AccountId: 011433970860
ContactId: 10c8bbe4-89ef-4d25-ae29-96431c15b109
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 790299 ms
Total Talk Time (AGENT): 345252 ms
Total Talk Time (CUSTOMER): 256288 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/10c8bbe4-89ef-4d25-ae29-96431c15b109_20250306T15:54_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, I received a check uh from a claim that I made and uh on the back of the um explanation, I have two questions. Um, one, it has a number and then it says in order to give consideration to this date of service, we need a fully itemized hospital and facility billing with all charges fully identified. Could you tell me what that is, what that pertains to?
[AGENT][NEUTRAL] Yeah, let me take a look. Do you by chance have the claim number? That would be helpful.
[CUSTOMER][NEUTRAL] Uh, see, my, my, my policy number claim number, let me see, where is the claim, uh, claim number, OK, 356-735-1.
[AGENT][POSITIVE] Thank you so much. Let me just pull this up here.
[CUSTOMER][NEUTRAL] It's item number 2 on those remarks on the back of my statement.
[AGENT][NEUTRAL] OK. OK. Let's see here.
[AGENT][NEUTRAL] And then just for security, can I get your first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] OK. Uh it's [PII], [PII].
[AGENT][POSITIVE] Thank you so much. And then if I could also verify the address and email address we should have on file.
[CUSTOMER][NEUTRAL] OK. Uh, the address is [PII] and my email is uh [PII].
[AGENT][POSITIVE] Thank you so much. OK, let me look at
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that's on.
[AGENT][NEUTRAL] The facility.
[AGENT][NEUTRAL] OK, so that denial, the itemized hospital billing, it looks like was for um the date of service and uh we need an itemized hospital bill, it looks like that was what that denial was for, was for the facility charges.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Do you know what, I don't, I've been to so many hospitals.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Do you know?
[AGENT][NEUTRAL] Yeah, let's see if we can look um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I need the date of service that it's talking about in the hospital if you can do that.
[AGENT][NEUTRAL] OK, let's see here.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so it looks like the date of service is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's showing the provider as Carty, that's C as in cat, A R T I.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Parta, yes, OK.
[AGENT][NEUTRAL] Yeah, uh, surgical center.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] I thought that everything from them, I'm telling you. OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I need uh an itemized hospital and facility billing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For all charges fully identified, huh? OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, and then if you're submitting these yourself, um, you can.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Once you receive that, you could uh submit it online through the portal or you can of course send it to us in the mail or fax, whatever is more convenient for you.
[CUSTOMER][NEUTRAL] OK. All right. Now I have another question. Another one is at 4 on that list. It says in order to consideration to this procedure, please send the pathological report for the date of this service.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and I, I thought I sent you.
[CUSTOMER][NEUTRAL] The pathology report on
[AGENT][NEUTRAL] On it.
[CUSTOMER][NEUTRAL] The actual can
[CUSTOMER][NEUTRAL] I don't know
[AGENT][NEUTRAL] Let me take a look.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] No, it's OK. It's so much um
[AGENT][NEUTRAL] Information and paperwork that, yeah, I mean, sometimes it does happen where it just gets
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Missed or, so yeah, let's just double check and see cause I do see that it's
[CUSTOMER][NEUTRAL] I, I've been.
[CUSTOMER][POSITIVE] Like me and my husband have been paying on this policy for probably 40 years. And I thought, I want every penny I can get.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] Yeah, yeah, absolutely.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, it says we need a pathology report. So let me
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] See that was for
[AGENT][NEUTRAL] OK, so the um date of service for that pathology looks like, I don't know if you
[AGENT][NEUTRAL] It looks like it's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I see.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think that may have been when I had, I was required to get a, a colonoscopy, an upper GI.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Uh, the pathology report, huh.
[AGENT][NEUTRAL] It does look like that's what it was. It was an endoscopy center.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Now, would, is there, is there a need for me to go ahead and do that? Do you all, would y'all pay on it if there's no cancer?
[AGENT][NEUTRAL] Oh let's see here, um.
[AGENT][NEUTRAL] I can double check on that and look at the certificate because you uploaded, I was pulling the upload up for that claim. I mean it was quite a few, it was 75 pages so.
[CUSTOMER][NEGATIVE] I know it was bad.
[AGENT][NEUTRAL] Um, what.
[CUSTOMER][NEUTRAL] Well, the first girl that I talked to when I called that I had, you know, been diagnosed, she said, send everything you get, you know.
[AGENT][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] And you want an out my statement everywhere you go, so I said, OK, so that's what I've been trying to do.
[AGENT][NEUTRAL] Yeah, I know.
[AGENT][NEUTRAL] Um, let's.
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So, if it's considered, so it does, the plan does have like a diagnostic and prevention benefit. So if it's considered something like, you know, that they were doing as, you know, preventative care, it does pay for that. It's $75. If it was like a cancer screening follow-up, it would pay, it shows $75. Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So there are some benefits on there. It looks like medical imaging, but let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's up to.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] I'll go ahead and try to get that and uh and send it. If there's a chance I can get some money for it, I'll do it for sure.
[AGENT][POSITIVE] Yeah, yeah, yeah, for sure. And so, yeah, I would just resubmit those those single items um that way, you know, you don't have to redo it all because you've already uploaded so much.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] All right. Um,
[AGENT][NEUTRAL] Is there any other questions?
[CUSTOMER][NEUTRAL] And and I I got a question. Yes, it, um, there's a number 7. It says that attained age of uh critical illness rider decreases by 50%.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] So that means all my benefits decreased at 50%?
[AGENT][NEUTRAL] Yeah, let's see.
[AGENT][NEUTRAL] What line item was it again? I apologize, [PII].
[CUSTOMER][NEUTRAL] Number 7.
[AGENT][NEUTRAL] 7
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I do you know that some of these plans have.
[AGENT][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] And I, you know, I know that I was not aware that this policy, you know, had had reduced. I mean, like I said, my husband before he died, he worked the state police in [PII], and he had this policy for years before he filed. And then after he died, I carried it myself. I did reduce it because I couldn't afford the one that he had, but
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, let me, I'm just pulling up this explanation of benefits that you're looking at. It'll be easier for me to see.
[AGENT][NEUTRAL] OK, so it's on the let's see.
[AGENT][NEUTRAL] Yeah, it does say that actually on, it looks like page 1 of 4 of the critical illness writer. Um, that's the portion that looks like decrease decreases. It says benefits decrease by 50% at the age of [PII]. Um, so yeah, it looks like that is in the policy certificate, so.
[CUSTOMER][NEGATIVE] Kind of dirty. I'm telling you.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Uh to be paying on something that long and then that happened. I mean, you know.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Cause every time it comes to, I think, OK, I'm too old. I won't, I'm not gonna get cancer. I'm gonna drop it and then I go ahead and
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, you know, to learn that, you know, and when I got the policy, I all that, you know, so.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, I know. And it's, it, it is a lot of information to try and just remember and what is covered and
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And all that, so.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] I'm getting half of what I've been paying for all these years.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That's what it sounds like to me.
[AGENT][NEUTRAL] Yeah, I mean,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I wouldn't know just right off the top of my head, you know, what the benefits have changed, you know, if they've changed or what's changed, you know, like you said, since you've had it, um, as far as, yeah, in the policy itself, what is, you know, changed or modified. I, I don't know off the top of my head, unfortunately, but yeah, because of, you know, hitting age [PII], it does, it does decrease.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Mm mm. All right. Well, I thank you so much and I'll try to get those two there and
[CUSTOMER][NEGATIVE] If I can get some more half of what I, what I've been paying for all these years.
[AGENT][POSITIVE] All right, [PII]. Well, if you have any other questions or concerns, please feel free to call. We're happy to help.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh OK, I appreciate it thank you bye bye.
[AGENT][POSITIVE] My pleasure. Bye-bye.