AccountId: 011433970860
ContactId: 19bc3ca1-4158-4d3a-a215-b7c38fb632dd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 528099 ms
Total Talk Time (AGENT): 182028 ms
Total Talk Time (CUSTOMER): 311802 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/19bc3ca1-4158-4d3a-a215-b7c38fb632dd_20250501T19:32_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh, I need some help with uh claim stuff, something on a claim.
[AGENT][POSITIVE] OK, well, I can definitely help you with your claims. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Thank you, Ms. [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] 00640053
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII] [PII] and what you said social security number, is that the thing?
[AGENT][NEUTRAL] Oh, no, ma'am. Your um date of birth, your email, and your mailing address.
[CUSTOMER][NEUTRAL] What was the other
[CUSTOMER][NEUTRAL] OK. What, what if I'm not giving you though? I don't, the mailing address, I, I, I
[AGENT][NEUTRAL] You gave me your
[AGENT][NEUTRAL] You gave me the date of birth and the um email address. I just need the mailing address.
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how may I help you with your claim?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. The claim number is 3586698.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment. 669 8.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I have it here and um what's going on with the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. The, the last thing on there was you wanted, says you couldn't, you needed EOBs on the claims from 128 to 318. I mean, I, we've uploaded them, but some, some way you said you couldn't read them. So I didn't know what else to do but to mail them to you. I don't know if you got them or what. What, what about we supposed to do, reload them or what? My daughter does this for me. She loads them from.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] You
[CUSTOMER][NEUTRAL] But I, I just put them in the mail and mail those to you cause I didn't know if you didn't, we uploaded them, you might not could read them again.
[AGENT][NEUTRAL] Oh, yes, ma'am. Um, so it's up to your preference. You can mail it in or you can upload it, um, either or if, if you feel more comfortable.
[CUSTOMER][NEUTRAL] But I mailed it [PII]. I mailed it like two weeks ago.
[AGENT][NEUTRAL] So let me
[AGENT][NEUTRAL] So let me see if we've received it. Hold on one second.
[CUSTOMER][NEUTRAL] And she can upload them again, but I don't, I don't know why.
[AGENT][NEUTRAL] And what mailing address uh did you send it to?
[CUSTOMER][NEUTRAL] I don't, I don't know what to do.
[CUSTOMER][NEUTRAL] To this [PII].
[AGENT][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I was just asking because we used to have one in [PII], so I just wanted to make sure you you didn't send it to the old one, but that's the correct one.
[CUSTOMER][NEUTRAL] Oh, OK. Yeah.
[AGENT][NEUTRAL] Um, but I'm not showing that we've received it yet though, um, but I mean it is coming to [PII]. So,
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Mhm. Well, does she just need to, what to, to upload them again, what does she need to do? Just uh send them to you again on the upload? Does she have to reference something or since she's already, you know, since she's already sent them one time, just to upload those 4 again then?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Oh, no, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. So once she uploads it it's.
[CUSTOMER][NEUTRAL] It's 4
[AGENT][NEUTRAL] When she uploads it, it's going to look like it's another, you know, like another um claim being submitted, but that's OK. It does that every time and then um we'll know that this is the additional information because and then we'll go ahead and continue processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I, I, I mean, I know you've already paid all the chemotherapy you're gonna pay for this year. It just says, list those claims and it says to upload them again. It said drugs and the service design, it said.
[CUSTOMER][NEUTRAL] Drugs that cancer drugs. So, I mean, I don't know what you're gonna pay cause you're not gonna pay any chemo on them. So, but anyway, we'll send them again. But I, I, I guess I'll still get mileage. Is that all I'm gonna get for the rest of the year till November again.
[AGENT][NEUTRAL] Um, what do you
[CUSTOMER][NEUTRAL] Is that all I'm gonna get paid on?
[AGENT][NEUTRAL] You mean in terms of everything else has has met its max?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because you can, you can file as long.
[CUSTOMER][NEUTRAL] The, the it says the chemo.
[CUSTOMER][NEGATIVE] I know, but it says the chemo treatments, every time we send something on them, it says you've met your maximum for the year and then they're not gonna pay anymore till November.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I mean, that's not much, it didn't pay but like $7500 on chemo and I paid my treatments cost $500 or $60,000 every time I get one.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] But that's, there's, there's always that little um
[AGENT][NEUTRAL] So yes.
[CUSTOMER][NEUTRAL] Little a note out to the side and it says option 4 I think means you've met your, you've met your max for the year.
[CUSTOMER][NEUTRAL] Maximum for the chemo and radiation has been met, so.
[AGENT][NEUTRAL] Yes, I see what you're talking about now. Yes, OK, I had to get up to speed. I, I see what you're saying on this claim, yes, but email does say that the benefit period, um, the max has been met. So yes, for that part up until November, the mileage would be um what we could, could possibly pay out on and then like if there's anything like this that you're getting ready to submit, we'll go ahead and um process that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I mean, I just, I don't really know what it, what you're even looking for on those dates then says but I will send them again because y'all asked for them, but I know it's not gonna pay anything on the chemo, but the definition out to the side just.
[AGENT][NEUTRAL] Well, you have a
[AGENT][NEUTRAL] You have a drug and medicine benefit and then you, that's separate from chemo, so there could be a payout for that.
[CUSTOMER][NEUTRAL] Excuse me, go ahead.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK, so it could pay or something on something else besides just the chemo then. OK, so she just needs to upload those, those 44 again and she don't have to reference it as reloading. She just uploads them again, right? That's all she's got.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am, she just reload.
[AGENT][NEUTRAL] reupload them and they'll see that data service and match it to that claim there.
[CUSTOMER][NEUTRAL] OK. All right. And because, because you didn't get the ones I sent, I'll just tell her to upload those again and um we'll, but when you do get them, they'll be something out there on your website that's showing that that's another that that claim is open or some way I know that it's, you know, you've gotten it.
[AGENT][NEUTRAL] Right, so when we, when we receive it, you'll see, uh, well, first you'll get the confirmation number as soon as she sends it in. If you don't get the confirmation number, then it didn't send correctly. But that confirmation number will let you know and then um the um what am I trying to say, you can follow it on the online service and as it's processing and it will let you know when it's done.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right, but I remember now I always get an email saying that you see the information when she uploads something. So I'll just look out there and, and then on your website, it shows me, you know, I can look at the claim and see what you're doing. So we'll just resend those EOBs again and for whatever uh.
[CUSTOMER][NEUTRAL] It might pay, but mileage, the last time it paid any mileage was on [PII]. So, uh, any claims after that, I hadn't gotten any mileage on anything past [PII]. So, OK. All right. Well, I'm just trying to figure out how, what needs to be done then. And I appreciate your help then. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, ma'am. I think that'll get me, get us where we need to be, OK?
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you have a good day and a good weekend.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. All right, bye.
[AGENT][NEUTRAL] Bye-bye.