AccountId: 011433970860
ContactId: 1672d99e-7066-42dc-bdc1-6eb45d1d0fb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 842520 ms
Total Talk Time (AGENT): 310854 ms
Total Talk Time (CUSTOMER): 418695 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/1672d99e-7066-42dc-bdc1-6eb45d1d0fb9_20250513T17:57_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, I'm trying to figure out um just how far my uh how far along my claim is gone.
[CUSTOMER][NEUTRAL] I'll be in process, been working on it for about 6 months.
[AGENT][NEUTRAL] OK, you're
[AGENT][NEUTRAL] OK, you're the insured and you're wanting to check on a claim status for yourself, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that and who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And Mr. [PII], what Mr. [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and your policy number please.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Policy number is.
[CUSTOMER][NEUTRAL] Oh, OK, hold on, I'm looking at this, uh, authorization form right now. Let me see if I can find it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I can try and look it up if it's easier with your full social if you're the subscriber on the policy.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 88
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you one moment while I look at the information.
[AGENT][NEUTRAL] OK, Mr. [PII], I will need to verify several things with you first, for security purposes and also any information that is provided would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you. Also your home mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. The phone number that is on file for you is the same as the one that you gave me, so that is the best number that.
[AGENT][NEUTRAL] We should have is that
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you and lastly your email address?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, and Mr. So, what is the data service that you're calling about?
[CUSTOMER][NEUTRAL] Um, the date of service.
[AGENT][NEUTRAL] Uh-huh, for your claim?
[CUSTOMER][NEUTRAL] Oh well, um, it has on my thing it says explanation of benefits thing it's [PII] was the check date.
[CUSTOMER][NEUTRAL] Um, and what it was is they needed some, uh.
[CUSTOMER][NEUTRAL] I had to send in um an authorization to release the disclosure patient information.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And I had to send walk out statements, diagnostic codes and walkout state so I sent all of that stuff in some time ago.
[CUSTOMER][NEUTRAL] And I'm just trying to figure out where you guys are with this processing this.
[AGENT][NEUTRAL] OK, but when when, when were you treated? What's the date of service for when you had.
[CUSTOMER][NEGATIVE] All that it was, it was, it was several dates, um, it was all of them, uh, accumulation of several different dates. I had to send in all the um all the itemized bills and everything for all the different times I went in, so all of that's been sent in, um, like I said, I'm just.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I sent in the authorization to release, huh?
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Uh-huh. No, go ahead.
[CUSTOMER][NEUTRAL] I just wanna see where you guys are, huh?
[AGENT][NEUTRAL] Yes, so I'm trying to locate the claims information that you're specifically inquiring on. What year did you have treatment that you were submitting claims for? Was it in [PII]?
[CUSTOMER][NEUTRAL] It was 2.
[AGENT][NEUTRAL] Like
[CUSTOMER][NEUTRAL] [PII], [PII] was last year.
[AGENT][NEUTRAL] OK, so I don't see anything for you for [PII], Mr. [PII]. What I'm looking.
[AGENT][NEUTRAL] Looking at is for [PII] multiple disservice.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In January, I mean, it goes from January all the way through [PII]. Is that the claim that you're inquiring on?
[CUSTOMER][NEUTRAL] Um, let's see here.
[AGENT][NEUTRAL] The dates of service in [PII] we had paid, there was a benefit paid.
[CUSTOMER][NEUTRAL] I'm looking, looking.
[AGENT][NEUTRAL] You have two different claims.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, what was the recent one paid?
[CUSTOMER][NEGATIVE] Because I'm still getting bills from a line of health.
[AGENT][NEUTRAL] OK, the
[AGENT][NEUTRAL] OK, so on.
[AGENT][NEUTRAL] The most recent claim that was reviewed.
[AGENT][NEUTRAL] There were 2. They were done [PII] and [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] where we issued the payment for $150.
[AGENT][NEUTRAL] That was for your dates of service in [PII].
[CUSTOMER][NEUTRAL] Yeah, I got that.
[AGENT][NEUTRAL] The other claim for your dates of service in [PII].
[AGENT][NEUTRAL] Now that claim has been denied. Let me see the remarks on that.
[AGENT][NEUTRAL] And the remark code on all of that states the charges submitted are not payable because services were rendered prior to the policy's effective date. So we received all of these claims for multiple dates of service and.
[AGENT][NEUTRAL] The year [PII].
[AGENT][NEUTRAL] But your coverage with our company was not effective until [PII].
[CUSTOMER][NEUTRAL] OK, and so.
[CUSTOMER][NEGATIVE] Um, so all these bills I got from a line of health care, you guys are not covering them then, right?
[AGENT][NEUTRAL] If it's for any treatment you received in [PII], no, sir, cause your policy wasn't active with us then.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] You must have had covered, you know, with a different carrier before.
[CUSTOMER][NEUTRAL] That's really weird because I have I.
[CUSTOMER][NEUTRAL] Well, that's really weird because I have correspondence with you saying that uh.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] What did it say?
[CUSTOMER][NEUTRAL] As the policy owner received your claim on your policy and review of this claim is started, in some cases additional information must be requested from you or your provider, um, of medical services for the claim to be processed and so I sent in all these diagnostic stuff and now you're saying that it wasn't even, I'll just, I'll just pay for it. I'll, I'll just take care of it, huh?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, but
[AGENT][NEUTRAL] So no sir, no sir, so what I'm trying to determine you you we're talking, OK, so there was a claim that was submitted to us for for dates of service in the year [PII]. All of those were were were denied because your coverage was not active with APL until [PII]. The claims that were submitted for [PII].
[AGENT][NEUTRAL] There were benefits paid in the amount of $150 on that claim. There were some codes.
[CUSTOMER][NEGATIVE] That's, that's, uh, listen, listen, that's, that's not doing anything for me. I've, I've got, I got some uh bills from a line of for $3000. What's the $150 for?
[CUSTOMER][NEGATIVE] I don't, I don't need $150. I just need, what's the point of me even having insurance? Never mind. I'll just pay the bill myself. I'll cancel you guys and I'll get another insurance company. Thank you. You just have a good day.
[AGENT][NEUTRAL] Do you have the company?
[AGENT][NEUTRAL] Yes, sir, do you have the phone number for member services, which is the company that you signed up with?
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] For your insurance?
[CUSTOMER][NEUTRAL] I just don't see that.
[AGENT][NEUTRAL] If you don't have their number, I can give you their number because that's who you would have to contact.
[AGENT][NEUTRAL] To cancel if you're wanting to cancel any of your insurances, you have to go through member services.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEGATIVE] No, I won't. I just have to go up to the bank because it's on a debit card and I will stop payment and then just get another company.
[AGENT][NEUTRAL] Oh, through. So, oh, OK, OK, so member services, yes, they are the ones, right. Member services has all of that information. We don't have any of that. That has not, yes, that's not affiliated with APL.
[CUSTOMER][NEUTRAL] That's what I'm gonna, that's what I'm gonna.
[CUSTOMER][NEGATIVE] That's alright. That's alright. I've been going around and around. You've been, I've been going around with you guys for this 6 months, and somehow you guys can go your way to get out from paying it. I'll just take care of it and I'll just get another insurance company.
[AGENT][NEUTRAL] No, sir, now wait just, OK, so hold on, just, just a moment. Wait, because I don't see, have you, where were you submitting your claims to?
[AGENT][NEUTRAL] To member services?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I just, I'm trying, you say you, you're referring as you and I'm trying to find out who you actually is.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I'm, I'm, I'm, I'm trying, I'm trying to figure out why, uh, uh, who, let's see, this is what happened.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], who's [PII] from Medical release. OK. A line of Health, OK, medical release release to American Public Life, [PII].
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Um, walk out statements, diagnostical, da da da da da da da da. This was 4-7-2025. I I I resubmitted this.
[CUSTOMER][NEUTRAL] And I'm trying to find the paperwork to where I got to this. Hold on.
[AGENT][NEUTRAL] Yes, sir, and if you could tell me where you submitted that to.
[CUSTOMER][NEUTRAL] It went to American Public Life. I sent this to [PII].
[CUSTOMER][NEUTRAL] [PII] [PII], Oklahoma.
[CUSTOMER][NEUTRAL] And this is what you guys asked for.
[CUSTOMER][NEUTRAL] You, you needed walk out statements, diagnostic codes, and that's what you needed and so that's what a line of healthcare, I had to have them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Had to have authorization to release this stuff to you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is what I initially got from you.
[CUSTOMER][NEUTRAL] Oh, this is from a line of Health. We are unable to comply with your request at this time for the for the following reasons. Um, thank you for your medical records request. Alin of health for specific is missing the authorization to the releasing facility. So the first time I filled it out, I didn't have the, the right information for the information to be released to. So then I had to fill it back out.
[CUSTOMER][NEUTRAL] And um I didn't have America public life in there for my uh uh medical records to be released and so I filled out another form.
[CUSTOMER][NEUTRAL] With American public life to where they can release the forms to.
[CUSTOMER][NEUTRAL] And and then I have not heard. OK, let's see here.
[CUSTOMER][NEUTRAL] Uh, we apologize for the delay, but we're.
[CUSTOMER][NEUTRAL] That was the first time around, so I went to this, OK, American Public, we received this is what I got from you guys, [PII]. We received the claim on your policy and a review of the claim has started.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, in some cases additional information may be requested. OK, so the additional information and information you requested.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Were the diagnostic codes and the walkout statements, OK, I have to send that authorization release form.
[CUSTOMER][NEUTRAL] To Alinna, OK, I sent that to them. I filled out the paperwork and then I, I'm just trying to figure out where you guys are with this authorization release form.
[AGENT][NEGATIVE] do not show that that was received.
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Yeah, it says, well, this the let's see, we received the claim.
[CUSTOMER][NEUTRAL] And that was in [PII], that was [PII], OK? And so I, the
[AGENT][NEUTRAL] Yes, sir. I'm looking at that and I can see, mhm.
[CUSTOMER][NEGATIVE] The form was incomplete. I filled it out incomplete 2 times.
[CUSTOMER][NEGATIVE] OK, the 3rd, the 3rd time I sent it in, I have not heard back anything from you.
[AGENT][NEUTRAL] OK, so for the date of service again because it's so many dates of service.
[AGENT][NEUTRAL] On the information that was received in January, it had [PII] dates of service rather.
[AGENT][NEUTRAL] For [PII], that one was initially denied.
[AGENT][NEUTRAL] And we stated we needed the item.
[CUSTOMER][NEUTRAL] OK, hold on a second, um.
[CUSTOMER][NEUTRAL] Hold on one second. Uh, what, what, um, I'm just gonna, just, I'll just be quick with this and then we can get off the phone. What amount have you paid besides $150? Have you paid anything besides $150? That's it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, OK.
[AGENT][POSITIVE] That's nice.
[AGENT][NEUTRAL] No, sir, we have not. Correct.
[CUSTOMER][NEUTRAL] OK then you're not then you're not needed as an insurance company thank you I'll just find someone else.
[AGENT][POSITIVE] You're welcome.