AccountId: 011433970860
ContactId: be9f1a8e-e013-4fe8-8961-5146c3eec449
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 977380 ms
Total Talk Time (AGENT): 209484 ms
Total Talk Time (CUSTOMER): 314659 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/be9f1a8e-e013-4fe8-8961-5146c3eec449_20250117T14:50_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes ma'am, what is your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I need somebody to.
[CUSTOMER][NEUTRAL] Um, look at a claim and.
[CUSTOMER][NEUTRAL] Explain to me why.
[CUSTOMER][NEGATIVE] This is as low as it is on my wife's cancer policy.
[AGENT][NEUTRAL] OK, sure. I can assist you with the information I can see. And may I have um your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Number is [PII].
[AGENT][NEUTRAL] Thank you and may I have the policy number?
[CUSTOMER][NEUTRAL] Policy number is 02533255.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Alright, I see.
[AGENT][NEUTRAL] OK, I need to verify um the mailing address on file and the date of birth for Miss [PII].
[CUSTOMER][NEUTRAL] Look it's [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, let me check and see.
[AGENT][NEUTRAL] So we send.
[AGENT][NEUTRAL] And you're um talking about the check we sent for 3950.
[CUSTOMER][NEUTRAL] Sure yeah.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] OK, let me go over the, the whole claim because there's a lot of things that it looks like um we're paying and then there's a lot more that that we're not paying and I just need to check and see if we're asking for additional information or or what's going on, OK? So I'm gonna put you on a brief hold.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for me. OK. Um, OK, so yeah, there's a lot of information that we need and there's some information that is waiting for, there's some uh like anesthesia is waiting for the itemized bill to be covered. So basically, um, we have 1234, like 6 items that need attention. Um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So we're gonna have, um, we need the itemized bill for the surgeries.
[CUSTOMER][NEUTRAL] Man, I've seen all this in.
[AGENT][NEGATIVE] They already processed what they have but they're still missing some information that's the only reason they pay only for the ones that they were fully itemized.
[CUSTOMER][POSITIVE] Everything I've sent in has been itemized.
[CUSTOMER][NEGATIVE] And y'all are telling me out of $400,000 worth of medical claims so far.
[AGENT][NEUTRAL] If you need for
[CUSTOMER][NEUTRAL] Just in the
[CUSTOMER][NEUTRAL] 4 weeks that we've been here.
[CUSTOMER][NEUTRAL] You're only gonna pay out $3900 on $400,000 worth of treatment.
[AGENT][NEUTRAL] We're gonna pay more once we get the information.
[CUSTOMER][NEUTRAL] So far ahead and
[CUSTOMER][NEUTRAL] Y'all have the information. It's all if you look at the.
[CUSTOMER][NEUTRAL] this is like 10 times I've called y'all and I'm sorry that you're having to get the brunt of this, but.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] This is, this is crazy.
[CUSTOMER][NEGATIVE] They haven't paid for our airfare from the [PII] when we got here. They haven't paid for.
[CUSTOMER][NEUTRAL] My hotel rooms.
[CUSTOMER][NEGATIVE] That they say they're gonna pay, they pay us $200 no $100 for our.
[CUSTOMER][NEUTRAL] Hotel stay, we've been here for 3 weeks.
[CUSTOMER][NEGATIVE] They're supposed to pay her $100 a day for every day that $125 a day that she's.
[CUSTOMER][NEUTRAL] In a hotel and they paid her $100.
[AGENT][NEUTRAL] What
[CUSTOMER][NEGATIVE] I don't understand what else that it is that y'all need. I've got a breakdown of every charge, every cost.
[CUSTOMER][NEUTRAL] Of everything that we have up to.
[CUSTOMER][NEUTRAL] Through yesterday
[AGENT][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] I've sent everything in surgeries I've sent in.
[CUSTOMER][NEUTRAL] I've sent in
[CUSTOMER][NEUTRAL] I mean, everything I've got.
[CUSTOMER][NEUTRAL] I'm sitting here looking at it everything from back from January the.
[CUSTOMER][NEUTRAL] [PII] when I sent in the first initial bill.
[CUSTOMER][NEUTRAL] That's $250,000 just right there.
[AGENT][NEUTRAL] OK, Mr. [PII], what I can.
[CUSTOMER][NEUTRAL] I don't see any of the surgeries. I don't see the colonoscopy surgery.
[CUSTOMER][NEUTRAL] That she had in here I don't see the.
[CUSTOMER][NEUTRAL] Chemotherapy that she's done.
[CUSTOMER][NEGATIVE] None of that's been paid.
[CUSTOMER][NEUTRAL] We're 8 hours from home.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] I mean, we're counting on this money for her to be able to live until she dies. And this is a terminal cancer, but
[CUSTOMER][NEGATIVE] The way that she's getting paid, she's not gonna be alive to even.
[CUSTOMER][NEUTRAL] See any of these benefits.
[CUSTOMER][NEUTRAL] And every time I call it, so by law we have 15 days to look at it. We have 15 days to look at it.
[CUSTOMER][NEUTRAL] And then when they do pay.
[CUSTOMER][NEUTRAL] You mean $3000 3900 dollars?
[CUSTOMER][NEGATIVE] It don't make any sense.
[CUSTOMER][NEGATIVE] Makes no sense to me.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Mr. [PII], what I can do is send this for research, review, and have the examiner call you.
[AGENT][NEUTRAL] Is that OK?
[CUSTOMER][NEUTRAL] Is he available where I can talk to him right now. We've got she's gotta go in for chemo treatments this morning.
[AGENT][NEUTRAL] Um, I can check.
[AGENT][NEUTRAL] OK, I can check and see if she can, if sh[PII]'s available, OK, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] S.
[CUSTOMER][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[AGENT][NEUTRAL] Hi, [PII], how are you? This is [PII].
[CUSTOMER][NEUTRAL] Hi sir.
[AGENT][NEUTRAL] Hey, um, um, I try not to transfer, but today is one of those days that everything is like, OK, I have a member on the line that, uh, he's calling about the wife, um, policy. He, he's authorized. He does have the paperwork here, he's authorized. um, and he is calling because we send the payment and he believes it's too low and he
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] OK, policy number is 2533255.
[CUSTOMER][NEUTRAL] Uh, this is a cancel policy, and it's on the first mail that first, uh, what claim number is it?
[AGENT][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] The most recent one that we sent out, um, yeah, the 286.
[CUSTOMER][NEUTRAL] OK, let's see. DHB. OK, OK, and this is, um, uh, [PII] did this and this be audited, so I know it's correct because, uh, uh, [PII], uh, audit them. OK, you can let me speak to him if you, you wanna know what's going on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, he just wanna know why we pay so little that um it should have been a little bit more than that, and I did advise him that we needed the itemized bills that we're still missing some itemized bills for the surgery, but um he, he just, he just wanna know why he needs to send more paper that he spend already all the paper he had. So let me put him in, OK? OK, thank you. Have a good day. Here he comes.
[CUSTOMER][NEUTRAL] OK, I can tell him.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what's his name?
[AGENT][NEUTRAL] His name is Mr. [PII] Mr. [PII].
[CUSTOMER][POSITIVE] OK, OK, thank you.
[AGENT][NEUTRAL] OK, you're welcome. Oh, do you need the uh the phone number, the callback number?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] If you if they need me to call him back what's the number.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] OK. You're welcome. Thank you for holding and being patient for me, Mr. [PII]. I got Miss [PII] on the line. She's in our claims department and she's gonna assist you from here.
[CUSTOMER][NEUTRAL] At
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] Uh, Mr. [PII], my name is [PII]. I'm in the claims department and you're calling in reference to the latest claim that was processed on Mrs. [PII], uh, cancer policy. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am. OK, tell me what, what, uh, question that you have about it.
[CUSTOMER][NEGATIVE] Same questions I've had every time I've called. I don't understand why she's only been paying out $3900.
[CUSTOMER][NEUTRAL] On her cancer policy.
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] The last 4 weeks that we've been here.
[CUSTOMER][NEGATIVE] And you guys are only paying out $3900 in our hospital bills so far with this cancer crap is already I don't know one statement shows $1.5 million.
[CUSTOMER][NEUTRAL] OK, and I.
[CUSTOMER][NEUTRAL] $3900 that's insane, OK, well let me tell you about the policy and I can go over the policy benefits with you. If she's in the hospital, her daily hospital benefit is a $200 benefit per day. She was in the 13 days and we paid her $2600. So if you take that $200 and multiplied times 13.
[CUSTOMER][NEUTRAL] You come up with $2600. So that's how it came out to be for the hospital stay for those 13 days.
[CUSTOMER][NEUTRAL] OK I mean I've already.
[CUSTOMER][NEGATIVE] Yeah, I have a lot of questions. That's not, that don't answer my questions.
[CUSTOMER][NEUTRAL] OK, I'm, well, I'm answering it the best I know how is to just go over the benefits with you to tell you what the benefit amount is for hospitals for DHB, OK.
[CUSTOMER][NEUTRAL] Go ahead Mr. [PII]. Go ahead.