AccountId: 011433970860
ContactId: b03d60aa-52ad-4541-8926-ec0f89c80c64
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1096640 ms
Total Talk Time (AGENT): 314795 ms
Total Talk Time (CUSTOMER): 411166 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/b03d60aa-52ad-4541-8926-ec0f89c80c64_20250512T19:17_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Good afternoon. Thanks for calling API. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. How are you? This is [PII].
[AGENT][POSITIVE] OK, I'm good how are you?
[CUSTOMER][NEUTRAL] I'm good, I'm good. OK. I thought you couldn't hear me. I'm like, oh, she cannot hear me. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I have a member on the line that she's calling, we just processed the claim and I explained to her why we denied the claim, um, but she's saying that we should pay at least for the mileage, so she's asking about that. So let me go ahead and give you the policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, that is 640053.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] On part one, part two.
[CUSTOMER][NEUTRAL] Part two, [PII].
[CUSTOMER][NEUTRAL] The my card it has passed, so it's just slow yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] for chemo.
[AGENT][NEUTRAL] Duplicate
[AGENT][NEGATIVE] Labs not covered.
[CUSTOMER][NEGATIVE] Yeah, I already went over that claim with her and explained to her why we didn't deny the claim. So she knows about that. She's just saying, well, why you didn't even pay for the mileage. So basically right now she's just um not happy about not getting paid for the mileage. She says she has not been getting paid since February, uh, for any kind of mileage to go and do her chemo.
[AGENT][NEUTRAL] Mm let me see if I see anything for mileage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Yeah sure, yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Last time we paid her was [PII].
[AGENT][NEUTRAL] We have [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright you can send her on over.
[CUSTOMER][NEUTRAL] Uh, OK, here she comes. I fully verify her the callback number is the same one in the system, OK?
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] Thank you. You're welcome.
[CUSTOMER][POSITIVE] Thank you for holding and being patient for Ms. [PII]. I got Miss [PII] on the line. She's in the claims department and she's gonna, um, go over the claim with you, OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Mhm. Have a good day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh, I, I, I was, do you have my claim my my policy number and everything? I gotta give you all that again or what?
[AGENT][NEUTRAL] No, ma'am, she gave me your policy number.
[CUSTOMER][NEGATIVE] Do you, do I need to start? OK. So why, why do they not even pay any more on mileage? I know that $7500 is all they pay on chemo and you know, that wasn't on my original policy. That uh they didn't say there was a limit of that amount on my original policy, but y'all told me that later. But I have a copy of the original policy and that wasn't even on there. So, um, but that what, what about, you didn't paid any mileage since [PII]. So do, are you not gonna pay that either?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me one second to look at your transportation benefit. 1 2nd.
[AGENT][NEUTRAL] OK, give me one second, can I put you on hold just one moment please.
[CUSTOMER][NEUTRAL] Yes I am.
[AGENT][NEUTRAL] OK, one second.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey [PII] how are you?
[AGENT][POSITIVE] I'm doing well thanks for asking. [PII] I have a question.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Policy number 640053.
[AGENT][NEUTRAL] Uh-huh, part two, yes, um, she was asking about her transportation and so the last time we paid I guess for was for the chemo I guess she had on 24.
[AGENT][NEUTRAL] So once her chemo benefits are maxed out, what about, do we still not pay transportation?
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Well, so you, so you maxed out her benefit 128 to 318 that you know her chemo benefits have been met.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And so would she still not be eligible for any transportation that she had?
[AGENT][NEUTRAL] Yes, so the issue is
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did we let her know that we can't read it so she'll know what to send again?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] here.
[AGENT][NEUTRAL] It's based on what they.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] There
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can you add something on to the claim that did you just process one today to let her know that we can't read it, that we can't read this, but I'll let her know she's on the phone now, but I'll let her know.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, OK, alright, let me get back with her.
[AGENT][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] OK, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Alright, thank you for holding.
[CUSTOMER][NEUTRAL] I'm here. Mhm.
[AGENT][NEUTRAL] OK, I was speaking with the lady, so the information that you sent in, uh, they're unable to read it, uh.
[AGENT][NEUTRAL] On the left side of the page.
[CUSTOMER][NEUTRAL] But I turned around and I mailed it.
[AGENT][NEUTRAL] You mailed it
[CUSTOMER][NEGATIVE] I mailed it in too. I mailed it and, and I, and I've, and then it's been uploaded and mailed. I, I don't understand where, where all the stuff going.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] No, ma'am. I'm saying that we do.
[CUSTOMER][NEUTRAL] I mailed it the first.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] OK, so we do have the information, but on the left side of the page is really dark, so we can't see uh what the procedures were that you had. So like where it says data service and type of service, that information is really dark like maybe a copy was made and it a copy is really really dark on that side.
[AGENT][NEGATIVE] So that's why the uh transportation has not been paid because they can't read it.
[CUSTOMER][NEUTRAL] Mhm. What, what?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] What, what date and what I mean, I don't know what, what I'm gonna resend again because we've sent it many times already. What, what page or what, what day or what, what do you topic do you need?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so looks like it's data service, uh, looks like it's [PII].
[CUSTOMER][NEUTRAL] You've already paid the mileage on that.
[CUSTOMER][NEGATIVE] You've already paid the mileage all the way to [PII]. It's all the visits after that. Nobody paid any mileage on any of that. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm, I'm just, I'm just reading to you. I'm just reading to you what I see in the claim information. Give me one second.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] And so if we've already paid it you can just disregard that one.
[CUSTOMER][NEUTRAL] That 120.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] And I see, uh, looks like it's 34-2025.
[AGENT][NEGATIVE] That one, that page is really dark.
[CUSTOMER][NEGATIVE] Can I tell you the dates that I, that came up to 34, OK. I, I, I mailed you on [PII] and again on the [PII], claims for 2434 and 318 because y'all ask for all that and you didn't get it on the upload and I said well I'll just mail it. I, I, I don't know how this is to you.
[CUSTOMER][NEUTRAL] Do you want us to upload it again or what? Just tell me what we need to do because I mean.
[AGENT][NEGATIVE] We need, we need a copy, we need a more legible, we need a more legible copy, uh, one side of the page is just really.
[CUSTOMER][NEGATIVE] Some way I'm supposed to get some kind of money.
[CUSTOMER][NEUTRAL] Uploaded or mailed?
[CUSTOMER][NEUTRAL] For what date?
[AGENT][NEUTRAL] 34
[CUSTOMER][NEUTRAL] I you've already done the the uh 34 uh-huh.
[AGENT][NEUTRAL] Yes ma'am, as long as it's not dark, it, it, it's too dark on the left side of the page so we cannot read the services.
[CUSTOMER][NEUTRAL] OK, I don't know what dates the two are. [PII], and what else?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One second while I go to each page because we have like 13 pages, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so 3:18 looks like it's OK. That page we can read.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see what's the next one.
[CUSTOMER][NEUTRAL] Uh, um, may not have seen any past that. What about, let's see.
[CUSTOMER][NEUTRAL] Cause we're just trying to get these straightened out before we send any more in. I don't think I've seen in more past those two, but um 34 and 3, 318. So we just gotta upload the EOB. Is that what you want from 34? Is that what you're wanting?
[AGENT][NEUTRAL] No ma'am, that's the last one.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I mean we, we just need to be able to read it to read it because right now it's too dark on one side.
[CUSTOMER][NEUTRAL] The EOB?
[CUSTOMER][NEUTRAL] Wait
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] But when you're looking, are you looking at it?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Are you looking at the page you are is it from Mutual of Omaha, Medicare or what? That's what I'm trying to figure out what, what I need to send to you. A Mutual of Omaha.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see, give me one second, yes ma'am, from mutual.
[CUSTOMER][NEUTRAL] That's the only thing I have is mutual on Medicare.
[AGENT][NEUTRAL] Yes ma'am, you live on my.
[CUSTOMER][NEUTRAL] Just that 134, right? And then, then they'll see that mileage or whatever after that.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Is that what? OK, OK, uh well just.
[CUSTOMER][NEUTRAL] Upload 34 again and do we have to put anything with it or just, just upload it and send it to you I mean that's all you need uh do we have to put an explanation for why we're sending it again or anything cause I've mailed it and uploaded it and
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] I, I understand that, but the issue is we cannot read it, so they know that we can't read it, that we, we cannot read it. So that's what we're looking for. We need to be able to see everything that was done and on one side, we cannot read that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so just upload mutual hall 34, and that's all I've got to do right now, right? OK, OK. Thank you very, thank you very much then. Uh, I, let me ask one other thing. OK. Can I ask one more question?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm, yes ma'am.
[AGENT][POSITIVE] OK, you're welcome.
[AGENT][POSITIVE] Yes ma'am, yes.
[CUSTOMER][NEUTRAL] Ma'am, OK, right. Like if I had my original policy.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And I've got it here and
[CUSTOMER][NEGATIVE] On the hospital expense on that page it is um cancer and specified disease policy. It says the policy benefits. It doesn't have anything on there about radiation and chemo benefits is only $7500 for 12 month period, but you're sent that to me a copy of it a month or two ago, and now that's on. Why would that not have been on the original policy?
[AGENT][NEUTRAL] Uh, let me see if I can.
[CUSTOMER][NEUTRAL] The one on the original policy.
[AGENT][NEUTRAL] OK, let me see if I can find your original policy in our system. One second please.
[CUSTOMER][NEUTRAL] Mm mhm.
[CUSTOMER][NEUTRAL] From page 3.
[AGENT][NEUTRAL] Um, effective date.
[CUSTOMER][NEUTRAL] It was on page 3 is where I'm
[AGENT][NEUTRAL] Yes, ma'am, I'm looking at it.
[CUSTOMER][NEUTRAL] Talking about on that policy.
[AGENT][NEUTRAL] But I'm looking at looking back at your your older one.
[CUSTOMER][NEUTRAL] OK. That is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so I don't see, but I do see where um your older policy.
[AGENT][NEUTRAL] And it does not show that policy only showed a daily hospital expense.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Uh, it doesn't show the chemotherapy expense.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Mhm. I just, I just wondered why that was known the original policy because it's um
[CUSTOMER][NEUTRAL] Says, let's see, I don't know.
[CUSTOMER][NEUTRAL] But you know, it was only when I resend it and I just wondered why, why it wasn't on the original policy like that, but I guess, I guess.
[AGENT][NEUTRAL] OK, because it looks like there was a there was a change in your benefits back in [PII].
[CUSTOMER][NEUTRAL] OK, I don't remember what my husband died.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He, he died in [PII] and then it became just my policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So he, he thought he actually was an APL agent and um
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Alright, I'm sorry to hear that, but yeah, but your benefit is always been uh the chemo, the 7500, so I'm not sure why it didn't appear that way on the other one on the previous policy.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. Well, I'll just get that other thing reloaded and uploaded and maybe y'all can go from there, OK?
[AGENT][POSITIVE] OK then, thank you.
[CUSTOMER][POSITIVE] About the mileage, OK? All right. Yes, ma'am. Thank you. Bye. Bye.
[AGENT][POSITIVE] Have a great day.
[AGENT][NEUTRAL] Bye bye.