AccountId: 011433970860
ContactId: 11748cc4-d374-4d6e-aa81-2cb9d85c2d65
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 911770 ms
Total Talk Time (AGENT): 341892 ms
Total Talk Time (CUSTOMER): 291280 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/11748cc4-d374-4d6e-aa81-2cb9d85c2d65_20250423T18:49_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] Hi [PII], yeah, I just wanted to follow up on a request you guys, uh, made from, um, my wife [PII] on regards to a claim that we've got we submitted with you guys to get adjusted and corrected hopefully.
[AGENT][NEUTRAL] OK, well, I
[CUSTOMER][NEUTRAL] It was you asked for a UB UB04 form?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I can look into the claims for you and make sure it's been received.
[CUSTOMER][NEUTRAL] Yeah, and I I
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] I haven't sent it yet. I want I just got it and I wanted to see where to send it and to make sure I have the right email.
[AGENT][NEUTRAL] OK, I understand. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, yeah, name's [PII].
[AGENT][NEUTRAL] And a good contact number and then your policy number.
[CUSTOMER][NEUTRAL] Sure it's 949.
[CUSTOMER][NEUTRAL] 246
[CUSTOMER][NEUTRAL] 0633
[CUSTOMER][NEUTRAL] And the claim number I'm sorry the our medical number is 6825.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 42457
[AGENT][NEUTRAL] Is that the do you have that number on your APL policy card?
[AGENT][NEUTRAL] Or is this a social?
[CUSTOMER][NEUTRAL] No, that's just, um, the, no, no, no, that was uh um our medical member number at the time the claim was made.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, because our, our policy is with a PC uh PCHS.
[CUSTOMER][NEUTRAL] And um they gave us your number to uh handle.
[AGENT][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm gonna see if there's a policy here, but we are so peace, I don't even know the acronym. It's a different insurance company than us. Sounds like you're trying to get to 90 degrees because they work with all of us. But let me make sure, hold on one moment.
[CUSTOMER][NEUTRAL] OK, well I got a letter from you guys from says American Public Life says we're working on a claim that has been started, so.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Is there a reference number on there?
[CUSTOMER][NEUTRAL] That's what I'm calling on.
[CUSTOMER][NEGATIVE] No, there never is a reference number on these letters. It's always just saying we're working on it. Uh, thank you for trusting APL with your insurance needs. Um, I, my, my insurance company told me to call you guys because you help. You look at bills and you you look at them and say, Hey, yeah, that's ridiculous. That's not right because they're really trying to collect a lot of money from us and, um, and they said no that's way too much you but but this is the company that handles that kind of stuff and so last time I talked to you guys, you know.
[CUSTOMER][NEUTRAL] You've got an itemized list from Providence. I gave you that and then um you guys looked at that and now we need uh the universal bill, the UBO4, you know, with the diagnosis diagnostic codes and all that kind of fun stuff.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's your date of birth?
[CUSTOMER][NEUTRAL] Uh, my wife's says [PII].
[AGENT][NEUTRAL] Now, I was asking for yours to see if this was the correct policy. Um, hold on one moment. Is the policy under your wife's name?
[CUSTOMER][NEUTRAL] Oh, well, no, this, yeah, that, right, yeah, it was under her wife, my wife's name at the time by herself.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said her name was [PII]?
[CUSTOMER][NEUTRAL] Uh huh, or [PII], yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And is her first name spelled [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, this might be it hold on one moment.
[AGENT][NEUTRAL] Are these all the same. I'm just trying to locate the policy. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Is it currently active or it's no longer active?
[CUSTOMER][NEUTRAL] Oh no, it's active yeah I mean the letter we got from you guys was, you know, not too old, just like just a couple weeks ago, yeah.
[AGENT][NEUTRAL] Alright, so it's this one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I hope this is it. What's your date of birth, Mr. [PII]?
[CUSTOMER][NEUTRAL] Mine's [PII].
[AGENT][POSITIVE] Alright, thank you and all the information provided.
[CUSTOMER][NEUTRAL] My wife, my
[AGENT][NEUTRAL] I just need yours. Hold on one second. All the information provided is a verification of benefits, not a guarantee of payment. And can you verify your mailing address and the email address on file, OK, I found the policy.
[CUSTOMER][NEUTRAL] Oh OK, alright.
[CUSTOMER][NEUTRAL] OK, the my email address is [PII].
[AGENT][NEUTRAL] And the mailing address?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, our mailing address is um [PII].
[AGENT][POSITIVE] Thank you for that. Um, and
[AGENT][NEUTRAL] So this is what happened. Business Workers of America, that 682 number, that's the member ID number for them, but we can't use that in our system. So let me give you your policy number and then um give us that number when you call and you should have no problem.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK, good. Alright, so what is the new, uh, policy number?
[AGENT][NEUTRAL] So it's 253.
[AGENT][NEUTRAL] 68
[CUSTOMER][NEUTRAL] 253.
[CUSTOMER][NEUTRAL] 68
[AGENT][NEUTRAL] Mhm. 96.
[CUSTOMER][NEUTRAL] 96 OK that's 253-6896.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, and that's your policy number and so um you're wanting the mailing address?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the claim?
[CUSTOMER][NEUTRAL] Uh, well, no, I, I have, I have, I just took a picture of it. I mean, I, can I email it to you guys? I, the email I have for you guys or that I've been sending stuff in the past is [PII].
[AGENT][NEUTRAL] OK, so let me, hold on one moment. So you do have the option to do both. That email address is to business workers of America who will also, uh, they, they will process the claims as well, so you can send it to us or them, but that email is theirs and the claim will be processed.
[CUSTOMER][NEUTRAL] OK, so you guys will get wind of it as well then.
[AGENT][NEUTRAL] Uh, not if you send it to Business Workers of America, they'll process it and they'll have a record of it.
[CUSTOMER][NEUTRAL] OK, well, every time I call them they tell me to call you guys, which is the, you know, the number I just called [PII].
[AGENT][NEUTRAL] Well, it depends on what your
[AGENT][NEUTRAL] Like what you're calling for. So like if you have questions about termination, things like that, then that'll go to them. That email address that you, I brought them up because that email address is not ours, that's their email address. You do have the option to file the claim there.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh yeah, no, I started with them, but now you guys have it, so OK, where should I email them, uh, give me your email and I'll email it to you guys because you have, you have the other form, right, the itemized breakdown of this $13,000 bill.
[AGENT][NEUTRAL] So we don't accept claims through um email because of HIPAA laws. You can mail it, you can fax it, or you can upload it to the online service center.
[AGENT][NEUTRAL] Um, I can provide you with any other information or if you have a particular option you want to use.
[CUSTOMER][NEUTRAL] Oh OK then I guess we'll have to fax then all right, let's do that. What is the, uh, your fax number?
[AGENT][NEUTRAL] So it's [PII].
[CUSTOMER][NEUTRAL] 877.
[AGENT][NEUTRAL] Yes, sir, [PII].
[CUSTOMER][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, and what do I put attention to?
[AGENT][NEUTRAL] So that will be attention APL claims department.
[CUSTOMER][NEUTRAL] APL claims department OK.
[CUSTOMER][NEUTRAL] And then of course put the member uh the policy number.
[AGENT][NEUTRAL] Correct. The, um, well,
[CUSTOMER][NEUTRAL] And, and
[AGENT][NEUTRAL] Are you, so you're going to need the hospital indemnity claim form. Do you have that form? If not, I can email it to you if you need it.
[CUSTOMER][NEUTRAL] What do I need that for?
[AGENT][NEUTRAL] So anytime you submit a claim, you're gonna need a claim form. Each product has their own claim form. It basically asks you for like your, your um
[AGENT][NEUTRAL] Policy number, all your demographics, no matter what policy you have or yeah, you have, you're gonna need the claim form, but I can email you a copy if you don't have one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. Yeah, do that email me a copy please and um I'll print that out along with the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And send it along with this uh UB whatever form.
[AGENT][NEUTRAL] OK. And let me just double check. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, because you guys work you guys are working on a claim. I'm sorry, go ahead.
[AGENT][NEUTRAL] And the email
[AGENT][NEUTRAL] The email address, um, just to confirm, is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK. And then what question did you have?
[CUSTOMER][NEUTRAL] I mean you guys are working on two claims from Providence uh Medical, uh, one's for 13, the other 381, the other one is for, um, I don't have in front of me it was like 1500 and some change.
[AGENT][NEUTRAL] As of right.
[CUSTOMER][NEUTRAL] Those are the two claims that we submitted.
[AGENT][NEUTRAL] Submit it when?
[AGENT][NEUTRAL] Did you send it to us or the email address?
[CUSTOMER][NEUTRAL] Um, I sent it to, uh, to you guys because I spoke to you guys last time and you said you needed this UB40 form.
[CUSTOMER][NEUTRAL] And um and I said OK and but she said they're gonna mail it to you it's gonna take a few days. I finally got it last week and so now I'm calling to get you that form.
[AGENT][NEUTRAL] OK, wait a minute, who is the claim for?
[CUSTOMER][NEUTRAL] It's for my wife, [PII] from a, a situation that occurred last year on [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] It's the claim number.
[AGENT][NEUTRAL] OK, hold on one moment. Let me take a look at this claim, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Come on, come on. Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I'm caught up here. I had to backtrack and see what was going on so I could understand what you were saying. OK. So this claim was denied because they couldn't um read the documents that were received and I saw the explanation of charges at the top, which is why you were advised for the UBO4. OK, so yes, we do have the claim here and it's not processing because it's denied, but once we receive that EOB that you're sending, I'm sorry, itemized bill, then they'll continue processing.
[CUSTOMER][POSITIVE] OK good
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] Got you. OK, so that, yeah, that's kind of what they told me last time, so that makes sense. OK, cool. Alright then, I will go ahead and, uh, fax that to you along with the form that you said I fill that form you emailed me, the claims form as well?
[AGENT][NEUTRAL] Yes, so you attached it with this email, uh, I keep saying email with this claim here, um, I'm gonna send you, it it's the same claim form. Mhm.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Oh, I did. OK, I thought, I thought I did.
[AGENT][NEUTRAL] You did, it just, so since it's additional, you can just send the UBO4 because we have this here. Well, no, because the dates are different. I don't want that to be denied because of that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, yeah, let me just send you, I just don't want any more, you know, delays, so I'll just send it to you and just have everything fresh with the documents.
[CUSTOMER][NEUTRAL] Yeah, neither do I. Yeah.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, that's what I'm thinking too. I mean, might as well, right? I mean, what's the big difference?
[AGENT][NEUTRAL] Just to be on the safe side.
[CUSTOMER][POSITIVE] Yeah, exactly, exactly my point, yeah.
[AGENT][POSITIVE] Alright, so I'm sending this to you now, so you should be receiving it in a few minutes. I haven't sent it yet. You should be receiving it in just a few moments. I'm attaching it now. And uh was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Sounds good to me.
[CUSTOMER][NEUTRAL] Uh, no, that should do it for now.
[AGENT][POSITIVE] Alrighty, Mr. [PII]. Well, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] I will thank you so much for the help.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] All right. Bye-bye now.