AccountId: 011433970860
ContactId: 23dff7ff-9877-4b77-81de-3f3b971f646e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326140 ms
Total Talk Time (AGENT): 163479 ms
Total Talk Time (CUSTOMER): 152338 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/23dff7ff-9877-4b77-81de-3f3b971f646e_20250619T20:21_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting APR. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I was calling to see if um the I, I sent in documentation to substantiate a claim and I was just wondering what the status of that was.
[AGENT][NEUTRAL] Yes, I can certainly look that up. And what is your policy number, please?
[CUSTOMER][NEUTRAL] 02485390
[AGENT][NEUTRAL] Thank you. And I'm sorry, 2489, I'm sorry, 2,485,390.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you. And
[CUSTOMER][NEUTRAL] Uh there's a 0 at the beginning.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, yes, thank you. And if I could just verify your name, and date of birth, and a phone number, please?
[CUSTOMER][NEUTRAL] Yes, it's [PII] um phone number is [PII].
[AGENT][NEUTRAL] Thank you. And when did you send in the is this for you or is it for another, uh, another participant on the phone, OK.
[CUSTOMER][NEUTRAL] Uh it's for [PII].
[CUSTOMER][NEUTRAL] My husband.
[AGENT][NEUTRAL] And when did you send this in um.
[CUSTOMER][NEUTRAL] It's been probably 3 weeks.
[AGENT][NEUTRAL] And do you remember?
[AGENT][NEUTRAL] weeks ago.
[AGENT][NEUTRAL] OK then I'm just looking that up now.
[AGENT][NEUTRAL] OK. Um, I have.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] It looks like there are multiple claims for Robert, um, Saint Francis Hospital. Does that sound right?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Now it looks like some of the charges were were already paid to the providers. Let me just look through here.
[AGENT][NEUTRAL] Um, OK, so it looks like, uh, several of the, of the, uh, charges have already been paid to the provider. That means that they sent their claim in before we got your documentation.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, now there is a lab, uh, there's a $35 lab, uh, we just need a, uh, this was for, um, [PII].
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] We would need something from your providing doctor letting us know what the lab is for, and it's called a diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm not really worried about that. I mean, because basically my husband gets chemotherapy every month and it's like $80,000 every month, so he hit his deductible in January, so my, my American public life should have paid the $2500 like in January.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um, and I, the letter I got said at first, you know, they didn't cover chemotherapy if it wasn't done in the hospital. Well, it's done in a specialty hospital that's just for cancer and so I talked to you all and you said well we need documentation that that went towards the deductible so that's what all that paperwork was.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To show that everything went toward the deductible what the pieces were.
[AGENT][NEUTRAL] Yes, yes, I see that. Let's, um, let's go over that some of the claims here because it, it looks like there's quite a lot of things that the that the, the provider is already turned in and, uh, turned in a claim for. So let me just see what we have here, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's totally fine. I was just trying to make sure that you guys have all the documentation that you needed.
[AGENT][NEUTRAL] Yes, it looks like we do, um, so what we did was, um, there's uh most of these, um, most of the, the charges that you that you submitted that they, they'd already been paid the, the provider had already sent in a claim for and it looks like we paid, uh, the deductible yeah, so it looks like it's all been paid but it's been paid to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, OK, perfect.
[CUSTOMER][NEUTRAL] Oh, that's totally fine. That's, that's fine because I owe, I still owe the provider. So they're just real, uh, Saint Francis is a really good hospital, but their billing department is terrible. So I just have to keep on top of them. So do, do you see if like the entire 2500 has been paid out for [PII]?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] It hasn't. No, it has not. It, it has not, um.
[CUSTOMER][NEUTRAL] At this point,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And uh yeah, it looks like there there's some more claims that we that we can process so uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it, it has not been paid out, so I would by all means send in any additional documentation, any additional charges that you have, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because yeah, because I mean we're in the middle of the and I mean our deductible.
[AGENT][NEUTRAL] For this.
[CUSTOMER][NEUTRAL] You know, it
[CUSTOMER][NEUTRAL] We get it pretty darn fast because like I said everything is charge I mean his chemo is like $80,000 in January per month so by this point we're close to, you know, $5 million so I don't, I'm not, I I guess I don't understand why everything hasn't been processed, but maybe y'all are still in the process of working on it.
[AGENT][NEUTRAL] Well, we don't have anything, but the, the only thing that we're, we're waiting for is the, is the document we're just waiting for new charges because the last thing that we received.
[AGENT][NEUTRAL] Excuse me, was May, and then that was taken care of. It was, it was uh what we sent to you, it looks like it all went, yeah, so we're just.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you're just waiting on more stuff, you're just waiting on more stuff from the hospital then.
[AGENT][NEUTRAL] From the hospital.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK alright I will call them then and see if I can't figure out what they're doing. I appreciate your help so much.
[AGENT][NEUTRAL] OK, if there's nothing I can help with, thanks for contacting ATM.