AccountId: 011433970860
ContactId: ac648bbc-b21a-4590-99d5-0d1159666f10
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 696770 ms
Total Talk Time (AGENT): 226298 ms
Total Talk Time (CUSTOMER): 291433 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/ac648bbc-b21a-4590-99d5-0d1159666f10_20250528T20:19_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] And uh my name is [PII], and I'm calling. I have some questions about my, um.
[CUSTOMER][NEUTRAL] Claim that I made my husband's cancer policy. I have the information if you need the policy number.
[AGENT][NEUTRAL] OK, um, so I'll be more than happy to help you with the claim. And, um, Miss [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] OK, I'm I'm at [PII].
[CUSTOMER][NEUTRAL] And the policy number is 00711167.
[AGENT][NEUTRAL] Thank you. And can you verify um the date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] Uh, my date of birth is [PII], 1958, and the address on file is uh [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you just verify the email address on file as well? I'm sorry.
[CUSTOMER][NEUTRAL] It's my first name [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment, and you said the claim is for Mr. [PII]. Let me go to him.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, so I see there's 2 claims that were reserved, 2.
[AGENT][NEUTRAL] Entries that were received on [PII], um, that are currently in processing and um did you have questions about those or would it be a previous claim?
[CUSTOMER][NEUTRAL] Um, the previous claim, what I sent in were doctors visits and, um, mostly that's what it was. The question I had was, the policy is supposed to pay all radiation treatments and I got payment for almost all of them, but there were still two weeks of payments that they did not, he went every day, um, but I didn't see, I've got the.
[CUSTOMER][NEUTRAL] Plas right in front of me and the pay that y'all sent and what each one, I don't know what y'all call the sheet, explanation of benefit sheets, and it paid for.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] All of the treatments except for [PII], there were 10 payments that we did not get any that are not on any of these sheets.
[AGENT][NEUTRAL] OK, you said March
[CUSTOMER][NEUTRAL] That were radiation treatments.
[CUSTOMER][NEUTRAL] OK, it's [PII], [PII], and [PII].
[AGENT][NEUTRAL] Hold on one second.
[CUSTOMER][NEUTRAL] And then [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The reason I'm asking is because the, so all of the, like you said, all of them were paid except this one claim. This is from date of service, [PII]. Um, it's claim number 359.
[CUSTOMER][NEUTRAL] Yes, but and
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] 442-24422
[AGENT][NEUTRAL] No, 8077.
[CUSTOMER][NEUTRAL] I'm finishing that
[CUSTOMER][NEUTRAL] OK, claim number, you're talking about claim number?
[AGENT][NEUTRAL] Yes, that's the claim number.
[CUSTOMER][NEUTRAL] No, I don't
[CUSTOMER][NEUTRAL] I don't have an 800.
[AGENT][NEUTRAL] 359 8.
[CUSTOMER][NEUTRAL] All of mine start with 35.
[AGENT][NEUTRAL] 359-8077 is the last claim that we processed.
[AGENT][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] OK, I have not gotten that claim.
[CUSTOMER][NEUTRAL] I have not gotten that one.
[AGENT][NEUTRAL] OK, so the one that you're reference.
[CUSTOMER][NEUTRAL] The, the only one.
[CUSTOMER][POSITIVE] Go ahead, I'm sorry. I'm sorry.
[AGENT][NEUTRAL] The one that you're referencing is the 3594422?
[CUSTOMER][NEUTRAL] OK, that was part of it and then there's.
[CUSTOMER][NEUTRAL] The same thing is 359-468-8. Both of those paid for radiation treatments.
[CUSTOMER][NEGATIVE] And I've looked over the explanation and we got payment for everything except [PII].
[AGENT][NEUTRAL] OK, so that one is.
[CUSTOMER][NEGATIVE] We didn't get payments for those.
[AGENT][NEUTRAL] So that um those dates of services also included in the claim that I'm referencing, but the reason that the that
[AGENT][NEUTRAL] That date range did not receive payment is because the maximum has been has been met.
[CUSTOMER][NEUTRAL] Oh, I thought they paid them regardless. I thought it said it paid for all radiation treatments.
[AGENT][NEUTRAL] No, there's a max. Let me see what this policy is. Hold on one moment.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Uh, let me do it this way.
[AGENT][NEUTRAL] I'm just waiting for the um.
[AGENT][NEUTRAL] Oh, the, the breakdown. Hold on one second.
[CUSTOMER][NEUTRAL] That's fine, that's fine.
[AGENT][NEUTRAL] OK, so for radiation therapy, chemotherapy, and immunotherapy, they're all together. Um, the policy will pay up to $15,000 per 12-month period.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So whatever we're billed for, we'll pay exactly what we're billed for up to that 15,000.
[CUSTOMER][NEUTRAL] OK, um, can you tell me that claim number because again for that you're saying that these were included on?
[AGENT][NEUTRAL] Um, it's 359.
[AGENT][NEUTRAL] 8077.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me make sure, uh.
[CUSTOMER][NEUTRAL] I don't have a claim with that number.
[CUSTOMER][NEUTRAL] On it and I, I've gotten all I've kept everything and there's no claim with that number on it that I've received.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can send you a copy of the explanation of benefits for this one if you'd like.
[CUSTOMER][NEUTRAL] Um, I, I would like that. I don't know how.
[CUSTOMER][NEUTRAL] Can you tell me how much to pay that that was sent, the total benefit at the bottom, can you tell me what that benefit was?
[AGENT][NEUTRAL] Um, hold on, let me pull up the explanation of benefits. Hold on one second.
[CUSTOMER][NEUTRAL] OK. OK. That's fine.
[AGENT][NEUTRAL] Oh no, that's the original documents. Hold on one second, I'm sorry.
[CUSTOMER][NEUTRAL] That's fine. I'm fine. No, you're fine.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] OK, so I finally found it. Now it's coming up. So the total, where is the total?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] I don't see a total on here.
[CUSTOMER][NEUTRAL] That that's the reason why I'm saying because I never got any claim of explanation of benefits with that claim number and I've, I've kept everything. I've just gotten 3.
[CUSTOMER][NEUTRAL] And none of them have that number.
[AGENT][NEUTRAL] OK, so would you like me to email you a copy of the explanation of benefits?
[CUSTOMER][NEUTRAL] Yes, for that one and uh can I give you the numbers I have and you tell me if I'm missing anything else.
[CUSTOMER][NEUTRAL] I have a 359-468-8.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then I have a 3594422.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And, and then I have a 358-828-4 and that those are the only ones that I have.
[AGENT][NEUTRAL] OK, so those are the 12, those are the last, those are the 3 before the one that we
[AGENT][NEUTRAL] So this one that you, this one the 359-8077, it was sent in on [PII]. I have a confirmation number, but the three that you just gave were the three that we processed before this last one here.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK, so I haven't gotten this one and you said it was, it was processed on [PII]?
[AGENT][NEUTRAL] Well, you all sent it in on the online service center on [PII]. We finished processing it on [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, well that one's I haven't gotten anything on that one, so if you, if you can, can you just email that one to me?
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And also you said y'all are still working on the last two that I sent in.
[AGENT][NEUTRAL] Right, the last two that came in on on [PII] are in processing.
[CUSTOMER][NEUTRAL] Right, you said.
[CUSTOMER][POSITIVE] OK, alright then that, that should take care of everything that I know of. This has been a process getting all this. OK, thank you so much for your help, [PII]. OK.
[AGENT][NEUTRAL] Hold on one moment. I'm.
[AGENT][POSITIVE] You're very welcome. Well, I'm getting the email together for you now, so you should be receiving this in just a few moments. I'm typing it up for you now.
[CUSTOMER][POSITIVE] OK, well, I trust you if not I'll call back later.
[AGENT][NEUTRAL] Alright, well,
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, I think that's it. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Mm ah.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.