AccountId: 011433970860
ContactId: 0c2aa75b-f677-4bba-a7b1-ab754b47ad0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 882940 ms
Total Talk Time (AGENT): 317072 ms
Total Talk Time (CUSTOMER): 320800 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/0c2aa75b-f677-4bba-a7b1-ab754b47ad0d_20250421T13:28_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][POSITIVE] Good morning, [PII].
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] I need to I need to check on the plane.
[AGENT][NEUTRAL] OK, well, Cancer claim. OK, well, I can help you with your claim. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Cancer
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Thank you for that. Mr. [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] My policy number 97205.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, let me take a look at. This would be the most recent claim, looks like it came in [PII].
[CUSTOMER][NEUTRAL] Yeah, that was the uh last piece of paperwork I think I was waiting on.
[AGENT][NEUTRAL] Now, this one is, well, there's a few, hold on one second.
[CUSTOMER][NEUTRAL] It's showing what, what.
[CUSTOMER][NEUTRAL] They should be showing what Medicare paid.
[AGENT][NEUTRAL] Yeah, but this claim, so the claim was denied, but it has several denial reasons. The main one is that the policy doesn't provide benefits for labs or diagnostic testing.
[CUSTOMER][NEUTRAL] I know about that one.
[AGENT][NEUTRAL] So it also has, let me see.
[AGENT][NEGATIVE] Office visits are not um covered.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] And then what's this one?
[CUSTOMER][NEUTRAL] The last one they were waiting on more information.
[AGENT][NEUTRAL] The explanation of benefits from primary?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] I see that one here. Let me see, did we?
[AGENT][NEUTRAL] So there's two of them. The one for the chemotherapy charge for [PII] is asking?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So you sent it in?
[CUSTOMER][NEUTRAL] Oh yeah, I'm looking at it on your website.
[AGENT][NEUTRAL] No, I'm saying, did you send the explanation of benefits in because we, the reason I'm asking is because I'm not showing anything incoming, or did you just do it?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yes, I, I, no, man, I didn't just do it.
[CUSTOMER][NEUTRAL] Uh, it was sent in.
[CUSTOMER][NEUTRAL] Um, maybe a week ago.
[AGENT][NEUTRAL] And you say you see what you sent in on our website?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] What does it say? because the
[CUSTOMER][NEUTRAL] It's the Medicare or something.
[CUSTOMER][NEUTRAL] It's the Medicare summary notice.
[CUSTOMER][NEUTRAL] Which tells you how much Medicare paid on that uh.
[CUSTOMER][NEUTRAL] On that claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It it it's got a claim number. Well, it's on Medicare.
[AGENT][NEUTRAL] But the reason I'm asking is because the online service center is linked with ours, but I don't see anything after your March claim submission. That's the last thing that's here. So let me pull up the documents and
[AGENT][NEUTRAL] But you said you see, you see it on the online service center for American Public Life or Medicare?
[CUSTOMER][NEUTRAL] Yes, you can up under the uploaded documents.
[AGENT][NEUTRAL] So let me
[CUSTOMER][NEUTRAL] Yeah, I'm on, I'm on the American public life uh portal.
[AGENT][NEUTRAL] OK, hold on one second. Let me maybe go this way.
[CUSTOMER][NEUTRAL] Are you in the office or working from home?
[AGENT][NEUTRAL] We all work from home.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, but that, that wouldn't, uh,
[AGENT][NEUTRAL] So, you're on the online service center and you see, I don't need, I don't see anything submitted after [PII] and this is what shows on the online service center. So now I'm confused.
[CUSTOMER][NEUTRAL] This, this was submitted, this was submitted before [PII].
[AGENT][NEUTRAL] So was it [PII]?
[CUSTOMER][NEUTRAL] Oh wait, wait, wait. It was, yeah, it was, it was, this is April. This was submitted in April.
[CUSTOMER][NEUTRAL] This is, this is April.
[CUSTOMER][NEUTRAL] I'm still I'm looking at the right calendar. OK. This was submitted in April.
[CUSTOMER][NEUTRAL] I submitted the, I submitted the final the last person I talked to.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They had, uh, they had the information where I submitted the uh
[CUSTOMER][NEUTRAL] The statement from the hospital and they needed the uh statement from Medicare showing what they pay.
[CUSTOMER][NEUTRAL] I think the last lady I talked to was, uh,
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If, if you're talking about in public life, yes.
[CUSTOMER][NEUTRAL] And that day, that I think.
[AGENT][NEGATIVE] See, all of this, all of this, it matches what I see, it's not matching what you see. Like the last time you called was [PII], that's the last that's the last submission I see. I, I don't see anything for April.
[CUSTOMER][NEUTRAL] Yeah, but I, I, I submitted this, uh, I'm on your line and it shows you what, when I, when I uploaded it and and I can view the file that I uploaded.
[AGENT][NEUTRAL] Well, let me do this then. Let me see if I can get a claims examiner on the line. Maybe they can see something on their back and that I that we just don't see here and then they'll also be able to help you further because they're processing the claims.
[CUSTOMER][POSITIVE] Yes ma'am, that's what I like. That's why I ask you where you were, yeah, that's why I asked you where you at, working from home or you're in the office.
[AGENT][NEUTRAL] You want to do that?
[AGENT][NEUTRAL] Oh, OK, they, they're at home too, but I can get you somebody.
[CUSTOMER][NEUTRAL] I like
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] OK, um, before I do that, Mr. [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Oh man.
[AGENT][NEUTRAL] Alright, well, thank you for calling APL. Hold on one moment while I get a representative for you, OK?
[CUSTOMER][POSITIVE] Yeah, OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Bring
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey, the phone's breaking up. I didn't hear your name. Can you say that one more time?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] Hey, [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] I'm good. How are you, [PII]?
[AGENT][NEUTRAL] I'm OK. Um, I have a member on the other line who wants to speak to a claims rep. He
[AGENT][NEUTRAL] So he has a claim here. He's under the impression that there's some claims docs somewhere else that he submitted in April. I don't see anything past [PII] in line or on base.
[AGENT][NEUTRAL] Um, the policy number is 97205.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's part two.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Did he happen to did he submit it through the OSC?
[AGENT][NEUTRAL] Yes, and he says that he sees it on there and I'm like, you see it on the online service center? And he said, yes, and I can click on it and it comes up and I'm like, what? Because I don't see anything.
[AGENT][NEUTRAL] Past [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah and there's not anything up under his other policy.
[CUSTOMER][NEGATIVE] At all
[CUSTOMER][NEUTRAL] Um, OK, let's see, let's see, let's see.
[CUSTOMER][NEUTRAL] See, and I don't even see anything for [PII].
[CUSTOMER][NEUTRAL] [PII] as far as stuff received.
[CUSTOMER][NEUTRAL] I see [PII].
[AGENT][NEUTRAL] Really?
[CUSTOMER][NEUTRAL] It was processed on the [PII] yeah it was processed on the [PII], but we received it on the [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, yeah, yeah, the EOB, I mean, the [PII] is the EOB.
[CUSTOMER][NEUTRAL] Oh, got you, got you. OK. I was like, I don't even say anything I'm so I don't know. OK, um, did he happen to mention like what it was?
[AGENT][NEUTRAL] But I don't see anything for April.
[AGENT][NEUTRAL] OK, yes. So on the last claim that we processed, um, ending in 9837, so we asked for the explanation of benefits for like two of his codes, so that's what he was uploading.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] I don't see it.
[AGENT][NEUTRAL] Anywhere.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But isn't the, OK, because isn't the OSC like linked with OnBase, right?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And lying. OK, I'm just making sure because I say that on the phone, so I want, I want to make sure I was saying the right thing.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah it is, yes it is so as soon as they upload it, it doesn't have to go through indexing like our paper or faxes do um it kind of automatically goes where it's supposed to because that person is putting in their policy number and it's so within a few minutes typically you can see that new mail.
[AGENT][NEUTRAL] Because I'm like it's linked.
[AGENT][NEUTRAL] Has come in.
[CUSTOMER][NEUTRAL] Is available online mhm and then you see on his client that confirmation number that's out there.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That should appear or he should have gotten a confirmation number for his upload and so it should like we should be able to match whatever his confirmation number is with a document received.
[AGENT][NEUTRAL] To that line.
[CUSTOMER][NEUTRAL] Yeah, so just a heads up that's probably what I'm gonna do I'm gonna be like, hey, do you have some type of confirmation number or something out there that I can get so that we can see if like.
[CUSTOMER][NEUTRAL] There was because I don't know I mean if it's not right exactly I have something to reference because if it's not there and he uploaded it through the OSC like that's out of my wheelhouse I have no idea where to find it. I can't go out to indexing and be like, oh yeah, you know, like did he say what day he uploaded it by chance?
[AGENT][NEUTRAL] We have something to reference.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, he said it was about, so when I asked him, he said it was about a week ago, and I said because the last thing I'm seeing is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And he said, well, it's on the online service center and I can, I said on APL online service center, and he said, yes, and I can click it, and I said, OK.
[CUSTOMER][NEUTRAL] Weird. OK, um, yeah, I'll just have to go through and essentially tell him the same thing and be like, OK, what, what is that number out there besides besides that that you've uploaded because.
[AGENT][NEUTRAL] We.
[CUSTOMER][NEGATIVE] It's not here that doesn't mean that it's not in our system but it's, it almost seems like it's lost somewhere you know.
[AGENT][NEUTRAL] Or he's thinking he sent it to us and sent it somewhere else, because he has Medicare too, and I asked him that and he was like, no, it's APL. I said, OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Okey dokey. Well, we, we shall see.
[AGENT][NEUTRAL] Alright, hold on one moment, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you so much for holding. I have [PII] on the line, I'm sorry, [PII] on the line and she'll be able to assist you further, OK?
[CUSTOMER][NEUTRAL] OK, [PII]. OK.
[CUSTOMER][NEUTRAL] Hey, Mr. [PII], this is [PII]. How are you?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] I'm getting off to a rough start this.