AccountId: 011433970860
ContactId: 84948c66-ec40-4725-9bec-dc9406cb9ee2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 457980 ms
Total Talk Time (AGENT): 163244 ms
Total Talk Time (CUSTOMER): 291667 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/84948c66-ec40-4725-9bec-dc9406cb9ee2_20250224T18:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], I'm trying to get some information. I have uh filed some claims and uh I, when I go to the doctor, they say that the policy doesn't pay for uh a doctor's visit, but I have infusions when I go there and
[CUSTOMER][NEGATIVE] From my understanding, they, they said that um that there was no infusion and I have infusions. I have an injection. I have cancer, stage 4 cancer and um I've been sending my claims in but a lot of them are being denied and I, I looked at my uh policy uh and it said that it pays for the uh
[CUSTOMER][NEUTRAL] You know, the um medication and stuff. So I'm trying to find out what's going on with that.
[AGENT][NEUTRAL] Yes, ma'am. I can help you with your benefits. And if I can't help you, we will get somebody that can, OK? Um, what is, what is your name and your policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] My name is [PII] and my policy number is 007.
[CUSTOMER][NEUTRAL] 27573
[AGENT][NEUTRAL] OK. Let me pull in your policy real quick, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, Ms. [PII], can you verify your date of birth for me?
[CUSTOMER][NEGATIVE] [PII]. I hate to keep worrying y'all. I've been calling, I called 3 days asking, asking different questions, but I just don't know.
[AGENT][NEUTRAL] No, it's OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] What the situation is.
[AGENT][NEUTRAL] Right, I
[AGENT][NEUTRAL] I understand
[AGENT][NEUTRAL] And for security reasons I'm gonna need for you to verify your address, phone number, and email address for me please Miss [PII].
[CUSTOMER][NEUTRAL] OK, my address is [PII]. My email is [PII].
[CUSTOMER][NEUTRAL] And my phone number I have to area code [PII] and [PII].
[AGENT][NEUTRAL] OK thank you I appreciate you verifying that now this phone number that you're calling from is that a good call back number if we get disconnected? OK thank you Miss [PII] let me look and see what's going on. I do see that you sent in a couple of claims um in February.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] The last one that was paid was paid $60 to, uh, right, OK, so that one was paid. Let me see what the remarks are on this claim for anything.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so on your policy, office visits are not covered.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so, but if I get injections, is that still considered the just the opposite even if I have uh infusion or injection, they don't pay that?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] If it's done in an office, yes, office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Well, yeah, it's
[CUSTOMER][NEGATIVE] It's not covered if it's done in the office.
[AGENT][NEUTRAL] So that was
[AGENT][NEUTRAL] Right. And then it looks like.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] Let me see the preventative on policy was what was covered was a preventative.
[AGENT][NEUTRAL] Um, expense on that.
[CUSTOMER][NEUTRAL] And what was the?
[AGENT][NEUTRAL] Let me look and see on the um claim.
[AGENT][NEUTRAL] What I can look at and see.
[CUSTOMER][NEUTRAL] Cause something just, I, I think that people are putting the wrong codes or something. I don't know, but I, I've not had a problem before when I was getting injections and stuff, they pay for it when I went to the uh I, I always have them in the doctor's office. I don't get them anywhere else and I take medication by my.
[AGENT][NEUTRAL] Right, I
[AGENT][NEUTRAL] OK, the preventative expense was paid $60 and if you can get the explanation of benefits from the facility at Saint Francis Medical Center.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Um, the procedure code was, I can give you the procedure code that was paid. It's 86,300.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, let me
[CUSTOMER][MIXED] Let me get me a pen, sweetheart. I, I appreciate it. I hate to be a bother, but you know, I've had this crisis for quite a while and uh I hate to keep calling and trying to understand what's going on. 86 what?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] You're not a bother at all.
[AGENT][NEUTRAL] 86,300. That's what was paid $60.
[CUSTOMER][NEUTRAL] OK, then yeah.
[CUSTOMER][NEUTRAL] Yes ma'am. Let me ask you this now, um.
[CUSTOMER][NEUTRAL] Does it show the infusion?
[AGENT][NEUTRAL] I am not sure because I can't see the procedures. I could just see the codes you've got.
[CUSTOMER][NEUTRAL] You, yes, ma'am. OK, OK. I, I'm, I just called them a little while ago and the lady, the lady said that she was sending me another paper in my chart with the infusion included in it because uh my daughter sends everything and I'm not well to be doing all that and she takes care of it and she told me that the infusion was not there and I
[AGENT][NEUTRAL] You got.
[AGENT][NEUTRAL] Right. OK.
[CUSTOMER][NEGATIVE] I have an infusion every time I go for the cancer in my bones right now. And um I'm taking a medication uh by mouth because it's stage 4 cancer and it's not a lot, you know, can be done and I'm, you know, the longer everything goes, I, I'll wait. I don't know that I have that time to, you know, to just do because when I first started this year, they denied me.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] In the first beginning of the year that I was supposed to get and it took almost a month to get the first payment because whoever did it, they said I had already received it for the year and my year just started in August on the [PII] and that was the, I didn't get any money for way over in September sometime and I had to call to get that and the lady, one of y'all ladies like um.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Beautiful people that answered the phone like you, she went back and look and she said this is wrong. And so she resubmitted it in order for me to be able to get that first payment that I was supposed to get. So that, that's one of the reasons that I keep calling because um a lot of the times they keep saying that I, I'm not, it's not covered or whatever, but then they keep saying it's it's been exhausted for the year and I just started the new year on the [PII].
[AGENT][POSITIVE] Oh, that is awesome.
[CUSTOMER][POSITIVE] So I appreciate your time, sweetheart, and I thank you.
[AGENT][NEUTRAL] Yes, ma'am, I understand.
[CUSTOMER][NEUTRAL] And I will um see if I can, if I find that.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Paper, uh, uh, the thing they put in my chart if it shows the infusion, I'll resubmit it.
[AGENT][POSITIVE] OK, Ms. [PII], that sounds like a plan, like a great idea.
[CUSTOMER][POSITIVE] Yes. Yes, ma'am. Thank you so much for your time. All right, bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. You have a blessed for calling APL.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] You too, darling. Bye-bye.