AccountId: 011433970860
ContactId: ecbe9f15-7048-47f3-acf0-a220ecd4e625
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1468469 ms
Total Talk Time (AGENT): 646214 ms
Total Talk Time (CUSTOMER): 402489 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/ecbe9f15-7048-47f3-acf0-a220ecd4e625_20250612T15:06_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, um, my name is [PII].
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Yes, I can hear you, Miss [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Oh, OK. I thought maybe I had lost you. Um, yes, I have some questions and I can't remember who I was, I've been talking to [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maybe, but I can't remember her name. Anyway.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I had received an explanation of benefits and uh I just wanted to see kinda.
[CUSTOMER][NEUTRAL] What I need to do or what else I need to send in?
[AGENT][NEUTRAL] OK. OK, I can check and see how we are with your claim and what we need. Um, may I have a callback number just in case we get disconnected and the policy number?
[CUSTOMER][NEUTRAL] OK, yes, um,
[CUSTOMER][NEUTRAL] If we get disconnected, call [PII].
[CUSTOMER][NEUTRAL] And that way, maybe we won't get disconnected on that line.
[AGENT][NEUTRAL] OK. All right. And what is the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] 301.
[AGENT][NEUTRAL] OK, I didn't get that. You broke up. I got 01.
[CUSTOMER][POSITIVE] Goodness. It is.
[CUSTOMER][NEUTRAL] Can you hear me now? It's 593-301.
[AGENT][NEUTRAL] I can hear you.
[AGENT][NEUTRAL] OK, thank you. All right, uh let's see.
[AGENT][NEUTRAL] Uh, OK, I don't think that's right. OK, let me repeat what I heard, OK? It's 593-301.
[CUSTOMER][NEUTRAL] Yes, it's for [PII]. I'm sorry.
[AGENT][NEUTRAL] Oh, OK. All right.
[AGENT][NEUTRAL] And what's her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, let me go through the notes really quick.
[AGENT][NEUTRAL] OK, Ms. [PII], um,
[AGENT][NEUTRAL] What is your relationship?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] going to my mother.
[AGENT][NEUTRAL] Oh OK, OK, yeah, I'm trying to find a note with your name.
[AGENT][POSITIVE] There's a lot of notes, so bear with me. Thank you.
[AGENT][NEUTRAL] OK, so you OK.
[AGENT][NEUTRAL] OK, I see it here.
[AGENT][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] And can you verify the mailing address for me just to make sure we have correct the mailing address correct.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. All right, let's see. Oh, there's a lot of open claims. uh, OK, so which one?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Sorry, that was noisy.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was on yesterday. Let me look at this information on yesterday and see.
[CUSTOMER][NEUTRAL] OK. Well, I had sent some um chemotherapy records in.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, because one of the last SEOBs said I needed.
[CUSTOMER][NEUTRAL] You know I needed more information on the chemo, so I found some UBO4s and sent those in so.
[CUSTOMER][NEUTRAL] And they said they finished up some claims yesterday was I got a text.
[CUSTOMER][NEUTRAL] So I'm, I'm not sure what claims those were.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, well, they review uh the ones they received on the [PII] and then they reviewed the ones that they received in May on the end of May. I see that you have submitted some more on [PII], there's a few submissions on [PII]. Those have not been reviewed just yet. Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, I think
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] Let me see what is.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And I'm waiting on the, on the decisions to pull up. OK, mammogram.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so I see that for the surgery, they're asking for the pathology report for the surgery. Um,
[AGENT][NEUTRAL] It was the surgery. OK. OK. OK. Um, let me go to the next one.
[CUSTOMER][POSITIVE] Yes, I'm working on getting that.
[AGENT][NEUTRAL] OK, so that's the same system for pathology.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that's the same thing. OK.
[AGENT][NEUTRAL] Let me look at this other.
[AGENT][NEUTRAL] It's gonna be one more minute. I'm just waiting on another EOB to pull up and see what's on that EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And those are the you'll be that was worked on yesterday, so I'm trying to see if they need anything else or.
[AGENT][NEUTRAL] Or what they have on these let's see, so this is the intensive care.
[AGENT][NEUTRAL] It looks like they're getting ready to send the payment as well.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's good. Do you know how much it is this time?
[AGENT][NEUTRAL] It's still not finalized. I do see that there's a payment about to go out, but it doesn't have like a final amount yet.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, it just shows whether it's gonna pay or not but yeah they're working on that one today. This, um, you'll be so I can see like the decisions, but yeah, when there's a payment, we don't seem to it's completely out.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEGATIVE] OK, so this one is not OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so what they're paying is probably the surgery in [PII], um.
[AGENT][NEUTRAL] Yeah, that one is about to pay.
[AGENT][NEUTRAL] Um, yeah, so what I see here, the most recent updates, so the most recent update is the, uh, that we needed, um, the pathology report for the surgery done in let's see what day is this.
[AGENT][NEUTRAL] On [PII], so we need the pathology report for [PII]. OK, um, it looks like the one we're getting ready to pay is the one for March. So that's the one that it looks like we did receive all the information, so we, we're getting ready to pay that one. And then, um, for the intensive care charges that um they have reviewed, it looks like um that was before the policy was or after the policy was terminated. Let me check again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] one again.
[AGENT][NEUTRAL] OK, that, that was before the policies was active on [PII].
[AGENT][NEUTRAL] So that one is not, yeah, it's not.
[CUSTOMER][NEUTRAL] Yes, I forgotten that you and I, I, this is all I.
[AGENT][NEUTRAL] OK. All right. OK, and the rest.
[CUSTOMER][NEUTRAL] For sending that to you.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Yeah, it's OK, it's OK. They're just going like line by line and seeing what we need to pay, so it's fine if it's not payable, we're just gonna let you know that it's not payable, so it's OK. Um, so right now the risk for the chemotherapy and all that, it looks like it's the ones that you submitted probably on the [PII] and they're still in line to be processed, so they should be worked on shortly and once we review all those, then we'll go ahead and make a decision on all those, but right now.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, that's those are the most recent ones that I see and um so that's what we're at right now, OK?
[CUSTOMER][NEUTRAL] OK, well I did have a question what.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] There was an EOB that talked that had some services for intensive care for sickness and um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The mom's policy had said it, excuse me, excuse me.
[CUSTOMER][NEUTRAL] It pays $650 a day for intensive care and um
[CUSTOMER][NEGATIVE] What else do I need to submit because that's not uh how much was paid. It looked like it was either between $200 and something dollars to $400 and something dollars a day is what was paid on those. There were 3 different.
[CUSTOMER][NEUTRAL] The claim date
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] Uh, for
[CUSTOMER][NEUTRAL] Uh, one of them was [PII], [PII].
[AGENT][NEUTRAL] OK, what's the next one?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, you have another one?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Which I think she was in the hospital more days than that, but it's, I don't know what it's.
[CUSTOMER][NEUTRAL] On that one it's just on your EOB it just shows one date of service.
[CUSTOMER][NEUTRAL] But I think she was in the hospital till the [PII], but they may not have all been intensive care days, so I, you know, I'm just going by memory.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I see that on the [PII] they pay 43333 for each one of them.
[AGENT][NEUTRAL] Um, for each day.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, on my EOB it just says 43333.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I mean it doesn't say like 4:30. I mean it wasn't 1200 or something that they paid.
[CUSTOMER][NEUTRAL] at least that's what's showing on mine. Am I reading that correctly?
[AGENT][NEUTRAL] Um, well, there's 3 different claims. There's 3 different EOBs.
[CUSTOMER][NEUTRAL] For those 3 days.
[AGENT][NEUTRAL] Yes, and they're for 33, 33 each. Mhm.
[CUSTOMER][NEUTRAL] For May
[CUSTOMER][NEUTRAL] Can I, can I send you a picture of, am I able to send you a picture of what I'm looking at?
[AGENT][NEUTRAL] What claim number are you looking at?
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Claim number there it is 3606652.
[AGENT][NEUTRAL] OK, so that's the first one. Look at um claim 3,606,910. That will be the second one.
[AGENT][NEUTRAL] And look at a claim.
[AGENT][NEUTRAL] 3606937 and that will be the third one.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] I just got um
[CUSTOMER][NEUTRAL] What did you say the other number was?
[AGENT][NEUTRAL] 3606937.
[CUSTOMER][NEUTRAL] I didn't get the paperwork on 693-7.
[CUSTOMER][NEUTRAL] I've got somebody coming to my house so I'm hoping he doesn't come while we're on the phone.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah, I don't, I didn't receive one for that. So have I maybe not been paid for all of it yet, uh, or?
[AGENT][NEUTRAL] Um, we did send the 3 checks. I'm looking at them.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 3 different payments for May.
[CUSTOMER][NEUTRAL] Three different, OK, oh OK, well, let, let me clarify to make sure I'm understanding what you're saying. You're saying that you have 3 different claim numbers for [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just for
[CUSTOMER][NEUTRAL] Well, I just have [PII] on one line on my EOB.
[CUSTOMER][NEUTRAL] That I'm looking at and at the end it says paid for 3333.
[AGENT][NEUTRAL] OK, and you say you're looking at claim 3606652. What was you able to put on 3,606,910?
[CUSTOMER][NEUTRAL] Yes,
[CUSTOMER][NEUTRAL] I don't have that list, I mean.
[CUSTOMER][NEUTRAL] No, I, I don't have a a paper for that.
[CUSTOMER][NEGATIVE] I don't, I haven't received a paper for that one.
[CUSTOMER][NEGATIVE] It didn't come with that one.
[AGENT][NEUTRAL] No, it will not come together. Whenever, whenever we have different claim numbers, it comes separate. They're all different claims, so they're separated.
[CUSTOMER][NEUTRAL] Well maybe I still haven't received that one yet in the mail.
[AGENT][NEUTRAL] Mm, probably.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Yeah, these are all separate claims, separate checks.
[CUSTOMER][NEUTRAL] Well, because the one I'm looking at is part of the check that was sent out for $383,865.40.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] I wish I could send you, can I email you a picture of what I'm looking at?
[AGENT][NEUTRAL] It will go to another department. It will not come directly to me, um, yeah, we have a department that received emails.
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] Um, yeah, uh, let's see, let me check this thing, uh, let me put this together.
[CUSTOMER][NEUTRAL] Well, it's
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] 37 29 10.
[AGENT][NEUTRAL] 6169.
[AGENT][NEUTRAL] OK. 5:13.
[AGENT][NEUTRAL] OK, um, 318.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] 21.
[AGENT][NEUTRAL] This is all different checks. What check number are you looking at on that EOB? Yeah, these are all different checks. You should be receiving 3 checks.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] On this one that we're talking about the [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What check number is
[CUSTOMER][NEUTRAL] 2047431
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 0431. Yeah, that's the one you're looking at, OK.
[AGENT][NEUTRAL] OK, so you have the 31 and there's a 32 and a 33 coming to you, so it's supposed to be three separate checks.
[AGENT][NEUTRAL] They're gonna come all three in separate envelopes, separate EOB, separate checks.
[CUSTOMER][NEUTRAL] 31
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, well, maybe that I just haven't received that yet. OK, well, uh, so, so, um, so you were saying, OK, back to what you said, so you're saying they paid 433 for.
[AGENT][NEUTRAL] Probably. Mhm.
[CUSTOMER][NEUTRAL] The ICU days and not the $650 per day.
[CUSTOMER][NEUTRAL] And I guess my question is, do I need to submit now to get the full amount?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Or what, I mean, what am I doing wrong?
[AGENT][NEUTRAL] OK, for that, um, if you're only getting 4 33 33, they're probably on covering just actual charges, but in order to determine if those are actual charges, I will have to get um somebody in the um support claim to call you because that will be an investigation to see why they only pay for 3333.
[CUSTOMER][NEUTRAL] OK, well, and yeah, I had another question um I mean I had submitted some wellness benefits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which I mean her policy says they pay a max of 75 per year and on.
[CUSTOMER][NEUTRAL] Let's see 2017, 2018, 2019, and [PII].
[CUSTOMER][NEUTRAL] What they paid was only $25.
[AGENT][NEUTRAL] It was 25. That was a different certificate. She had two policies.
[CUSTOMER][NEUTRAL] Of
[AGENT][NEUTRAL] Um, let me go ahead and pull this other information because it looks like she had two different policies during that time, so that may be where the confusion is coming from, OK? One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK. Yeah, I am, I'm definitely confused.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] Let me look at this kind.
[AGENT][NEUTRAL] Let me pull
[AGENT][NEUTRAL] OK, is it OK for you to get a call back or?
[AGENT][NEUTRAL] You'd rather not.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, that's fine. That's fine. I do.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I think uh.
[CUSTOMER][NEUTRAL] A repair
[AGENT][NEUTRAL] OK, it's OK. I think I rather just go ahead and get a specialist to go over each charge with you and explain to you why she paid it the way she paid it or why is it paid that way because like I said, there are 3 payments. Um, the 3 payments, they seem to be similar, but there's 3 separate claims, and there are 3 separate claims is $25 for each date of service which they look all the same to me.
[AGENT][NEUTRAL] So if we added it together, it is 25 plus 3 I mean times 3 is 75. So I'm not really sure um how she processed the claim. Um, I can only go ahead and let her know that um you're a little bit confused about why is it showing 25.
[AGENT][NEGATIVE] Why is it 4333 and it's not the whole it's 50 so she can just do a research and call you back and tell you why she's only paying those amounts or if they're all supposed to be together or it because yeah and in my end I'm showing 3 different checks, 3 different EOBs for the same date of service.
[AGENT][NEUTRAL] The same amounts. So I just need to have somebody to look into this and give you a call back so she can have a better answer for you because what I'm seeing is is it's confusing to me a bit it's confusing to you.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Let me go ahead and get a specialist to look into it and see what happened, why it was processed like this, OK?
[CUSTOMER][NEUTRAL] OK, yeah, that.
[AGENT][NEUTRAL] Um, yeah, OK. All right, and she's gonna call you back at [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am, yes ma'am. If she would do that, uh, I will be unavailable for the next maybe 15 minutes, but, uh, you know, it'll probably be longer than that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] It's gonna be a lot longer than that because they will have to review and see why they process like that. They probably get need to get with the person who processed the claim, so it's gonna be a research, research usually takes some time for them to determine what happened with the claim, OK.
[CUSTOMER][NEUTRAL] Uh hello
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][POSITIVE] OK, thank you so much. I appreciate, appreciate all your help.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Thank you for calling APL. Have a good day. Oh, Ms. Cheer, I'm sorry. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Right.