AccountId: 011433970860
ContactId: 49566250-8d60-443b-8de3-f42974b63db4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 780039 ms
Total Talk Time (AGENT): 373816 ms
Total Talk Time (CUSTOMER): 402121 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/49566250-8d60-443b-8de3-f42974b63db4_20250123T18:51_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I've had some claims and I had some questions about uh some stuff that I sent back to y'all about the claims. Uh, can you help me, you need my policy number or what do you need?
[AGENT][NEUTRAL] OK, Ms. [PII], so you submitted claims for yourself to APO and you have some questions regarding them, is that correct?
[CUSTOMER][NEGATIVE] Yeah, you, I did and then y'all sent me back some paperwork telling me that, you know, things you needed. So I've sent that back. And I just, you know, cause they're not pays not paying hardly any, anything on my claims. And I've had this cancel policy for years. And so I wanna see if that's what I sent back is gonna, you know, pay for some of the, pay me for some stuff.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am. I can
[AGENT][NEUTRAL] OK, Ms. [PII], yes, ma'am. I can help you with that. First off, what is your callback number?
[CUSTOMER][NEUTRAL] So what
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] 00640053
[AGENT][NEUTRAL] Thank you. One moment while I get all of your information pulled up, Miss [PII], and then once I do, I will have to verify several things with you first for security purposes and also any information that is provided today would be a verification of benefits and not a guarantee of payment. So give me just a moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so first off, Ms. [PII], if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. The phone number that we have for you is the same as the one you gave me, so that is the best contact number for you. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am mhm.
[AGENT][POSITIVE] Thank you and lastly, Ms. [PII], your email?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Alright, so do you have a specific date of service that you want to discuss or do you have a claim number? Did you say you had a claim number?
[CUSTOMER][NEUTRAL] Uh, yeah.
[CUSTOMER][NEUTRAL] Let's see, see whether.
[AGENT][NEUTRAL] Cause I can, while you're looking at that, I can see that there were, you have uploaded several things.
[CUSTOMER][NEUTRAL] Yeah, oh.
[AGENT][NEUTRAL] Um, that are in line for review, Ms. [PII]. They have not yet been reviewed, but I can see that you did upload several things on multiple different dates.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, my daughter's helping me with that, but then I mailed in some stuff too cause when y'all, y'all sent me things and saying you needed certain, certain documents, so I mailed some things in too, but like some of these claims like for 12 3 and 1210 and uh 1217 when I had chemo, you know, all those I sent you the EOBs from my, from my provider showing.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What, you know, what the, the cost was and then I sent you about about the mileage because I have to drive 100 miles one way to get to a treatment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I sent some letters with all that information and then my daughter's uploaded a lot of the files into the files. So some of them are, are being reviewed then, even though it says processed.
[AGENT][NEUTRAL] Yes. Well, if you have a specific, what I'm OK, I can see that we have like 1235 different things that have been uploaded that have not yet been reviewed, but if you have a specific claim number that you would like for me to look at, I will be happy to look at those um.
[CUSTOMER][NEUTRAL] OK, and those that particular one, OK. All right, I'm trying to see where the, where I see the claim number on this.
[CUSTOMER][NEUTRAL] OK, and it's policy number, reference number.
[CUSTOMER][NEUTRAL] Claim number OK 354-8461.
[AGENT][NEUTRAL] Yes, OK. Well, I thought I lost you.
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] 354. I couldn't hear you for a moment. 354-846-1, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh-huh.
[AGENT][NEUTRAL] OK, all right, so give me just a moment. Now I can see on that one.
[AGENT][NEUTRAL] There has been a benefit paid to you in the amount of $495.
[AGENT][NEUTRAL] Let me look at the remarks.
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] Yeah, but they, that didn't cover.
[AGENT][NEUTRAL] So I can see that.
[CUSTOMER][NEUTRAL] That's the.
[AGENT][NEUTRAL] Cause there's multiple dates of service on that claim number. Those were the payment was issued for your.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Something on [PII], 24, and [PII]. Now, I can see that there was your chemo on [PII]. It states to please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. I didn't, I didn't even, I didn't have chemo in the hospital. I just hadn't, it, it wasn't, it wasn't, I don't, I didn't really have chemo in the hospital. The chemo started with the next outpatient visit. So I, I don't, I, I don't have any, I've got what I have from when I was in the hospital. I don't see anything on there where it shows a chemo treatment.
[AGENT][NEUTRAL] That is
[CUSTOMER][NEUTRAL] Um, I, I, I, I, what about 123 then?
[CUSTOMER][NEUTRAL] And that, and that, and I probably didn't pay anything on mileage. So I've, uh, you know, every time I've
[AGENT][NEUTRAL] That does
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, for your [PII] or.
[CUSTOMER][NEUTRAL] Every time I go, it's
[CUSTOMER][NEUTRAL] Go ahead. I'm gonna listen to you then.
[AGENT][NEUTRAL] Yeah, that's OK. Now, go ahead. I was gonna give you the information I can see about the 123 data service. That's one that we're needing your primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And I sent that on um
[CUSTOMER][NEUTRAL] This [PII]. I sent that back to you.
[AGENT][NEUTRAL] OK, we
[AGENT][NEUTRAL] Yes, ma'am. Um,
[CUSTOMER][NEUTRAL] I mailed a letter.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] We have not received that if you mailed it on the [PII], if that's not been received.
[CUSTOMER][NEUTRAL] OK. All right. Well, I, so I'll just watch, so that'll be because that chemo is $53,000 for the, you know, amount of the chemo and I sent you about the about the mileage also.
[AGENT][NEUTRAL] Are you, mhm.
[AGENT][NEUTRAL] You included that with your chemo explanation of benefits.
[CUSTOMER][NEGATIVE] Cause I
[CUSTOMER][NEUTRAL] OK. I send a letter and it said, uh and uh on [PII], I sent you the copies of the EOBs for [PII] and [PII], and then I sent you a letter telling how much, how far it was and what the mileage was.
[CUSTOMER][NEUTRAL] For those, those two visits.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that, that, and then on [PII] for the [PII], I did the same thing but I mailed that [PII], so maybe y'all haven't gotten any of these things yet then.
[AGENT][NEGATIVE] No, we haven't received anything that's been mailed as of now.
[CUSTOMER][NEUTRAL] OK. But my, OK, my daughter is uploading all those EOBs also, so that, you know, you ought to have them.
[AGENT][NEUTRAL] OK, so that's why I was asking you is what you mailed just a duplicate of what your daughter is uploading for you?
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] Yes, yes, but I don't.
[AGENT][NEUTRAL] OK, so everything that your daughter has recently uploaded has not yet been reviewed. That is still in line for review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So when you say recently, how, how far back is recently cause
[AGENT][NEUTRAL] OK, so she's uploaded a couple of things on the [PII]. She uploaded stuff on one thing on the [PII], 1 thing on the [PII], and then it looks like maybe on the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I just need to wait and let you review some, let them go through those and those haven't been reviewed or they're working on.
[AGENT][NEUTRAL] No, ma'am. So I can't, they have not yet, right. They haven't been reviewed yet, so I can't tell you if that, you know, information is sufficient for what we were needing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But once it has been reviewed and processed, then let me double check because I can, you know, again I can see that you're set up on that portal that we have and there is uh it does show that you opted in for text notification alerts so once the claim has been processed, Ms. [PII], you should receive a text message. You may not be able to instantly see what your status.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm, yeah, and
[AGENT][NEUTRAL] is in the portal since it has to go through our overnight processing but you would, you know, once you receive your text notification you could call us if you're not able to see that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. I mean, I'm, I'm on your, I'm on your website right now where I can see all my claims out there and see what's processed. Is that what you're talking about? I, I mean, I, I'm, I can see that and I can see I've been paid $495 and the $10,000 lump sum, but it's, it's, uh, you know, all these others.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And then you should be able to see those other ones that say they're I mean you should see them out there but you don't, they don't have a claim number they just have a confirmation number at this point.
[CUSTOMER][NEUTRAL] Let's say.
[CUSTOMER][NEUTRAL] OK. So if it just says um.
[AGENT][NEUTRAL] If it does
[CUSTOMER][NEUTRAL] OK, so it just says so.
[CUSTOMER][NEGATIVE] So you, so even though it says processed and it says 0 for the amount paid, does that mean I may, you can go back and for like for 1217 and uh some say process but they didn't pay me anything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you
[AGENT][NEGATIVE] Right. And on page 2 of the remark, uh, on the page 2 of your explanation of benefits, you know, it gives all of the remarks as far as why it wasn't, why there were no benefits paid.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and that's what I sent back to you to to ship. I gave you the physical address that it asked for and then I gave you the copy of the EOBs on all those dates. And y'all just hadn't got all that sent uploaded and checked out yet. So I'll just give it some more time, but you know, I looks like to me I should be paid for the mileage and whatever I, the, what is it I should have on the chemo treatments.
[AGENT][NEUTRAL] So for example,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] But I'll just call back later when you have, when everything's been received and you know, we can.
[AGENT][POSITIVE] Yes, ma'am, and like I said, you should have, right, once it has been reviewed, you should receive that text notification alert and then um yes ma'am, you could call us and we'd be more than happy to go over, you know, the status of it with you over the phone.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And that's what, that's why I'm calling today because I had gotten a message and then I look on here and it says they're processed and it doesn't pay anything. So that's why I'm trying to figure out why I'm not getting paid anything on these. But I'll give it a little more time and maybe you've received the additional information and uh perhaps it'll, we'll make some progress and they'll get paid as time goes on then.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] But I'm gonna have a lot of these treatments.
[AGENT][POSITIVE] Oh goodness. Well, um, yes, ma'am. We just haven't reviewed what your daughter has uploaded yet and then again, we just haven't received what you sent in the mail because the mail, you know, it's, it's quite a lengthy process with the mail. Yes, ma'am, these, these days. So, the portal is the easiest way to, you know, be able to see that we actually officially received something instantly since you get a confirmation when it's uploaded.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yes, ma'am. Oh.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Saying, you know, documents successfully successfully uploaded and it does get, you know, your claims in line for review a lot faster.
[CUSTOMER][NEUTRAL] OK. All right. Well, I'll just give it some more time and cause it should pay some more on even some of the ones, some of the ones that is processed, it ought to go back and pay something on my mileage and my chemo. So I'll just check, I'll keep watching it for you don't, and then I'll see what, watch every time I get a message about it. OK. Thank you.
[AGENT][NEUTRAL] Yes, ma'am. So
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Well, you're welcome. So, can I help you with anything else at the moment, Ms. [PII]?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] No, ma'am. I think that was all I was trying to find out. Thank you. Bye.
[AGENT][POSITIVE] All right. Well, you're welcome and thank you for calling APL. I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] Yeah.