But those were actual.
[CUSTOMER][NEGATIVE] Ones I had scanned, the ones that say in progress, I scanned those myself and the files were way too large.
[AGENT][NEUTRAL] OK. I see the radiation, uh.
[AGENT][NEUTRAL] Let me pull up and we received, it looks like the claim itself from [PII] Medical.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII] is calling melawas is calling me.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, let me, I found where you're talking about. OK, hold on one moment, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] Well let me get you to our claims department because I do see where it it shows that 11,000 but I don't know why it it doesn't have any remarks by it so I'm not sure why it's.
[AGENT][NEUTRAL] I'm not understanding why it's pending so our claims department can look into it further than I can um do you mind if I get.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] Say it one more time, I'm sorry.
[AGENT][NEUTRAL] Is it OK if I transfer you over to our claims?
[CUSTOMER][NEUTRAL] Yes, yes, it kind of skipped. I'm traveling, so yes, that'll be fine, thank you.
[AGENT][NEUTRAL] OK, hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He sees 11,000.
[CUSTOMER][NEUTRAL] There's
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Oh, [PII], it's [PII] and the care team. I've got an insured on the line calling on claim status, and I'm not sure what's going on with the claim, so I was gonna see if you could help them or help me, um, if it's an easy explanation.
[CUSTOMER][NEUTRAL] Certainly
[CUSTOMER][NEUTRAL] [PII], what's the uh policy number?
[AGENT][NEUTRAL] It's 711167.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me take a look here.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Yes, and it's for her spouse. They're in the car together. Um, I verified her information.
[AGENT][NEUTRAL] It's for [PII]. There's 3, there's three claims in there that have a stat date of [PII], but, and, and it shows a potential payout of over 11,000.
[AGENT][NEGATIVE] But we received them on [PII] and nothing's been done, so I don't, and there's no comments by the radiation charges so I don't understand what's what's happening.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's what they're questioning is the radiation, um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I'm not sure what's going on with that. The [PII] usually means that it's.
[AGENT][NEUTRAL] And processing, but that's really old.
[AGENT][NEUTRAL] I mean, I know your turnaround time faster than that, so.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I just didn't know what to tell her.
[CUSTOMER][NEUTRAL] Might be
[CUSTOMER][NEUTRAL] Right, and then I see another one that was processed for radiation that was for the March services. It looks like that one processed.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEGATIVE] Yeah, we got, we got the one that processed [PII], um, and it says it's denied for Maxnet, but.
[AGENT][NEUTRAL] But I, and then also what was throwing me off was on the policy certificate it says actual charges to 15,000. So I, I'm assuming it'll pay out 15,000 on the policy, that's my assumption.
[AGENT][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] So it looks like that one that's pending it's just not been released I'm guessing.
[CUSTOMER][NEUTRAL] So I'm not sure why I would probably have to reach out to the adjuster looks like because I'm not sure on that to me because like what that looks like to me is it's in the final processing stage but it's not been released but like you said that that date is, I don't know when she processed it.
[AGENT][NEUTRAL] Yeah, and what
[CUSTOMER][NEUTRAL] Um, it looked it to me if I was looking at it right now without you, it would, I would tell me that it's been sent to audit basically so like that for that amount that adjuster can't release it so she sent it to audit and it's up to the auditors to release it.
[CUSTOMER][NEUTRAL] Is the way it looks at this point because it doesn't show there's been any check or any direct deposit authorized as of yet, but with that uh [PII] date in there that shows me that it's like in that process and it it most likely went to audit and it's waiting let me see if I can find the status this way bear with me for just a moment.
[AGENT][NEUTRAL] OK, it's just she's uh just concerned or a little she she called last Friday. It's been a week, um, she talked to one of somebody else on the care team. I'm sure they sell the same thing I did, so they were like, give it another week, um, because we've got notes in there from another care team member from last Friday telling her, yeah, it's in processing you should get it by next Friday, so.
[CUSTOMER][NEUTRAL] So it's been in that status since then you think?
[AGENT][NEUTRAL] It's been in that status since [PII], so it's been, does it typically take the auditor seven days or a week to.
[AGENT][NEUTRAL] Release
[CUSTOMER][NEUTRAL] Not usually and that's what I'm looking at now to see if there's any notes because usually they'll tell me what queue it's in.
[CUSTOMER][NEGATIVE] When you pull it up by the mail number but it's not, it's not telling me that's where it's at so it's almost like it's kind of lost in.
[CUSTOMER][NEGATIVE] Lost somewhere
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And from what I'm seeing when I pulled the mail, it looks like it's completed so.
[AGENT][NEUTRAL] I just don't know what's
[CUSTOMER][NEUTRAL] I guess the best thing we could do, yeah, um, I guess we need to reach out to the adjuster and ask her if she can review it and let us know what the status is, um.
[CUSTOMER][NEUTRAL] And we're just speaking of that 4359-4422 claim.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Um, I mean, I, I guess probably the best thing would be to let me see, do you wanna go, I'm gonna send a message to April. That's who the adjuster is on this and see if she can just take a quick peek at it and let us know what the status is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if you wanna uh they you said they're in the car on the phone, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so I sent a message to her and see if she responds because I'm not really sure other than to tell him it's in the final processing stage because at this point that's normally what you know it looks like but like I said when I pull up the mail, it looks like it's completed so it's not, it's not been released or sent back to the adjuster because usually there would be some kind of pin code there.
[AGENT][NEUTRAL] OK, um, do you know what I should tell the member?
[CUSTOMER][NEUTRAL] Um, if you wanna come either get a phone number from them if unless they wanna hold, um.
[AGENT][NEUTRAL] If I get a phone number
[CUSTOMER][NEUTRAL] I'm waiting for her to respond.
[AGENT][NEUTRAL] Can I send it to [PII]?
[CUSTOMER][NEUTRAL] Um, or to me. She's, she's looking at it now. She just said hello, OK, so she's gonna take a look at it.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] All right, let me, let me get her back on it.
[CUSTOMER][NEUTRAL] If you want, if you, yeah, I was gonna say if you wanna get back with her and let her know that we're checking on it and, and ask if they wanna hold or if they wanna call back.
[AGENT][NEUTRAL] OK, OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] They picked it.
[AGENT][NEUTRAL] OK, I'm so sorry for the long hold. We're actually checking with the processor to see what what's going on. So do you mind holding just a minute more or do you want me to call you back?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that's
[CUSTOMER][NEUTRAL] No, it's OK. I'll hold.
[AGENT][POSITIVE] OK, hold on one moment. Thank you so much. I appreciate your patience.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I told her she, she wants to hold.
[CUSTOMER][NEUTRAL] OK, I figured that you were gonna say that usually they don't wanna call back because they don't know if we're gonna actually call them back.
[AGENT][NEUTRAL] Our money.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Sorry I'm eating some chips.
[CUSTOMER][POSITIVE] Oh, you're fine, absolutely fine.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, I'm thinking that that's what happened either there was.
[CUSTOMER][NEUTRAL] It it set back from audit or someone didn't release it or something happened here because I don't see anything wrong with it other than like I said I don't see any notes so.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I think it just didn't get released for some reason.
[AGENT][NEUTRAL] Hopefully.
[AGENT][NEUTRAL] If it gets released, do you know when that typically would direct deposit? Would that be like Monday, Tuesday, or?
[CUSTOMER][NEUTRAL] Yeah, I usually tell them.
[CUSTOMER][NEUTRAL] OK, she said it was sent to audit but not released, so she was gonna call [PII], and [PII] is the audit her auditor I guess for her team so um.
[CUSTOMER][NEUTRAL] So usually what I tell them once it's released I usually tell them it's like 1 to 3 business days for a direct deposit most of the time it'll go in that next day, but because you know today of course typically Friday, um, it's probably gonna be Monday or Tuesday I would think.
[AGENT][NEUTRAL] You know, [PII]'s here.
[CUSTOMER][NEUTRAL] And they
[CUSTOMER][NEUTRAL] I think so.
[CUSTOMER][NEUTRAL] Let me check.
[AGENT][NEUTRAL] I didn't know. Is she checking with her now or should I uh
[AGENT][NEUTRAL] Should I, um,
[CUSTOMER][NEUTRAL] Well she said she was gonna call her so.
[AGENT][POSITIVE] Oh, OK, cool.
[CUSTOMER][NEUTRAL] I'm, I'm assuming that she's just gonna was gonna give her a call, so I think [PII]'s getting ready to leave at [PII], so hopefully she can get her before she leaves.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It does show her to be offline so she may not.
[CUSTOMER][NEUTRAL] Hopefully she can grab her before she leaves.
[AGENT][NEUTRAL] Is it typically like a claim that pays out over 10,000? Is that like an audit claim? Is that usually how it works, or does it depends?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Usually because it it right it it depends on that amount and what that adjuster um their what their limit is to release um but you know typically these larger claims like this they would you know require um someone, you know, above, uh, an adjuster more than likely to release it because it is over 10,000 so I believe that generally yes it would go, it would be the auditors that release anything than those larger claims.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Makes sense.
[CUSTOMER][NEUTRAL] So I'm uh.
[CUSTOMER][NEUTRAL] I'm still waiting to see if she responds. It does look like she's red as well, so it does look like [PII] maybe was able to grab her before she left, so.
[AGENT][POSITIVE] Oh, good. OK.
[CUSTOMER][POSITIVE] Hopefully she can, she'll respond to us here.
[AGENT][POSITIVE] Hopefully I can give her good news.
[CUSTOMER][POSITIVE] Right, absolutely.
[CUSTOMER][NEUTRAL] I've never
[CUSTOMER][NEUTRAL] I've never seen one like this before where this has happened.
[AGENT][POSITIVE] Yeah, I know y'all are really fast on your turnaround time, so that's why I was surprised.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] OK good she said she just released it.
[AGENT][POSITIVE] Oh, awesome. Awesome, awesome. Cool. OK, so, probably tell her no later than Tuesday, that should be direct deposited.
[CUSTOMER][NEUTRAL] Yes, um, she's typing me another message, so just hang tight one second, see if she says anything else, OK.
[AGENT][POSITIVE] She's still on the line, so we're good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yep, now, uh, let me see if I refresh if it's showing yep, OK, good, so it is showing that why now so when you refresh it, it, it does show it was released. So yeah, just let them know that, um, and I would just tell them that it was in that final processing stage but it now has been released and that um typically like I said that 1 to 3 days, OK?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you so much for your help. I appreciate you.
[CUSTOMER][POSITIVE] No problem [PII].
[AGENT][POSITIVE] OK, have a good weekend.
[CUSTOMER][POSITIVE] Have a great weekend, thank you.
[AGENT][POSITIVE] Thanks bye.
[CUSTOMER][NEGATIVE] Like no.
[AGENT][POSITIVE] OK, thank you so much for your patience and holding. So, uh, good news, it's been released. um, this should hit your account no later than Tuesday, and that's for, let me get the direct amount for you.
[CUSTOMER][NEUTRAL] You're.
[AGENT][NEUTRAL] It because it was over $10,000 it has to go to another supervisor to be released and that's um sorry about.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Oh, I got you.
[AGENT][NEGATIVE] I took so long.
[CUSTOMER][POSITIVE] Oh, it's no problem.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] And it was 11,000 something is what she told me.
[AGENT][NEUTRAL] Yeah, 11,000
[CUSTOMER][NEUTRAL] I'm writing it down, so.
[AGENT][NEUTRAL] 11,87775.
[CUSTOMER][NEUTRAL] Oh my [PII].
[CUSTOMER][NEUTRAL] OK. All right. Well, I was, I was thinking maybe it was because I didn't have the explanation of benefits for all of it. I was thinking maybe that was the hold up and I may have that in the mail today. It looks like something's coming from my insurance, but anyway, if you say it's been released, we're good.
[AGENT][POSITIVE] OK. Well, thank you again, I appreciate your patience, really appreciate you and I hope, I hope y'all, I hope y'all have a good weekend.
[CUSTOMER][POSITIVE] Oh no problem, no problem, no problem.
[CUSTOMER][POSITIVE] OK, you too. Thank you.
[AGENT][POSITIVE] Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.