AccountId: 011433970860
ContactId: 4ea743f7-55ac-4eb4-8459-0666785089ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 587289 ms
Total Talk Time (AGENT): 216538 ms
Total Talk Time (CUSTOMER): 291720 ms
Interruptions: 6
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/4ea743f7-55ac-4eb4-8459-0666785089ed_20250225T21:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello and I need to check your status on a claim please for my wife.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and the phone is breaking up. I didn't hear your name. I'm sorry, but I got the phone number though.
[CUSTOMER][NEUTRAL] My name is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK, and
[CUSTOMER][NEUTRAL] I think, yeah, well.
[AGENT][NEGATIVE] Uh oh, it's breaking up. Say that one more time.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And Mr. [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Um, policy number is 2533255.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] OK, here it is coming up now. Hold on one moment.
[AGENT][NEUTRAL] Alright, and Mr. [PII], can you verify uh Mrs. [PII] date of birth and um the mailing address on file?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]. Um, I probably need to change the address. I think y'all still have the [PII] address.
[AGENT][NEGATIVE] You said Dre's way, it broke up again.
[CUSTOMER][NEUTRAL] On there or the.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] For the [PII] address, [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you for that and I and um all the information provided is a verification of benefits, not a guarantee of payment. And do you have the claim number?
[CUSTOMER][NEUTRAL] That's the last one that I submitted.
[AGENT][NEUTRAL] Last one, OK, hold on one second.
[CUSTOMER][NEUTRAL] Again, for the 3rd time.
[CUSTOMER][NEUTRAL] Said they needed insurance.
[CUSTOMER][NEUTRAL] Everything that was billed to the insurance I sent that in.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Hold on, wait a second. So the one that you just submitted on [PII] or [PII]?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] Well, when I looked, it said they were all combined. They only showed one being, one being open.
[AGENT][NEUTRAL] Is this for [PII]? OK.
[CUSTOMER][NEUTRAL] For some reason.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, I sent, I sent them the whole insurance.
[AGENT][NEUTRAL] The reason I'm asking is because the, the one that's most recent was denied as a duplicate, but the one before it was paid. So I'm wondering if it's the one that was paid.
[CUSTOMER][NEUTRAL] parts or
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] No, we've already been paid for that one, I guess the one for like $400 or whatever it was.
[AGENT][NEUTRAL] This is $608.35?
[AGENT][NEGATIVE] It, I mean, I doubt you got that, they just finished processing this. It doesn't even have a processing date on it yet. It just has like 1900, so they just finished that either yesterday or today.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And how much is it?
[AGENT][NEUTRAL] This one is
[AGENT][NEUTRAL] Hold on, it's coming up. $608.35.
[CUSTOMER][NEUTRAL] $608?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, the one before that one was 400.
[CUSTOMER][NEUTRAL] I got the one for 4 hunters. So the one that y'all got that, that's been processed for today, the one for.
[CUSTOMER][NEUTRAL] $300,000.
[AGENT][NEUTRAL] 3, let me see what this total. Hold on one second.
[CUSTOMER][NEUTRAL] On the on the insurance part of it.
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] They're only gonna pay her $600?
[AGENT][NEUTRAL] Well, I'm not sure. I'm just trying to get to the right place, but if this is the correct claim, then, yes, that is what was sent. Let me look for the
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] What was sent in so I can see if this is the 3000.
[CUSTOMER][POSITIVE] I'll tell you what you want is. I've got it here.
[CUSTOMER][NEUTRAL] Now, it's the one that ends in 3981, I guess. The one before that they said is.
[CUSTOMER][NEUTRAL] From
[AGENT][NEUTRAL] The one that ends in
[CUSTOMER][NEUTRAL] was completed on [PII].
[CUSTOMER][NEUTRAL] Yeah, so the one I guess, see, I sent them two different ones. I sent them all the bills and then also send them the insurance that they needed from the insurance company.
[CUSTOMER][NEUTRAL] With all the billing on there.
[CUSTOMER][NEUTRAL] Cause they still haven't paid her for her chemotherapies or anything.
[CUSTOMER][NEUTRAL] She's now on her 4th chemo treatment.
[CUSTOMER][NEUTRAL] And every time I call you guys.
[AGENT][NEUTRAL] OK, no, this is a chemo. Let me see if this is chemo.
[CUSTOMER][NEUTRAL] It's that medical bill from
[CUSTOMER][NEUTRAL] Her health insurance that you guys have.
[AGENT][NEUTRAL] OK, wait.
[CUSTOMER][NEUTRAL] Is what they were telling.
[AGENT][NEUTRAL] Now there's
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] There's chemo on this one that they just finished, but like for example, um, [PII] was billed $90.48 for chemo and that's what was paid.
[CUSTOMER][NEUTRAL] Oh, her chemo's been.
[CUSTOMER][NEUTRAL] $15,000 or more.
[AGENT][NEUTRAL] Now, this is after primary, this is after.
[CUSTOMER][NEUTRAL] Each treatment
[AGENT][NEUTRAL] We probably last. So other things have been applied to this. This is just what it was when it came to APL, that's all that was left.
[CUSTOMER][NEUTRAL] That's not, what do you mean that's all that was left.
[AGENT][NEUTRAL] The charge, so the charge for [PII] was $90.48 for chemo, and that's the amount that we paid $90.48. There's also one for
[CUSTOMER][NEUTRAL] Explain that.
[CUSTOMER][NEGATIVE] So y'all just pay the, you're just paying the difference that my health insurance doesn't pay?
[AGENT][NEUTRAL] Yes, where this could be considered like a secondary policy.
[CUSTOMER][NEGATIVE] That's not the way
[AGENT][NEUTRAL] We're not a major medical.
[CUSTOMER][NEUTRAL] OK. How come nobody explained that to me 2 months ago?
[AGENT][NEUTRAL] Well, I'm not sure, sir.
[CUSTOMER][NEUTRAL] It says in here cancer plan benefits.
[CUSTOMER][NEUTRAL] Level 3, up to $15,000 in chemo treatments.
[AGENT][NEUTRAL] Right, now, now hold on. Now just because it says 15, that that's the max that it will pay, that doesn't mean that's what you're being billed for chemo. That's how much you have to use for chemo. You're being billed a different amount than 15,000. Now that said 15, whatever the amount was that it said, we can pay that up to the 15,000, but that's not the charges that you're being charged on these bills.
[CUSTOMER][NEUTRAL] Well then, we haven't been.
[CUSTOMER][NEUTRAL] Come on man.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, um.
[CUSTOMER][NEGATIVE] So confused on this because, like I said, I've been talking to you guys for since she was diagnosed with this.
[CUSTOMER][NEGATIVE] And I keep getting the runaround on how this is supposed to work, how it's not supposed to work.
[CUSTOMER][NEGATIVE] Airfare, travel, hotels, all the stuff that this policy is supposed to pay doesn't pay crap.
[AGENT][NEUTRAL] All we can pay is the bill charges, sir. Um, you do have those maxes, but that's not was billed to us after the other insurance.
[CUSTOMER][NEUTRAL] In fact, you know
[CUSTOMER][NEGATIVE] Nobody explained it to me. That's what I'm saying. Not one person from your company has explained this that that's how this works.
[CUSTOMER][NEGATIVE] That's not how this works. It says on here, surgery, X amount of dollars per surgery, $50 per treatment.
[CUSTOMER][NEGATIVE] All this, it doesn't say that y'all are just gonna pay the couple I've already met my deductible.
[CUSTOMER][POSITIVE] For this year, of course the insurance, the insurance is gonna pay for everything.
[CUSTOMER][NEUTRAL] After my deductible,
[AGENT][NEUTRAL] But this isn't your health insurance. This isn't that policy though.
[CUSTOMER][NEUTRAL] So if my insurance pays the bill.
[CUSTOMER][NEGATIVE] I understand that, but you're telling me, I understand that. But you're telling me that y'all only pay, so chemo's $5000 and my health insurance pays for $4950 of it. You're paying $50?
[CUSTOMER][NEGATIVE] That don't make any damn sense.
[AGENT][NEGATIVE] Well, sir, we can't pay more than what we're billed.
[CUSTOMER][NEUTRAL] Why?
[CUSTOMER][NEGATIVE] It, this is a, this is not a, this is a cancer policy. This has nothing to do, so if I didn't have insurance.
[AGENT][NEUTRAL] Then we would be paying out the bulk of it.
[CUSTOMER][NEUTRAL] And they were.
[CUSTOMER][NEUTRAL] OK, so they don't, so what's the point of having
[AGENT][NEGATIVE] You can't, you, so you, I don't understand. So you don't.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Well, it, it, I know you don't understand it. It's fine, it's fine. Just, you know, every time I call this.
[AGENT][NEUTRAL] I don't understand your confusion. I understand how insurance works.
[CUSTOMER][NEUTRAL] Obviously, man, you need to make your company, not you. I know you're just a representative, but
[CUSTOMER][NEUTRAL] Every time I talk.
[CUSTOMER][NEUTRAL] It's a different story.
[CUSTOMER][NEUTRAL] Every time
[AGENT][POSITIVE] Well, I certainly apologize. I mean, I
[CUSTOMER][NEUTRAL] Every time.
[CUSTOMER][NEUTRAL] I think. I mean, it shows on here.
[AGENT][POSITIVE] For the company, I apologize that you were.
[CUSTOMER][NEGATIVE] It shows on there that I still owe $100,000 out of pocket, and you're paying $600 400 dollars for this.
[CUSTOMER][NEUTRAL] I mean, it's fine, it's.
[CUSTOMER][POSITIVE] It's whatever. It's good. Thanks for your help.