AccountId: 011433970860
ContactId: b87a4e91-5c5d-4d2b-bcbb-e7c35714025e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 276709 ms
Total Talk Time (AGENT): 140496 ms
Total Talk Time (CUSTOMER): 108098 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/b87a4e91-5c5d-4d2b-bcbb-e7c35714025e_20250507T13:20_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in [PII]. How are you doing?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][POSITIVE] Doing great, doing great just calling to see if I could check on a claim for one of our customers.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim, and [PII], may I have a good contact number and the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's uh my phone number is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 227.
[CUSTOMER][NEUTRAL] 12:46.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I have the member here. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and that's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So it looks like, hold on one moment, the claim just finished processing yesterday. There's a payment of $10,000 that's being sent to the insured. Um, let me see, and she set up on direct deposit, so it, it's um,
[AGENT][NEUTRAL] It'll be direct deposited to her. It just finished yesterday, so it went out like this morning at [PII], so she should be receiving it in the next few days.
[CUSTOMER][NEUTRAL] OK, perfect, perfect. So now that her claims open it and she was paid the initial diagnosis as she starts to go for the treatments we can just keep sending in that as well.
[AGENT][NEUTRAL] Right, well, this, OK, so this claim is closed, but once her treatments and stuff come in, do you know if she's filing it herself or if she's making the provider file?
[CUSTOMER][NEUTRAL] Um, she's probably gonna start sending everything to me, so, but, um, so, but it's all connected to the same claim. So basically when you start sending in getting her radiation and chemo, just keep uploading that as well. It is basically what I was saying, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, OK, perfect, I appreciate your time today and um.
[CUSTOMER][NEUTRAL] She also there's also a claim under her husband um.
[CUSTOMER][NEUTRAL] It's under the same exact policy. His name is [PII]. Um, do you see that we processed anything recently for him?
[AGENT][NEUTRAL] The last thing I see for him was uh April. Hold on.
[AGENT][NEUTRAL] [PII] of this year was the last claim. Should it be something, is that the one or should it be something after that?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] That that's probably it.
[AGENT][NEUTRAL] OK. Um, well, yes, we processed this claim on [PII]. It was a payment of $100 sent to the patient.
[CUSTOMER][NEUTRAL] OK, um, quick question for you. He, he does have to travel for treatment. Um, what is the minimum mileage that they, they have to travel to get, uh, mileage?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 50. Um, so it needs, um, so it needs to be 50 from their home to the treatment system, yes.
[CUSTOMER][NEUTRAL] Is it like 50 miles?
[CUSTOMER][NEUTRAL] I couldn't remember it's 40 or 50.
[CUSTOMER][NEUTRAL] Mhm. Got it. OK. I think he said he talked to somebody the other day and they tried to, um, tell him that it wasn't covered, but he said it's over 50 miles from his house to.
[CUSTOMER][NEUTRAL] To the, to the center where he gets treatment. So, right, so I will uh I'll talk to him.
[AGENT][NEUTRAL] To the facility.
[AGENT][NEUTRAL] Yeah, it's um 50 mile minimum and um
[CUSTOMER][NEUTRAL] But um.
[AGENT][NEUTRAL] I mean, I'm just double check for his policy since.
[AGENT][NEUTRAL] Someone else already told them something different.
[CUSTOMER][NEGATIVE] And and and I don't even remember how do we even prove mileage? How do we do that? We just.
[AGENT][NEUTRAL] Well, I mean, it's two ways. So either, you know, when they send in the billing and everything, it usually has the facilities address on there and like phone number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or um and and we'll have their address, so we'll be able to see the distance or if they want to just print out like, well Lord, we don't have Map Plus anymore. I guess like Google, you know, just somewhere where they can see this is the to and from address, um, people print out Apple and everything, just something to show it to.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. Alright, I will work on that and I I appreciate I appreciate your time.
[AGENT][NEUTRAL] I was gonna say that.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] That's it. Have a great day.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.