AccountId: 011433970860
ContactId: e7a9ba66-a752-4aa9-88c2-cadf5318c96f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1092579 ms
Total Talk Time (AGENT): 213442 ms
Total Talk Time (CUSTOMER): 444216 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=-1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/e7a9ba66-a752-4aa9-88c2-cadf5318c96f_20250317T19:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Sorry, my name is [PII]. I have some several questions I need to ask about, uh, some claims and uh some information on my, my, uh, policy. Uh, I had talked with someone last week. Uh, my policy number is um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 00727573
[AGENT][NEUTRAL] OK, let me look that up, Miss [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] And my address is [PII]. My email address is [PII]. And what was the other thing you asked for?
[AGENT][NEUTRAL] Your email address, please, and phone number. I got your email and
[CUSTOMER][NEUTRAL] [PII], oh, the phone number, the phone number [PII] [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK Miss [PII], now is that phone number the first one that you gave me is that a good number to call you back on if we get disconnected? OK, perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am, the [PII]. Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and you said you had several questions. I can help you with questions.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] OK, first thing I had called the sweetheart a week ago and I talked to someone about uh, uh, a check that they said they had sent me and I filled the paperwork out and everything. The lady told me she's gonna call me back when she found something out, but I never heard from anybody and it's about a check for $150 and uh the number of the check is 185.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] 553.
[CUSTOMER][NEGATIVE] And I did never receive it and I filled the paperwork out and sent it back to them the same day, but they said they, they, they did, they sent me another thing say second request.
[AGENT][NEUTRAL] OK, let me look and see.
[AGENT][NEUTRAL] OK, so you said a check was supposed to come to you and that check number was 185553.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] 1856553
[AGENT][NEUTRAL] OK, let me look and see.
[CUSTOMER][NEGATIVE] If the check date is [PII], and they said they sent it but I never received it and I had sent to fill the paper out back and sent back to them that I didn't receive it and had never gotten it or anything and they said they sent me another paper just uh on the
[CUSTOMER][NEUTRAL] The [PII] saying that they still hadn't received the paperwork back from me and I put it in the post office. I didn't put it in the mail, you know, in the mailbox. I put it in the post office when it was sent to them and she said she was gonna try to look and see what she could find out.
[AGENT][NEUTRAL] OK, alright, let me, um, I do see the check is still outstanding, which means you haven't received it, so let me.
[AGENT][POSITIVE] Sees real quick.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So she told you when you, when you called that day.
[AGENT][NEUTRAL] She told you that you needed to speak with Ms. [PII], is that correct?
[CUSTOMER][NEUTRAL] Right, right, but she told me she was gonna speak with her and she was gonna call me back and let me know what she found out. Cause I called Miss [PII]'s office and she wasn't in.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] What I can do is I can send Ms. [PII] an email and let her know that you're still waiting for a call back from her.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I'll do that. I'm gonna put you on a quick hold, yes ma'am. I'll put you on a quick hold while I get that email together and I'll be right back. I'm gonna do it while we're on the phone, OK?
[CUSTOMER][NEUTRAL] That'd be fine.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, it's gonna be a quick hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, Ms. [PII], I've got that email sent to Ms. [PII] um to give you a call back and I and I gave her the phone number [PII] so that um.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And now she's gonna be out of the office until [PII].
[CUSTOMER][NEUTRAL] Oh well, I'll be out of town by the month, yeah, that'd be fine. OK.
[AGENT][NEUTRAL] Just so you know.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Just so you know.
[CUSTOMER][NEUTRAL] That's good. Yes, ma'am. That'll be fine. I'm still now I'm trying to get back to this policy. All of the claims that I've been sending, and it said I got a check the other week for $100 for my, on my medication now.
[CUSTOMER][NEGATIVE] One lady told me that maybe it was a medication that I, that y'all don't pay for. But and then, and then on the, on the, on the back of the um statement that they gave me, they sent me, they said that uh it uh my benefit had been exhausted for the year. And for my chemo medicine or whatever, the che my therapy that I have, the pills that I take, it's you, it's supposed to be $15,000 and they have not paid me $15,000 on the, on the.
[CUSTOMER][NEGATIVE] The immunotherapy thing this year. So this is the 2nd year that uh my stuff has been messed up somehow whoever did it the first time when I seen the first claim in, in [PII]gust, they denied it and then I had to call back and I talked to a lady like you, a person that, you know, was helping me do it and she said, she found, yes ma'am, she found that the claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] My claim doesn't start until [PII], and they've only sent me two checks, one with $4000 and $4700 and $4800 or something like that and for my chemo stuff and everything that they're saying, they said that they don't pay for the medicine that I'm taking now. So I was just trying to understand.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] About it, why they don't pay for the medication or whatever that I'm on uh uh uh I didn't know that they have certain medicines that they pay for.
[AGENT][NEUTRAL] Right. OK. So, on that one, you said that, um,
[AGENT][NEUTRAL] The claims mentioned that your benefits had been exhausted. What is the claim number for that one?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, I can't, I don't really know that one right now cause I don't have that particular bill, but I do have the one that I got the $60 check that I got, uh, on the, this one was sent to me in on the [PII]. It says that check date [PII] and everything says it's not covered. Now what do you need on it? The claim number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, the claim number says 3563872.
[AGENT][NEUTRAL] OK. So I've got this one.
[AGENT][NEUTRAL] Written down and again what I'm going to do is we're gonna go a different direction with this one make sure that you get good help um I'm going to send a request from somebody in the claims department.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] An examiner that looks over the claims for them to give you a call back and help explain this claim to you and what's going on with your medications now, OK? So we're gonna make sure we get you a call back on that one too. So it's gonna be just a moment again, just so that I can um
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Get somebody to help you, OK?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So I'm gonna go, I'm gonna put you on a quick hold. I'm gonna do a request now, OK?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you, ma'am.
[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] OK, Ms. [PII], I've got that request in now for the claims department to call you back about your claim and explain to you why your medicine isn't being paid for anymore.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEGATIVE] Yes, ma'am. Yes ma'am. I thank you and he said that the administrative lab said, oh, it's, I, I don't know why. I mean, all of this was being paid before and, and like I said, my year only started in August, so I haven't received.
[CUSTOMER][NEUTRAL] $15,000 in the, in the um chemotherapy stuff at all because uh they said uh several of the medicines that I'm taking now that uh they don't pay for the injections, I mean, the infusion that I get, they say that that medication is not one that, uh, they pay for. That's what the other lady told me, so I don't, I don't know what's happening, but I'm just trying to uh
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Get an understanding of everything cause I've never had this problem before until the last couple of years, they, my original.
[CUSTOMER][NEUTRAL] that you have exhausted the payment and um.
[CUSTOMER][NEUTRAL] I have stage 4 cancer, so, you know, it ain't like I got a lot of time to play around and find out what, you know, what's going on. So I was trying to um
[CUSTOMER][NEGATIVE] Get an understanding of what's going on because I pay the premium every 3 months and everything and now things have changed, you know what I'm saying? And I don't, I asked the lady about a formulary. Y'all don't send out a formulary or nothing like that that tells what medications are available or whatever for your company.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] No, ma'am. We don't have that.
[AGENT][NEUTRAL] Not that I know of, no.
[CUSTOMER][NEUTRAL] OK, OK. All right. But that's the lady said it probably was due to a medication that y'all don't pay for. And of course, the medication that I'm taking now is a, a fairly new uh medication that has just come on the market for a while and it seems to be doing pretty good, but you know, like I said, I just don't know.
[CUSTOMER][NEUTRAL] If it's there and they said when they gave me the $50 they sent me a check yesterday for 50 for $100 and it said that that was for my medication and that I had uh
[CUSTOMER][NEUTRAL] Exhausted the, you know, the, the, the, the the money for this year and I know I have.
[CUSTOMER][POSITIVE] So I, I don't know what's going on, but I appreciate your time. Yes, ma'am. I appreciate you taking the time to do that, and I'll be looking to hear from them whenever I can. Thank you so much. Yes, ma'am.
[AGENT][NEUTRAL] OK. Yeah.
[AGENT][POSITIVE] OK. Yes, ma'am. Well, you're so very welcome, Ms. [PII]. And hopefully, somebody will be getting back to you soon and get this stuff cleared up for you, OK?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Yes, ma'am. Yes, ma'am. Thank you so much. You have a good evening.
[AGENT][NEUTRAL] Alright.
[AGENT][POSITIVE] You have a blunt too thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yes, ma'am. Bye-bye.
[AGENT][NEUTRAL] Mm