AccountId: 011433970860
ContactId: 3d196e62-b36d-465d-a40c-07bd2abe6691
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 562989 ms
Total Talk Time (AGENT): 189810 ms
Total Talk Time (CUSTOMER): 175813 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/3d196e62-b36d-465d-a40c-07bd2abe6691_20250207T20:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. What can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and I sent in a claim, a cancer claim, and I was just needing to please speak with the claims adjuster so that I could speak with them about what I got, um.
[CUSTOMER][NEUTRAL] Uploaded today on my account.
[AGENT][NEUTRAL] OK, do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, let me find it.
[CUSTOMER][NEUTRAL] It's 242-858-9.
[AGENT][NEUTRAL] OK, just one moment.
[AGENT][NEUTRAL] Miss [PII], what's your date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Can you please verify your mailing address and your email address?
[CUSTOMER][NEUTRAL] Yes, it's [PII], and I believe the email I've got several of them, but is it [PII]
[AGENT][NEUTRAL] Right, yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is a good call back number the [PII]?
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] OK, and you just need to discuss what um you submitted today.
[CUSTOMER][NEUTRAL] Um, I submitted it a couple of weeks back and I just was uh there was a notice that it had been processed and so I wanted to talk with them about how it had been processed because I'm not sure that they looked at everything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So let me see.
[AGENT][NEUTRAL] 428589
[AGENT][NEUTRAL] Let me get that claim pulled up.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] When I looked at it, it's showing $10 paid for a, a Pap smear or something like that, which I don't even remember sending that in.
[CUSTOMER][NEGATIVE] But I sent a much larger claim.
[CUSTOMER][NEUTRAL] So I just kinda wanna figure out what's happening.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] 26291.
[AGENT][NEUTRAL] Where is that $10? I saw it. I can't find it now.
[AGENT][NEUTRAL] OK, $10.
[AGENT][NEUTRAL] OK, 564.
[AGENT][NEUTRAL] OK, yeah, that $10 was paid last year, um, the one that we, the one that we processed yesterday.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it paid $50. It paid $50 on your drugs.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Well, the one I sent in was.
[CUSTOMER][NEUTRAL] I don't know, it may be close to $70,000. It may be if they just looked at one part of it, one part of it is $43,000.01 part is $32,000.
[AGENT][NEUTRAL] OK, so let me look.
[CUSTOMER][NEUTRAL] So is that part showing up?
[AGENT][NEUTRAL] Um, we have.
[AGENT][NEUTRAL] Let's see what we have here.
[AGENT][NEUTRAL] OK, what we received on 123.
[AGENT][NEUTRAL] It was 11, it was for 11 pages.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, there was a
[CUSTOMER][NEUTRAL] I'm sorry, did you say 11 pages?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, uh huh.
[AGENT][NEUTRAL] Um, there was a bill from Covenant Children's Hospital.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, for 5:30 to 6:20.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] A 2024. Um, it looks like that bill is what? $83,850.95.
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][POSITIVE] Sounds right. Uh-huh.
[AGENT][NEUTRAL] OK. Um, we were able to pay, um, we did pay the drug, um, for 5:30, but for the um chemo, we'll need the explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] I'm pretty sure I already sent those in in an earlier date and this was in response to needing more information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me.
[CUSTOMER][NEUTRAL] It would be back. I've got a record. I don't have the most recent record of the conversation, but it started on um [PII] with a person named [PII].
[AGENT][NEUTRAL] OK, so let me see if I can find.
[AGENT][NEUTRAL] Um, can, will you allow me to just go through your, um, history, um, and then call you back and see if we did receive, receive that, OK.
[CUSTOMER][NEUTRAL] Yes, OK, because like I mentioned, I know I have the records that they pay this in full.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So were they gonna tell me about this or uh I'm just confused because since I just got that $10 thing.
[CUSTOMER][NEUTRAL] Is it just not showing up correctly in the computer or something?
[AGENT][NEUTRAL] Right, it was just processed yesterday, um, so, um, today an explanation and a, um, let me.
[AGENT][NEUTRAL] Let me see, yeah, an explanation and a check for $50 was mailed out today, um, so, um, it probably just has not hit our, um, computer system yet.
[AGENT][POSITIVE] Um, but, um, yes, ma'am. Let me just, um, do some research on your history and um I will definitely give you a call back.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] To do that.
[CUSTOMER][NEUTRAL] And if you could just look through if there's another name mentioned because like I said I've been communicating since the [PII] and so this was supposed to be the last information that was needed.
[CUSTOMER][NEUTRAL] Um, so I don't know who that I can't recall the person's name and I just can't find it.
[CUSTOMER][NEUTRAL] But um
[CUSTOMER][NEUTRAL] Yeah, like I said that was supposed to be the last thing needed and so I'd like to speak to that person if they're.
[AGENT][NEUTRAL] OK, yes ma'am.
[CUSTOMER][NEUTRAL] You know available or whatever.
[AGENT][NEUTRAL] OK. Yes, ma'am. I.
[CUSTOMER][NEUTRAL] Will you be able to call me today?
[AGENT][POSITIVE] I should, yes, ma'am. Yes ma'am.
[CUSTOMER][NEUTRAL] OK, since I'm off work because I had another cancer treatment, but I will be working Monday.
[AGENT][POSITIVE] OK, I, I will make sure that we um get get back to you today then.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.