AccountId: 011433970860
ContactId: eeb17825-ab20-4624-b912-667aee429afe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 454309 ms
Total Talk Time (AGENT): 123791 ms
Total Talk Time (CUSTOMER): 357572 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=2.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/eeb17825-ab20-4624-b912-667aee429afe_20250108T13:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. I received some um explanation of benefits yesterday in the mail and I do have a question in reference to I think there's an error but I just wanna verify, um.
[AGENT][NEUTRAL] OK. What's your, what's your name?
[CUSTOMER][NEUTRAL] My name is [PII]. I do have the claim numbers in front of me.
[AGENT][NEUTRAL] OK, let me get the policy number and then the claim number, [PII].
[CUSTOMER][NEUTRAL] OK, um, the policy number is 02286545.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the claim numbers?
[CUSTOMER][NEUTRAL] The fir the claim number that I'm concerned about is 3546914.
[AGENT][NEUTRAL] OK. What's a good phone?
[CUSTOMER][NEGATIVE] And I'm gonna apologize if I forgot something, but I think there's an error.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And [PII], you're the policy holder?
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] OK, can you verify your date of birth, your mailing address, and then your email address, please?
[CUSTOMER][NEUTRAL] Sure, my date of birth is [PII]. My home address is [PII], and my email is [PII].
[AGENT][POSITIVE] OK, thank you. I like that the email address.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so we're checking, taking a look at claim number 3546914.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let's see, and who is, is it for you or a dependent?
[CUSTOMER][NEGATIVE] Well, this, I think that this is wrong. It says that it is for my daughter [PII]. It says that it is for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It says that it's for Florida cancer specialist and that it paid 19656, so a couple of things, one being my daughter definitely was not seen at Florida Cancer on [PII], but I can tell you what I think happened. My husband was.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it was inpatient in the hospital and I got an EOB for him also for the same amount of money, same patient account number.
[CUSTOMER][NEUTRAL] Everything about it was identical except it was two different claim numbers and I think what happened because I recently uploaded a receipt for [PII] for Emily's sheets for might have been about $250 275 somewhere around there I uploaded it over the holidays.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, with the EOB from Blue Cross because Blue Cross put it to the deductible. I uploaded it for you guys and I'm just wondering.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] If maybe the person that was keying it in keyed it in wrong, my concern is that it appears that a check was sent to [PII] Cancer for [PII], and that should not have been, and I'll explain to you why I'm crystal clear on this being an error.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're correct, yeah, as you're talking, I was looking I was looking through the.
[CUSTOMER][NEUTRAL] On January, yeah, on [PII], my husband um was diagnosed with cancer. I'm sorry. I'm sorry.
[AGENT][POSITIVE] I'm sorry to hear that, [PII].
[CUSTOMER][POSITIVE] Let me catch my breath, um, so I know, I know that it's, I'm sure it's a simple error. I'm happy that they paid the bill to Florida Can because I do know that there's some outstanding ones.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But I just think it was a keystroke. Maybe they were working on [PII] and [PII]'s at the same time, but I just want that check pulled back.
[CUSTOMER][POSITIVE] Um, definitely for that was made an error on [PII]'s part. If one was definitely sent out I'm assuming because it has two account numbers, um, that there was a check sent to them. So if we can just get that fixed, I would appreciate it and thank goodness you guys send the EOBs. I, I don't know that I've ever had to call for an error before.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And so after looking at the file I do show that the claim was also processed under your spouse, the payment was made and then it was uh reversed under [PII], so we're requesting a refund. Uh, we've already sent out a letter to Florida cancer specialists. Mhm.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right, thank you, and I'm sorry I do apologize.
[AGENT][POSITIVE] The catch on your part. No, no, no, it's OK. Thank you for calling us with that. No, no, no, no, no, no.
[CUSTOMER][NEUTRAL] Well, I apologize for falling apart.
[CUSTOMER][POSITIVE] But, but thank you for processing you guys have been absolutely amazing with helping take care of our family with this benefit. It is a spectacular benefit that our insurance reps set us up with.
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][POSITIVE] And I'm super appreciative for everything that you guys do. Do you, may I ask you why I do have you on the phone, do you write individual policies for people or is it only like a group kind of thing?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Group, no individual.
[CUSTOMER][POSITIVE] OK, OK, I had a feeling all right, uh, I just, I, I recommend you guys to anybody that I know we stopped doing life insurance well we stopped doing life insurance with our group, um, fortunately had not had to use it and for the same benefit that my boss was paying for the life insurance we were able to do this, this, you know, gap insurance for my staff and it's just been unbelievable.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh, that's wonderful to hear.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] How wonderful it's been. I reaped incredible rewards, of course, with my husband. um, he's, he has since passed away, but during the cancer treatment and the hospitalization and whatnot, you guys were phenomenal with taking care of bills for us to the point I will share with you, I almost, if I'm out of pocket, I'm out of pocket less than $1000 and it's because he made payments to Florida Cancer and they will owe me that money back. So I do believe when it's all said and done.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I probably will be 0 out of pocket for a 6 month salacious battle with cancer, and I think that that's a big deal for you guys to understand what you're doing for the people that you insure. You probably only hear the complaint part of it when claims aren't getting paid or something's wrong, so I like to share the positive with you if you would extend that on to your team. You guys are doing an amazing job there and I'm super appreciative.
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] Uh-huh. Mhm.
[AGENT][POSITIVE] Thank you. Thank you so much, [PII]. And yes, that is good to hear some positive.
[CUSTOMER][NEGATIVE] OK, well, we don't get enough of it in our world.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Right, exactly.
[CUSTOMER][NEUTRAL] So if I can share some of it with someone and have you guys know that what you're doing is super important, I do have my moments when I'm like, gosh, I wish it was more than $500 a day, but that's only when it's been an ER visit. But it also reminds me on a day when there's a $200 balance I'm not paying that $200 balance you guys are taking that for me, so thank you, thank you, happy, [PII], and I appreciate you being all over this.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Exactly.
[AGENT][POSITIVE] Oh wow, well, listen, [PII], thank you so much for that comment. I will pass it on to my supervisor and um if you have, do you have any other questions?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] That's it. That was it. It was just the one that I just happened to, and if they hadn't been sent together, I don't even know if I would have caught it, quite honestly, um, but I know, you know, fortunately she's not been at Florida Cancer, so that's a good thing. I'm gonna celebrate that today too.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Absolutely, absolutely, absolutely.
[CUSTOMER][POSITIVE] Alright thank you so very much for your time I appreciate it you enjoy the rest of your day.
[AGENT][POSITIVE] You too, [PII] and thank you for calling APL. Have a good day uh huh bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.