AccountId: 011433970860
ContactId: 36374313-eb4a-49bf-a66f-83708e9e1289
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410369 ms
Total Talk Time (AGENT): 140400 ms
Total Talk Time (CUSTOMER): 223812 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/36374313-eb4a-49bf-a66f-83708e9e1289_20241230T18:48_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling Apo. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[AGENT][NEUTRAL] I'm doing fine, and yourself?
[CUSTOMER][NEUTRAL] Doing well thank you. I've got an insured on the line uh just calling regarding a claim. Um, I could give you that policy number and claim number if you want that's a little, OK, um, so the policy number is 640053.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's the claim number?
[CUSTOMER][NEUTRAL] It is 354-2155.
[AGENT][NEUTRAL] And what's your callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] OK, and who's calling?
[CUSTOMER][NEUTRAL] Uh, we are speaking with [PII].
[AGENT][NEUTRAL] OK, and she had a question about that claim.
[CUSTOMER][NEUTRAL] Yes, um, in short, she's saying that she believes that information is incorrect, um, so I think she just wants to look at what was submitted.
[AGENT][NEUTRAL] OK, you can go ahead and send it through.
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Good afternoon. Thanks for calling AP's [PII]. Am I speaking with Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Um, the rep said that you had a question about, um, my claim number 3542155.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, and how can I help you on that, please?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. This letter I got in the mail today said you need the surgery relative value and the anesthesia, but the value of those, I didn't have surgery. I had like, I was in the hospital and through all the tests they did, they discovered that I had multiple myeloma, bone cancer, but I, I don't have any, I didn't have a surgery.
[CUSTOMER][NEUTRAL] So I assume the cancer policy pays on your treatments and so forth because I'm gonna have a lot of treatments. Is it, and they gonna pay on that?
[AGENT][NEUTRAL] So, let me go and put the claim and let me um see, give me one moment, please.
[CUSTOMER][NEUTRAL] And I've, I've already gotten a lump sum and I assume we had to have the
[CUSTOMER][NEUTRAL] The pathology report for the lump sum.
[AGENT][NEUTRAL] 1
[CUSTOMER][NEUTRAL] And my daughter sent has uploaded a whole bunch of stuff.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Mm. What kind of pause. So normally, um, they're probably referring to the, the surgery charges for, um for the one they did the biopsy, um, the surgery bill.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I mean it's just being a.
[CUSTOMER][NEUTRAL] Oh hospital bills.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Let me see. But I mean, if your daughter's, if she submitted some information, I mean, it might be in the paperwork that she submitted. So if you want,
[CUSTOMER][NEUTRAL] I've gotten.
[CUSTOMER][NEUTRAL] He submitted out.
[AGENT][NEUTRAL] Yes, so I'm showing that we received some documents on the [PII] and we haven't worked on those claims that they received that date. So like if you wanna hold off until we process those claims, because what we requested might be in those that documentation.
[CUSTOMER][NEUTRAL] She submitted all the.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK. All right. Well, I know she, uh, that the day she uploaded lots of stuff and I've some EOBs from the Mutual of Omaha insurance that shows what Medicare paid and what they paid and shows that I didn't, you know, that I didn't know anything from everything from [PII] on and I guess she'll upload those and I, I guess that's something you need too.
[AGENT][NEUTRAL] If, like I'm, I'm showing that there were 5 different documents uploaded on the [PII], but like I mean, once we look at them, um, if we need any more information, we'll reach out. I mean, we'll send something out, but if not, um, we'll send out payment. But like I said, I would just wait until we process those documents to determine if we need something else.
[CUSTOMER][NEUTRAL] They mentioned a Medicare something.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, that's fine. Let me just ask this, but doesn't it, won't it pay on the treatments because I know, because since I didn't have a surgery, it should pay on the treatments, won't it?
[CUSTOMER][NEUTRAL] Are you
[AGENT][NEUTRAL] Uh, let me see what's your um policy if it pays for.
[CUSTOMER][NEUTRAL] On this plan.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] So it pays for um chemo, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, like, it just really depends on what treatments because some of them are not covered. It's based on what, what they do as far as what the treatments are. So, um, but once those are sent in, we can determine if it's covered or not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, cause I'll be taking chemo all the way through March once a week, so she'll be continually submitting the.
[CUSTOMER][NEUTRAL] Invoices as we you know as as they come into the sheet we get them OK.
[AGENT][POSITIVE] Alright, that's no problem, Ms. [PII]. Was there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Uh, one other thing, I, um, I had, I've been paying like $31.60 and I think that includes the.
[CUSTOMER][NEUTRAL] Lump sum premium and this policy to get I just wondered do you know what my premium will be or do I just wait and see what y'all draft? It's not a big deal.
[CUSTOMER][NEUTRAL] I just figured I didn't know if the premium would go down.
[AGENT][NEUTRAL] So when you say lump sum, what are you referring to as a lump sum?
[CUSTOMER][NEUTRAL] I had two, I had two policies. I had a lump sum policy and then just cancer policy. There were two different policies. When I'm ended in 58 and when I'm ended in 53. I didn't know if there was two different premiums or, or what, but the lump sum policy.
[AGENT][NEUTRAL] Oh, so you have a, you have a critical illness policy and you have a cancer policy. So, um,
[CUSTOMER][NEUTRAL] But I had a lump sum policy too and it already paid me $10,000 so that's that policy ended. I just didn't know if my monthly premiums would change or not, but I'll just see what y'all draft, I guess.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] No, that's not because I'm just showing the 3160, but I mean if it changes then um it will.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Come out at that time.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] OK, alright, thank you so much and I'll just if y'all need something, you have my number and you can give me um let me know if I need if you need additional information.
[AGENT][NEUTRAL] No problem, Ms. [PII].
[AGENT][POSITIVE] Oh, no problem, Ms. [PII], but thanks for calling APO. You have a wonderful day.
[CUSTOMER][NEUTRAL] OK, I