AccountId: 011433970860
ContactId: 3fc3a180-37d9-4f90-9086-75c54fc6b9ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 996599 ms
Total Talk Time (AGENT): 252386 ms
Total Talk Time (CUSTOMER): 210934 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/3fc3a180-37d9-4f90-9086-75c54fc6b9ce_20250512T19:05_UTC.wav
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[AGENT][POSITIVE] Good Morning thank you for calling APL this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, this is, I need some help with the claim.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims and this is your personal policy you're calling from provider's office.
[CUSTOMER][NEUTRAL] This is my policy.
[AGENT][NEUTRAL] OK, and may I have
[CUSTOMER][NEUTRAL] And the, and the place.
[AGENT][POSITIVE] Insured. OK, sure, no problem. And may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] 640053
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Why
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And Ms. [PII] for security, may I have your date of birth, mailing address, and email address on file?
[CUSTOMER][NEUTRAL] [PII] mailing address [PII] [PII]. Did I give you what all you wanted?
[AGENT][POSITIVE] Yes, thank you. All right. And how may I assist you today, Miss [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I'm looking at my claims and all the claim number is 360082. That's what I'm calling about.
[AGENT][NEUTRAL] Bear with me, let me pull the image on this one.
[AGENT][NEUTRAL] OK, I'm waiting on the system. OK, one moment.
[CUSTOMER][NEUTRAL] It just says, oops, documents are missing. What does that mean?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me click on it.
[AGENT][NEUTRAL] Um, let me look at the notes. One moment.
[AGENT][NEUTRAL] OK, so it was processed today, so it's, it's taking a little bit to pull up because usually um when it's processed the same day, it takes a little bit because there's not an explanation of benefits just yet, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let's see let me see.
[CUSTOMER][NEUTRAL] So I could be processed if there's no files out there.
[CUSTOMER][NEUTRAL] And how did you know what, how did they know what was going on?
[AGENT][NEUTRAL] Yeah, right now, it's being processed today, [PII] is the same day as the process, which is the [PII]. So there's not an explanation of benefits there just yet. Um, so I'm just trying to determine to see if there's any notes or anything that I can go by and see why or what happened to the claim, OK? Um, let me go ahead and put you on a brief hold. I probably need to call the examiner and see um if she has more information that I can give you, OK? One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII].
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Ms. [PII]?
[AGENT][NEUTRAL] Hello, Ms. [PII].
[AGENT][NEUTRAL] Hello, Ms. [PII], can you hear me?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Miss [PII], can you hear me?
[AGENT][NEUTRAL] Hello, Miss [PII], can you hear me?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Ms. [PII]. Can you hear me?
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes ma'am.
[AGENT][NEUTRAL] OK. OK. I came back a minute ago, but uh it looks like you couldn't hear me. OK, so it looks like I went ahead and check all the benefits and uh look at the most recent claim, which is the one that you gave me. And it looks like that claim was denied. It was denied completely. Um, for the chemotherapy, it looks like you already exhausted the benefit for the 12 month waiting period. Um, so there's no more benefits for chemo.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Mhm. Why don't they ever pay me any mileage? What, why don't I ever get any mileage even. The last time you paid any mileage was on a trip for [PII].
[CUSTOMER][NEUTRAL] Do, why, why I don't, there's no limit on the mileage too, is it?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] Um, not in the balance.
[CUSTOMER][NEUTRAL] Because I drive 200 miles every time I go.
[AGENT][NEUTRAL] OK, and you said the last time that you have been paid for the mileage is on [PII].
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] OK. I can check with the examiner on that. I was just checking on the information on the claim, which is the chemo and the, the other, mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Cause it, yeah, but see, they told me to resend it all those uh claim, the infusions from [PII] on [PII].
[CUSTOMER][NEUTRAL] Something about, it said drugs administered with cancer drugs and it said to resend them, so I did cause they asked for them. But I don't know. I mean, I knew they weren't gonna pay more on the chemo, but they said something about the drugs that go with it. But y'all had requested that we resend all that stuff, so we did. But still, I mean, at least they ought to pay me some a little bit of mileage on some, on these trips, cause they quit paying that too.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let me check on the mileage, OK, um, because all I gathered was just the information, um, that I was seeing on the claims, but yeah, and that one is not payable because it's already a soft debit. So let me go ahead and get the information about the mileage. OK, it's gonna be um a little bit longer, OK, I have to ask them one moment.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling AP. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], how are you? This is [PII].
[CUSTOMER][POSITIVE] OK, I'm good how are you?
[AGENT][NEUTRAL] I'm good, I'm good. OK. I thought you couldn't hear me. I'm like, oh, she cannot hear me. OK.
[AGENT][NEUTRAL] Um, I have a member on the line that she's calling, we just processed the claim and I explained to her why we denied the claim, um, but she's saying that we should have paid at least for the mileage. So she's asking about that. So let me go ahead and give you the policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, that is 640053.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, part one, part two.
[AGENT][NEUTRAL] R2, Gloria.
[AGENT][NEUTRAL] The master card it has passed, so it's just slow, yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh gosh
[CUSTOMER][NEUTRAL] And for chemo.
[CUSTOMER][NEUTRAL] Duplicate
[CUSTOMER][NEGATIVE] That is not covered.
[AGENT][NEGATIVE] Yeah, and I already went over that claim with her and explained to her why we didn't deny the claim. So she knows about that. She's just saying, well, why you didn't even pay for the mileage. So basically, right now, she's just um not happy about not getting paid for the mileage. She said she has not been getting paid since February uh for any kind of mileage to go and do her chemo.
[CUSTOMER][NEUTRAL] Mm let me see if I've seen anything for mileage.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] Sure, yes, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Last time we paid her was [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We have [PII].
[CUSTOMER][NEUTRAL] Alright you can send her on over.
[AGENT][NEUTRAL] OK, here she comes. I fully verify her the callback number is the same one in the system, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. You're welcome. Thank you for holding and being patient for Ms. [PII]. I got Ms [PII] on the line. She's in the claims department and she's gonna um go over the claim with you, OK?
[CUSTOMER][POSITIVE] Alright thank you.
[CUSTOMER][NEUTRAL] Mm mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Have a good day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh, I, I, I was, do you have my claim my policy number and everything? I gotta give you all that again or what?
[CUSTOMER][NEGATIVE] No, ma'am, do I need the number? OK, so why, why do they not even pay any more on mileage? I know that $7500 is all they pay on chemo, and you know that wasn't on my original policy that, uh, they didn't say there was a limit of that amount on my original policy, but y'all told me that later. But I have a copy of the original policy and that wasn't even on there. So, um, but that what, what about you didn't paid any mileage since [PII]. So do, are you not gonna pay that either.
[CUSTOMER][NEUTRAL] OK, give me one second to look at your transportation benefits. 1 2nd.
[CUSTOMER][NEUTRAL] Mm.