AccountId: 011433970860
ContactId: 1557b638-deec-4e92-b2a5-dc72699f40fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 777429 ms
Total Talk Time (AGENT): 301495 ms
Total Talk Time (CUSTOMER): 286703 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/1557b638-deec-4e92-b2a5-dc72699f40fa_20250327T14:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. My husband has a policy with y'all and I'm insured under there.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I'll send you a claim form.
[CUSTOMER][NEUTRAL] I don't know, it's almost probably about 2 months now and I just heard it something.
[CUSTOMER][NEUTRAL] And uh I was just wondering if you can help me out with something.
[AGENT][NEUTRAL] Yeah, absolutely, [PII]. We can look at the claim. Do you have the policy number?
[CUSTOMER][NEUTRAL] Let me see if I can find it.
[CUSTOMER][NEUTRAL] 9 A as in apple 010335.
[AGENT][NEUTRAL] Alright, let me pull this up here. Give me just a second.
[AGENT][NEUTRAL] Alright, [PII], bear with me just a second. I think this is an older policy.
[CUSTOMER][NEUTRAL] Oh yes, [PII] old.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Do you need my claim number maybe?
[AGENT][NEUTRAL] Yeah, we can try that if you have a claim number, go ahead.
[CUSTOMER][NEUTRAL] 357-6791
[AGENT][POSITIVE] Thank you so much. Let me try that here.
[AGENT][NEUTRAL] Alright, and then just for security, [PII], I will need to verify please your date of birth and address.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much and then last piece is can you verify the email we would have on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. All right. So let's see.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I mean, I send in everything they had told me to send in and.
[CUSTOMER][NEGATIVE] I don't think they paid anything on this time either.
[AGENT][NEUTRAL] Yeah, let's see what's happening here.
[AGENT][NEUTRAL] OK, let's see what.
[AGENT][NEUTRAL] OK, so one of the denials on here Dolores looks like is saying.
[AGENT][NEUTRAL] Surgical benefit is payable one operation. It says 2 or more procedures performed through the same incision are considered one operation. Our records indicate that 2 or more surgical procedures were performed on this date. We have paid the greatest benefit amount payable between the surgeries performed.
[CUSTOMER][NEUTRAL] OK, so I have never ever.
[CUSTOMER][NEGATIVE] Got any money from American public other than my one time occurrence. I have sent in multiple, a lot of paperwork and I've never even got a payment from y'all.
[CUSTOMER][NEUTRAL] So I don't know where they say that they paid it.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] First current benefit.
[AGENT][NEUTRAL] I see that.
[CUSTOMER][NEUTRAL] That's the only time I received, received.
[CUSTOMER][NEUTRAL] Anything and I've sent in.
[CUSTOMER][NEUTRAL] Mileage I sent in uh
[CUSTOMER][NEGATIVE] Biopsies. I've sent in my cancer, you know, my chemo and immunotherapy. Never got a payment from nothing.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm, OK. Let me see.
[CUSTOMER][NEUTRAL] Does it show that they're they're gonna pay something?
[AGENT][NEUTRAL] And this particular claim, it was, it looks like was denied and that was one of the denial reasons um there were a couple others I can look at here. Let's see.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] There's 7 of them. I mean.
[CUSTOMER][NEGATIVE] When they, when I send in my first claim, they said they needed all this other stuff, so then I send it all in and they still denying it.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Transportation.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I understand that when I first went to [PII], they said it was under 50 miles.
[CUSTOMER][NEUTRAL] But I've been going to [PII], which is 193 miles one way.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] And I've been sending dates and I have never received no money for that.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yeah, there was a lot of, cause even the transportation, it says.
[CUSTOMER][NEUTRAL] Um, you know, I've had chemotherapy and immunotherapy, and I put my date and now I just had surgery last Wednesday.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I don't know exactly what they want. I had a uh a lobectomy.
[CUSTOMER][NEGATIVE] That's why I'm kind of hard to trying to breathe good. And then you get stuff like this and you, you know, you send it all kind of stuff and you, they don't pay nothing. I mean, I haven't received.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Nothing.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Have you, OK, yeah, um, I just, I see what you're talking about because I see the first occurrence that was paid back in [PII] at the end of the year, but it looks like going forward, it looks like there's been some denials and stuff like that. Um, I think that the best thing that maybe
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] A bunch of them.
[AGENT][NEUTRAL] To do, Dolores is, um, if you're OK with it, I can create um
[AGENT][NEUTRAL] A request to have somebody in the claims department that's an examiner.
[AGENT][NEUTRAL] Uh, give you a call and go over this that way they can look at exactly what is needed. I'm not a claims examiner, um.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And so, yeah, so I mean I see the the reason for the denial, like the transportation, it looks like they denied it just because all the other stuff was denied. You see what I'm saying? Like it's saying, well,
[CUSTOMER][NEUTRAL] Yeah, I understand.
[CUSTOMER][NEUTRAL] And, and I had talked to, I had, I had talked to a lady about that and she's like, I'm sending it back to them because you're going to [PII], so she says, you know, that's over 50 miles. I'm like, yes, ma'am.
[AGENT][NEUTRAL] Right, right, right.
[CUSTOMER][NEUTRAL] And I never heard anything like on, on this last claim.
[CUSTOMER][NEUTRAL] That I sent in
[CUSTOMER][NEUTRAL] Are they gonna pay anything on the what I sent in?
[AGENT][NEUTRAL] Right, OK. So,
[CUSTOMER][NEUTRAL] Are they?
[AGENT][NEUTRAL] I, I mean, I believe that like based off of, I mean, you've only had the first occurrence, it seems like there should be something additional on on your policy for sure.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'll send them send in stacks of papers and.
[CUSTOMER][NEUTRAL] It's, it's unreal. I mean, what else more do they want?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Is this, uh, what is a good call back number for you, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm going to create a callback request and send it to claims. I'm gonna include this claim number and let them know that you need to know what else is needed and I will also put in the notes that um.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEGATIVE] You know, you're just frustrated at this point because you've submitted a lot of claims and you've not had any success with getting anything paid out.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, and then hopefully if they can look at this and then just be able to tell you you need A, B, and C those things because you should not have to resubmit anything that was already submitted. All that stuff is still there, you know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the first time, you know, they sent me this explanation of benefits. I called them, they tell me, they told me what I needed, and I just send in a bunch of stuff and then now they're sending it again.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Nothing's getting paid. I don't, I don't understand.
[AGENT][NEUTRAL] Right. Right.
[AGENT][NEUTRAL] Right. OK. Well, [PII], I will most definitely have somebody call you back and then go over this with you. Um, do you have any other questions or concerns before I let you go?
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it's my bills are coming in and
[CUSTOMER][NEGATIVE] If I don't have my cancer money to pay it, they don't get paid.
[AGENT][NEUTRAL] Yes, ma'am. I understand.
[CUSTOMER][NEGATIVE] Now I did read up on there for a low the net to me they're gonna pay me $4200 now. I didn't, you know, get all my paperwork with that. Are they gonna deny that? Come on now.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] And then they said something about they would pay $2500 on uh my chemo and my immune therapy. Never heard nothing from that. I don't, you know, they don't say what they need, they just say what they deny it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] So I'm just a little frustrated today.
[AGENT][NEUTRAL] Yeah. No, definitely. And when the claims, yeah, and when the claims examiner calls, um, and you speak to them, it's like you said, you had that lumpectomy, like if you need to um go ahead and see, they can tell you what would be needed, you know, for that if you're gonna submit that separately.
[CUSTOMER][POSITIVE] But I appreciate it.
[CUSTOMER][NEUTRAL] Yeah, well, that, that'll be my next one in the hospital and then they said to pay uh so much on a um.
[CUSTOMER][NEUTRAL] Uh, uh, hotel for my husband to stay in while I was in the hospital. So,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I mean, every time I do something, they say, oh no, we gotta do this, you know, you didn't do that, you didn't do this, and it's like, oh God. And they don't want my husband to get on the phone. I've been paying for 33 years on this and now I need it.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] It's aggravating.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Um, I'm so sorry for the frustration [PII]. Hopefully we can get it squared away. Uh, my name is [PII], and, um, like I said, I put in for the call back from claims, so somebody should be reaching out, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you. Have a great day.
[AGENT][NEUTRAL] You too.