AccountId: 011433970860
ContactId: 4807a6e5-1085-45ca-94a1-fe65a936fdd0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 569580 ms
Total Talk Time (AGENT): 254778 ms
Total Talk Time (CUSTOMER): 300099 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/4807a6e5-1085-45ca-94a1-fe65a936fdd0_20250220T20:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII]. How are you today?
[AGENT][POSITIVE] Hey [PII], I'm good how are you?
[CUSTOMER][NEUTRAL] I'm so sleepy. I think I need some sugar. I think I'm gonna give me a cup of coffee because I only had one today and I usually almost have 3.
[AGENT][POSITIVE] That sounds like a plan.
[CUSTOMER][NEUTRAL] Maybe that's the reason why, but uh.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I have an insured on the phone. She's calling by her claim that was processed. She at first wanted to make sure we received it, which we did, and it was processed yesterday, but it was only $50 for hormone, and she is stating that she sent a whole year.
[CUSTOMER][NEGATIVE] A bill showing the whole year and want to know why it's just 50.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the policy?
[CUSTOMER][NEUTRAL] 255-83558.
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right, you can send her over.
[CUSTOMER][POSITIVE] All right, lady [PII]. Have a great day.
[AGENT][POSITIVE] Thank you. You as well. Bye-bye.
[CUSTOMER][NEUTRAL] Uh bye.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII], my name is [PII], and I was calling to check to make sure that y'all had gotten my information for my cancer medicine I take. Uh, so, um, because it was mailed this time and the mail has kind of been crazy. So I just was checking to see if it had gotten there and I thought she told me she received it yesterday or something, but that y'all have already you've uh.
[CUSTOMER][NEUTRAL] Already done it and I was getting a check for $50 but I take this medicine.
[CUSTOMER][NEUTRAL] For a whole year.
[CUSTOMER][NEUTRAL] And before it's been $50 per I guess month or something like that.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Because, uh, but then they started writing me a prescription for 90 days instead of 30 days, you know, like they were doing. And
[CUSTOMER][NEUTRAL] Before I've got $600 but she just said something about y'all were sending out a check for $50.
[CUSTOMER][NEUTRAL] I was just wondering what happened.
[AGENT][NEUTRAL] OK, sure, Ms. and I can take a look at that. Just bear with me just a moment.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I do show the claim processed on yesterday for a total benefit of $50.
[AGENT][NEUTRAL] And that was only for
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] October.
[AGENT][NEUTRAL] The hormone drug for October.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so did y'all not a packet that had, uh, it was from like [PII].
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So what happened um effective I'm sorry, [PII], um a new policy number was generated for the current year. So the
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Earlier dates were processed on the older policy number. And so let me just pull that up.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So yeah, so there was another claim that was processed on yesterday as well.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And it starts for [PII], and I show that total benefit to be $250.
[CUSTOMER][NEUTRAL] OK, so then there'll be another one?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] From [PII] to [PII] or something like that.
[AGENT][NEUTRAL] Yeah, only because that year there was a, a crossover from one policy number to the next. So that's why they were separated, just to have those dates under the correct policy number.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so then you think the total will be what now? I mean, so right now you said there's a $200.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] $250 and then the $50. So all together it would be a $300 benefit for the claim submitted.
[CUSTOMER][NEUTRAL] And then uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That's true. So, OK, now, so did they go down or something?
[CUSTOMER][NEUTRAL] The payment because I mean I have my sheets here from before prior and y'all gave me $50 for the hormone therapy benefit but it was $50 per.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I'm not
[AGENT][NEUTRAL] That is correct, mhm and it it's the same.
[CUSTOMER][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] So I, I got one.
[CUSTOMER][NEUTRAL] You do what now? But then so.
[CUSTOMER][NEUTRAL] Uh, so there's not gonna be 12 in there, is that what it is?
[AGENT][NEUTRAL] Let me just look at.
[CUSTOMER][NEGATIVE] I mean, OK, there's not gonna they're doing it every 3 months now. This one, I got an explanation of benefits, and it, it was, you know, it was like every month and every month that I did it, y'all gave me, y'all paid me $50 but now they're doing it for 90 days. It's lasting 90 days. Does that make sense? So did they.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] Is that, did they misunderstand that that wasn't for 3 months or something?
[AGENT][NEUTRAL] I am looking at that to see now, um.
[AGENT][NEUTRAL] Let's see, so.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] As well as [PII], which is 30 days.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, the quantity, but then starting May.
[AGENT][NEUTRAL] It went up to 90. So let me just check those benefits to see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] primary physician.
[AGENT][NEUTRAL] I'm gonna check to see if that's reflected on the claim that was processed.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, because last year they understood because I even circled my, you know, and I don't know if I circle those.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And uh because I know it's so confusing, it's confusing to me, I'll tell you and uh but anyway, OK, so y'all.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I see that here, so what I'm gonna do, because let's see on that, the claim with the $250 benefit.
[AGENT][NEUTRAL] That is 5 months.
[AGENT][NEUTRAL] So it looks like, yep.
[AGENT][NEUTRAL] We'll have to go back and and process those dates where the quantity is 90 to process that is 3 months, yep. So um what I'm gonna do is forward this over to the adjuster to reprocess the claim for those additional benefits for each month where we had the 90 instead of 30.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Makes sense. OK, I appreciate. I'll tell you, and my Edison, it seems like they've screwed up on it, yeah, you know, 30.
[AGENT][NEUTRAL] All right. So, uh,
[AGENT][POSITIVE] Understood. Sorry about that.
[CUSTOMER][NEUTRAL] Uh, that's OK, and I just thought, OK, wonder why the payments went down, and then I did ask the lady before. I have forgotten that they.
[CUSTOMER][NEUTRAL] If I turn in, you know, I have a mammogram and an ultrasound every year too, of course I have forgotten to do it, which I don't know, I've had so much going on with me, but anyway, uh, so I'm going in March so I can mail that receipt in or something too.
[CUSTOMER][NEUTRAL] And uh for a mammogram.
[AGENT][NEUTRAL] Yeah, um, you can send in either the, it has to show the type of test and the date of service. So you could fill out a wellness claim form and submit submit that or send us the test results or um your doctor's notes.
[CUSTOMER][NEUTRAL] Ma'am
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So do I have to send, oh, so is it a different form, the wellness one instead of the cancer claim form? Yeah, OK, wellness.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Exactly, yup.
[CUSTOMER][NEUTRAL] OK, let me write myself a note because I won't remember that.
[CUSTOMER][NEUTRAL] OK, alright, well.
[AGENT][NEUTRAL] Yeah, if you complete the wellness claim form, you won't have to send in any other um documents related to that benefit. You'll just fill it out, make sure you have the doctor's name, the date of service, and check off the test that was performed, and you're good to go.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, I will put that down. OK, so y'all are probably redo everything then on my thing, my year end and on those other things. OK, alright.
[AGENT][NEUTRAL] That's correct. So you're gonna receive the benefits that's already been processed and then you'll receive maybe a little delay a couple of days you'll receive that underpayment amount once it's reprocessed, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you so much, appreciate it.
[AGENT][POSITIVE] No problem, Miss. Sorry about that. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No, ma'am, that's, that's just, I make sure it got there because mailing seems like here lately there's stuff that's not even getting to me or you know, so I worry about the mail.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] All right, yup, I can relate to that, but yup. All right, Ms. [PII]. Well, thank you for calling ATL and you have a great day.
[CUSTOMER][NEUTRAL] Uh huh you too bye bye.
[AGENT][POSITIVE] Thanks bye bye.