AccountId: 011433970860
ContactId: f9222a69-d586-48fe-a9e4-5f66c6ce9a89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 533960 ms
Total Talk Time (AGENT): 264575 ms
Total Talk Time (CUSTOMER): 248918 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/f9222a69-d586-48fe-a9e4-5f66c6ce9a89_20250307T19:07_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I was trying to uh check on the status of, of, of a claim that I filed. Uh, this is [PII].
[AGENT][POSITIVE] OK, Ms. [PII], well, I'll be more than happy to help you with your claim. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 00711624
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Because healthy joint.
[AGENT][NEUTRAL] And can you verify your date of birth and your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And um my mailing address is [PII].
[AGENT][POSITIVE] Thank you and then just your email address.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. So this would be the the most recent claim here that was processed from [PII] looks like.
[CUSTOMER][NEUTRAL] That's the
[CUSTOMER][NEUTRAL] I need to
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] For a mammogram?
[CUSTOMER][NEGATIVE] Oh, I, I received the check for the mammogram today, but I had sent in another one for, for, for chemo and I haven't received that one.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, hold on one second. So this is for lodging.
[CUSTOMER][NEUTRAL] And I was trying to see the status on that one.
[CUSTOMER][NEUTRAL] you're saying more.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][POSITIVE] It is your lucky day.
[AGENT][NEUTRAL] Oh, I see, it's multiple. OK, so I found the one with the chemo on it. So it looks like that was also.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Maybe you should ask yourself.
[AGENT][NEUTRAL] Um, hold on one second, I'm going through the screen, sorry.
[CUSTOMER][POSITIVE] So now, my mother will want it.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEGATIVE] They haven't given it to me.
[AGENT][NEUTRAL] So it looks like a payment of $15,000 is coming to you. Um, the claim just finished processing on [PII]. Um, so you should, it went out to the banks, when was the [PII], was that Monday? It was Tuesday. So it went out to the banks the night of the [PII], um, so depending on your um bank or if you get it, it looks like it's a paper check, so you should be receiving it in the mail, but it did mail out on the [PII], that was this Tuesday.
[CUSTOMER][NEGATIVE] OK, cause I received the one for mammogram, but uh that's why it, it wasn't um cause I had put um another one for a mammogram in that in that claim too, so it's just like even $15,000.
[AGENT][NEUTRAL] Let me see, I think so. So the one for the mammogram, that one was um processed on the [PII]. This one is on [PII]. Yes, ma'am, 15,000 even.
[CUSTOMER][NEUTRAL] What's
[CUSTOMER][NEUTRAL] OK, cause I had put um for another mammogram from last year in there.
[CUSTOMER][NEGATIVE] With that one, so I can't get paid for that one either.
[AGENT][NEUTRAL] Let me see if there was
[CUSTOMER][NEUTRAL] For my
[AGENT][NEUTRAL] I see this memo here for [PII]. Hold on one second.
[CUSTOMER][POSITIVE] You can empathize with what you went through with [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So, per calendar year is only one preventative test and it looks like you had a preventative test also in [PII]. Um, let me see if I can find what claim it was.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEGATIVE] So I got paid for [PII] for the mammogram. I got that check today, but the one for the year before I had put it in there with the with the um chemo thing, so I can't get paid for that one.
[AGENT][NEUTRAL] Um, so the mammogram that you got paid for was for [PII]. So that was [PII], but there is one that was denied for [PII] because it was already paid out. So I'm trying to see where that came from. It sounds like there was, so it's only one preventative test per year. So I'm trying to see if it was another type of preventative test or because it just said preventative, it didn't say what it was from [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, so I, I only get just that I don't get paid for the mileage and uh hotel accommodations and travel or nothing. I don't get nothing for that, huh.
[AGENT][NEUTRAL] Well, no, that's not true. Um, so you have another payment coming to you. Hold on one second, let me go through that screen. That was for the lodging. Mhm.
[CUSTOMER][NEUTRAL] Cause I sent my hotel bill.
[CUSTOMER][NEUTRAL] Yeah, for [PII], for [PII].
[AGENT][NEUTRAL] Yes, ma'am. So I see 4.
[CUSTOMER][NEUTRAL] Come on
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Is this a new one? Hold on one moment, I'm trying to get it all together. 106.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Later baby.
[AGENT][NEUTRAL] OK, yeah, this is 2025. OK. So the lodging is by itself is 24. Hold on, I don't want to tell you the wrong thing. Let me, hold on one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You have to get the drink.
[AGENT][NEUTRAL] OK, so that's the mammogram.
[CUSTOMER][POSITIVE] But a lodging and travel, so I, I should get paid for that too, right?
[AGENT][NEUTRAL] Yes, ma'am. I'm trying to, OK, yes. So you have the [PII] payment?
[AGENT][NEUTRAL] That's coming to you?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't want to mix up these lines. Hold on one second because this is 24.
[CUSTOMER][NEUTRAL] She did you check it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Where is the one with the lodging by itself for 25, I mean 24?
[CUSTOMER][NEUTRAL] Or maybe we should talk about.
[CUSTOMER][NEUTRAL] Find out if he's on the right car.
[AGENT][NEUTRAL] OK, the lodging is a line on the [PII], OK, so the lodging was under the claim with the 15,000, but it was denied. Let me see what the reasoning was.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1 and 2 depression.
[CUSTOMER][NEGATIVE] Yeah, lodging and travel, that's what I was concerned about.
[AGENT][NEUTRAL] OK, so the lodging and the travel, so that comes into play when it's in, um, it says that it appears no covered treatment was received there for transportation and lodging is not covered for this data service.
[CUSTOMER][NEUTRAL] You don't understand that, OK.
[AGENT][NEUTRAL] The lodging and the transportation was to go to the chemotherapy sessions?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is it at least 50, so it also has to be at least 50 miles away from your home?
[CUSTOMER][NEUTRAL] Let it
[CUSTOMER][NEUTRAL] It's 300 miles away from my home.
[AGENT][NEUTRAL] So I, and it was for the chemotherapy treatment.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Well, I take chemotherapy is in a pill.
[CUSTOMER][NEUTRAL] You you can buy the cars. Who's that?
[AGENT][NEUTRAL] OK. So the reason I'm so the hm.
[AGENT][NEUTRAL] The reason I was asking is because when I was looking at the, the denial reason.
[CUSTOMER][NEUTRAL] The freedom
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's saying like if you work like you know how you can go to like the some of the cancer treatment centers and they like you go there and they like you get the chemo and the liquid, then that lodging and that transportation because you're receiving treatment there in that facility.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that's what the difference would be.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEGATIVE] So they say I, I don't get anything for that. I, I'm just gonna get some chemo, that's all.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you so much, sweetie.
[AGENT][POSITIVE] You're welcome. Well, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] No, that's it, but um I, I just received a check, you know, today. So I guess the other one is in the mail, huh?
[AGENT][NEUTRAL] Yes, ma'am. The other one was mailed the next day. One was mailed on the [PII], 1 was mailed on the [PII]. So if you've already received the [PII], then the [PII] should be coming.
[CUSTOMER][NEUTRAL] Here
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling [PII]. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] like
[CUSTOMER][NEUTRAL] OK alright bye bye.
[AGENT][NEUTRAL] Bye bye.