AccountId: 011433970860
ContactId: 23864f40-6d3a-4c3d-b19a-936656b98280
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 967539 ms
Total Talk Time (AGENT): 273224 ms
Total Talk Time (CUSTOMER): 187470 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/23864f40-6d3a-4c3d-b19a-936656b98280_20250217T22:32_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. I, um, just sent in some information about a claim and I'm just needing some help with it.
[CUSTOMER][NEGATIVE] To understand what all I'm trying to, I mean, I'm very overwhelmed because I, you know, I have so many bills and what all I need to be sending in and then kind of clarification on how I do the mileage that kind of stuff but.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the one I just sent in.
[CUSTOMER][NEUTRAL] I don't know if you need any information for me to pull it up.
[AGENT][POSITIVE] Yeah, if you have your policy number, whatever, yeah, absolutely.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Policy number is 02428939.
[AGENT][POSITIVE] OK, thank you so much. Let me just pull this up here.
[AGENT][NEUTRAL] And if I could get your first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you [PII] and then last piece of verification that I do need is the address and email address on file.
[CUSTOMER][NEUTRAL] It's probably the [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the email, uh, same as my workman [PII].
[AGENT][POSITIVE] Yes ma'am, thank you so much.
[CUSTOMER][NEUTRAL] If not, it could be my home. OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so let me look at claims here.
[AGENT][NEUTRAL] So, I see.
[AGENT][NEUTRAL] You said that you just did some online is that correct?
[CUSTOMER][NEGATIVE] Yes, I just received a check today, but there's a lot of missing information.
[CUSTOMER][NEUTRAL] Um, that I need to clarify and see what, what I need.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you get a claim number in response to what was requesting additional info?
[CUSTOMER][NEUTRAL] Um, let's see on here.
[CUSTOMER][NEUTRAL] I mean, it has the remarks, it has.
[CUSTOMER][NEUTRAL] Oh, here's a claim number up here for this claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what is that?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 3561086
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do see that so let me see here.
[CUSTOMER][NEUTRAL] So the first thing I was gonna ask is, like this is my first diagnosis on this cancer.
[CUSTOMER][NEUTRAL] So do they provide you anything at the first initial?
[AGENT][NEUTRAL] Oh, like a first occurrence benefit?
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Like this is my um initial biopsy of this cancer.
[AGENT][NEUTRAL] OK, let me see if your plan has that a month.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I'm pulling up the policy here to take a look, so just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still scrolling through here. I'm sorry for the wait.
[CUSTOMER][NEUTRAL] No, there's, it says a lump sum for internal cancer.
[AGENT][NEUTRAL] Yeah, it looks like 5000.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] But um my deal is I had.
[AGENT][NEUTRAL] So it does
[CUSTOMER][NEUTRAL] I had breast cancer and I did get initial sum.
[CUSTOMER][NEGATIVE] But now I have a different cancer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I'm not sure on that. I know I've read before that when it was the 2nd time, it was a lower amount or something or, but I'm not sure where that is.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] First occurrence, let's see.
[CUSTOMER][NEUTRAL] And maybe I was reading the older the year before that and it's changed. I
[AGENT][NEUTRAL] Yeah, I don't know.
[AGENT][NEUTRAL] I'm looking at the schedule benefits page to see if I see anything that says.
[AGENT][NEUTRAL] Like if you're
[AGENT][NEUTRAL] Diagnosed with a different
[AGENT][NEUTRAL] I see like 2nd 3rd opinion.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah, I don't see anything in here about like um a second diagnosis if it would pay any sort of lump sum if it were different.
[AGENT][NEUTRAL] Um, the only thing additional I see is that you had the writer for like heart attack and stroke for that lump sum benefit.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so I, I don't see anything else as far as lump sums.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. Just the first time ever any cancer and then after that, it's
[AGENT][NEUTRAL] Yeah, it's just gonna pay for like the treat yeah, treatments or um uh like if you got a second or third opinion, it would pay for that.
[CUSTOMER][NEUTRAL] There's no
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it has a, you have medical equipment. It looks like maximum one benefit per covered person per calendar year. There's some therapy, like as far as occupational um stuff like that that's covered too.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, let's go back to the claim.
[CUSTOMER][NEUTRAL] Where it's saying some it still needs things.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Surgery charges not.
[CUSTOMER][NEUTRAL] Like on the mileage.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] On the mileage one and it says need home address. I had my home address on there.
[CUSTOMER][NEUTRAL] I'm not sure.
[AGENT][NEUTRAL] For the transportation portion.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Maybe if I look at it, cause I'm.
[CUSTOMER][NEUTRAL] Cause it says more than
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] But it says more than 50 miles away and it was 150 miles away, so I know that's.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I'm wondering if it's facing it.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Because you have a PO box.
[CUSTOMER][NEUTRAL] I'm wondering if they're gonna be.
[CUSTOMER][NEUTRAL] Right, but I, on this last one.
[CUSTOMER][NEUTRAL] I don't know there was the place and I put my home address so they'd have it so I don't know if they're not using it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But even the PO box, you know, that would be 150 miles away, but
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] It may not, it may be
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Um, yeah, it's the claim has got a couple different denials on it, so, um.
[AGENT][NEUTRAL] Let me reach out to somebody that actually processes these claims and have them look at it um because they may be able to give you better information in regards to like the transportation and like you said you're overwhelmed we wanna just whatever you need to get that submitted so um do you mind holding the line one moment darling?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thanks
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] that.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can I get a clean.
[CUSTOMER][NEUTRAL] ring
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] in customer care. How are you today?
[CUSTOMER][POSITIVE] I'm doing well thanks for asking how are you?
[AGENT][NEUTRAL] I'm doing OK hey I'm not sure if I'm calling the right line or not. It's is claim support, right?
[CUSTOMER][POSITIVE] Mm, that's correct.
[AGENT][NEUTRAL] Is it, are you able to help an insured if she has some questions on a denied cancer claim?
[CUSTOMER][NEUTRAL] Uh, I can try. What's the policy number?
[AGENT][NEUTRAL] 02428939
[AGENT][NEUTRAL] We're speaking with a Miss [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what was the question?
[AGENT][NEGATIVE] Um, so she has a claim number, the last one submitted. There are 3 denials on it. It was surgery charges, anesthesia, and transportation.
[AGENT][NEUTRAL] Um, her biggest question on the transportation was why it was even denied because she said it's over 150 miles.
[AGENT][NEGATIVE] Um, she's kind of overwhelmed. She's got a lot of medical bills right now and so I just thought somebody that processes claims would be able to give her exactly what she may need to submit to maybe lessen some frustration.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You can send her on over.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?