AccountId: 011433970860
ContactId: 19e47693-a2f6-4f61-806e-3bb8bdfeb149
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1127420 ms
Total Talk Time (AGENT): 539065 ms
Total Talk Time (CUSTOMER): 354205 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/19e47693-a2f6-4f61-806e-3bb8bdfeb149_20250529T17:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, I was just talking to one of your colleagues there and uh we got cut off some for some reason, uh, so I'm just calling back, needed to check up on a, uh, yeah, no, it happens just needed to follow up on a claim that we have submitted to you guys, uh, for hopefully a lower price with Providence.
[AGENT][NEUTRAL] Oh no. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And uh you know I just wanted to get status. It's a pretty big bill that we owe them and they sent it to collections and they said they wouldn't until this was resolved, so they're stupid and I gotta call them and chew them out so uh.
[AGENT][NEUTRAL] Oh my.
[AGENT][NEUTRAL] Oh my, OK.
[CUSTOMER][NEUTRAL] But either way, yeah, it is what it is, not a big deal.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes sir, I understand um about your claim and what is your name sir and your callback number just in case our call is disconnected I can call you right back.
[CUSTOMER][NEUTRAL] But uh yeah, if you could just tell, yeah.
[CUSTOMER][POSITIVE] Yeah, good idea. Uh, yeah, my name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you sir and then [PII], may I also get your um policy number so I can look up your claim information?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes ma'am, it's 025.
[CUSTOMER][NEUTRAL] 368
[CUSTOMER][NEUTRAL] 96.
[AGENT][NEUTRAL] OK, let me pull that up real quick, sir.
[AGENT][NEUTRAL] OK, [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][NEUTRAL] Thank you sir, and then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You should have um
[CUSTOMER][NEUTRAL] My email is [PII].
[CUSTOMER][NEUTRAL] And my address should be [PII].
[AGENT][NEUTRAL] OK, looks like I have a different uh physical address for you in [PII].
[CUSTOMER][NEUTRAL] You might have, you might, you might have an old one, yeah, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and what should it?
[CUSTOMER][NEUTRAL] We just maybe haven't updated yet, yeah.
[AGENT][NEUTRAL] Yes, sir. What should it be again? Can you repeat that for me?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sure, yeah, yeah, no problem at all, it's [PII] I'm sorry [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII] is [PII]?
[CUSTOMER][NEUTRAL] Yes, 2 words, mhm.
[AGENT][POSITIVE] Oh yes sir, OK, alright, thank you very much for giving me that information. Let's first go in and get your address corrected.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] But we did this once before, but maybe it didn't take.
[AGENT][NEUTRAL] Sometimes that happens. um I'll double check it and make sure that it holds this time.
[CUSTOMER][POSITIVE] Yeah, no problem.
[CUSTOMER][NEUTRAL] I mean we've been getting mail from you guys, you know, um, so when it did come to that address, so.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] It might have. It just maybe maybe on that screen it didn't, you know, who knows, or it's still rerouting from the old address with the mail that they give you a year, you know, yeah, so I didn't actually pay attention now that I think about it, so.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It could be. Yes, sir.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Gonna double check it, make sure it took.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, they are taking me like they're taking like 100.
[AGENT][NEUTRAL] OK, I've got you fixed up on your address now.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] OK, and now we're going to look at your claims, um, do you have the claim number?
[CUSTOMER][NEUTRAL] Um, you know, I don't think there was ever a claim number.
[AGENT][NEUTRAL] OK, uh yes, sir. OK.
[CUSTOMER][NEUTRAL] Given to me
[CUSTOMER][NEUTRAL] To be honest, let me, let me just check.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm, no, I don't see one.
[AGENT][NEUTRAL] OK, is the claim for yourself or another member?
[CUSTOMER][NEUTRAL] All I have is uh is just the policy number. It it was for my wife [PII], yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're, OK, [PII]. All right. And um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I'm showing two claims here um.
[CUSTOMER][NEUTRAL] Yeah, that's right. There's one for like a big 1, 13,000 and some change and a small one for like 14 or 15.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's look
[AGENT][NEUTRAL] At the one that was submitted on [PII].
[AGENT][NEUTRAL] It has a remark on it.
[CUSTOMER][NEUTRAL] Yeah, that was for the big one I believe.
[AGENT][NEUTRAL] Let's see what that remark says.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this one just has a couple of things that are needed, uh, and let me give you the claim number.
[CUSTOMER][NEUTRAL] Alright, hold on here.
[AGENT][NEUTRAL] Uh, you just let me know when you're ready.
[CUSTOMER][NEUTRAL] Um, OK, go ahead.
[AGENT][NEUTRAL] It's 356-613-9.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was for Providence?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And let me tell you the date of service was [PII].
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEGATIVE] OK, and then it has a couple remarks of some things that it's needing um it says that the claim information was received but they are unable to process because the copies could not be read.
[CUSTOMER][POSITIVE] That sounds right.
[AGENT][NEUTRAL] So if they
[CUSTOMER][NEUTRAL] And I did resend them
[AGENT][NEUTRAL] OK, you did. OK. And then.
[CUSTOMER][NEUTRAL] Yeah, I did, I did, I did, yeah, they asked me to, yeah, because they said that before, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And then it also says that we're needing a um itemized statement with diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] Wait, I'm sorry, which one are you talking about here?
[AGENT][NEUTRAL] This is the same one.
[AGENT][NEUTRAL] The the one that we just talked about on.
[CUSTOMER][NEUTRAL] Is this the one for [PII]?
[CUSTOMER][NEUTRAL] The 3rd, the one for 13,000?
[AGENT][NEUTRAL] Uh let me let you know what the.
[CUSTOMER][NEUTRAL] Because the because the date because the data service on the data service on that one was um May is actually about a year ago, [PII].
[AGENT][NEUTRAL] This one, this one is for [PII].
[AGENT][NEUTRAL] And the charge amount for.
[CUSTOMER][NEUTRAL] And how much, what's what's the claim on the amount, yeah.
[AGENT][NEUTRAL] It was $16,854.35.
[CUSTOMER][NEUTRAL] Oh no, that's it, yeah, and then we paid, uh, for 33,400 got paid and then there's 13,000. OK, well that's weird. I don't know why the dates say October when it was actually she was discharged on [PII], but I guess that doesn't really matter.
[AGENT][NEUTRAL] OK. And then that's, that's the two things that it was asking for, um, an itemized statement with the diagnosis codes and procedure codes for that one. You said that you've already sent in the claim information because they couldn't read it, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] Well, that's what they said and I and I did resend it, yeah, so I did you it was the UB 40, um, and explanation of charges. Those are the two things I sent along with a cover page. So it's just 3 pages.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then let's look at this, um.
[AGENT][NEUTRAL] Looks like it was reprocessed.
[AGENT][NEUTRAL] With claim number 3599685?
[AGENT][POSITIVE] For the amount of $16,854.35 and then this one does have the good um
[AGENT][NEUTRAL] Data service of [PII].
[CUSTOMER][POSITIVE] Yeah, that's correct. There you go.
[AGENT][NEUTRAL] OK, let me see what the remark says on this one.
[AGENT][NEUTRAL] OK, so it's saying that the charges submitted are not payable because services were rendered prior to the policy's effective date. So let's see what the effective date was.
[AGENT][NEUTRAL] Yes, your effective date for this policy is [PII] and the services were for May.
[CUSTOMER][NEUTRAL] No, but she had her own uh uh account at that time.
[AGENT][NEUTRAL] Let's
[AGENT][NEUTRAL] If she had it with us?
[CUSTOMER][NEUTRAL] Yes, but she was individual at the time before we added her to the family in June.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me see if I can find her.
[AGENT][NEUTRAL] Um, old policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you know
[CUSTOMER][NEUTRAL] Yeah, because we've been over this before and they said oh.
[AGENT][NEUTRAL] OK. OK. Do you know Ms. [PII]'s um social so I can pull up her old policy?
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Oh gosh, I don't know if I have it I'm off the top of my head.
[CUSTOMER][NEUTRAL] Which I know I probably don't.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let me see if I can find her old policy.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] I might be able to find it yeah.
[AGENT][POSITIVE] Go ahead and take your time.
[CUSTOMER][POSITIVE] Thank you, thank you. I just got, I'm gonna look through all these photos. He's uh.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Oh yes sir, I understand.
[CUSTOMER][POSITIVE] [PII], um, OK, actually I found it, yes, I did find it.
[AGENT][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] So yeah, it says uh [PII] effective date [PII], um, the mem what do you need the member number?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Um, 682-542-457.
[AGENT][NEUTRAL] OK, that seems like a very long number for us, um.
[AGENT][NEUTRAL] Was she with business?
[CUSTOMER][NEUTRAL] Oh no, no, I'm just giving you that that's the, that's the member number from PHCS who is the who's our actual insurance people we submit to you guys when there's a claim. I don't have a policy number like the one you have, you know, for this one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, OK, and do you have her social and I can try to pull it up because this policy number is not gonna pull up for me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, gosh, your social, um.
[CUSTOMER][NEUTRAL] I don't think I have that um on me.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] I actually, I'm almost 100% positive I don't, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because I'm, I'm working out of my car right now, so I, I did not.
[AGENT][POSITIVE] Bless your heart. You try to get it all together in your car.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, you know, you know how it is, yeah, it just is what it is, so.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Let me try to pull up by her name and see if I can do it that way.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, yeah, right, yeah, try that [PII] yeah, [PII].
[AGENT][NEUTRAL] OK, let me try that way.
[CUSTOMER][NEUTRAL] And it had the older address before the [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you spell her name, [PII]?
[CUSTOMER][POSITIVE] Uh huh correct.
[CUSTOMER][NEUTRAL] Yeah, yeah, [PII] correct.
[AGENT][NEUTRAL] OK, I may have found her. I might have looked out and found her.
[CUSTOMER][POSITIVE] Oh good.
[AGENT][NEUTRAL] Let me check
[AGENT][NEUTRAL] OK, so her policy number.
[AGENT][NEUTRAL] For her old policy.
[AGENT][NEUTRAL] Is 249-9914, but it looks like.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 249-914 OK.
[AGENT][NEUTRAL] 249-9914
[AGENT][NEUTRAL] But it looks like it was, yes sir, it looks like it was issued and lapsed on the same day they must have issued an individual policy for her and then you guys decided to do family and then issued a new policy.
[CUSTOMER][NEUTRAL] 03 9s, OK.
[CUSTOMER][NEUTRAL] And that was the next, the next month, yeah, but.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that's, that's what it looks like to me looking at it um that's why they're saying that the services were rendered prior to the effective date because the effective date of your policy, your original policy um was in June.
[CUSTOMER][NEUTRAL] Right, but her policy was still in effect until the end of that month.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] At least that's what they told me.
[AGENT][NEUTRAL] OK, that's, that's fine, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Because we had already paid we'd already paid for it.
[AGENT][NEUTRAL] OK, so what, what I wanna do for you sir because you guys are trying to get this taken care of is transfer you over to a claims specialist.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, so that we can let them know what's going on that she had that previous policy and it was effective for a month.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] But even if it was an effective for a month, it would have ended.
[AGENT][NEUTRAL] Right now.
[AGENT][NEUTRAL] [PII] is what you're saying is, is that what you're saying it was effective from.
[AGENT][NEUTRAL] [PII] to.
[CUSTOMER][NEUTRAL] Well, I didn't know it was her, she, her, her policy was actually effective, uh, [PII] according to my card here.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And then you know and then so I went in to pay it and uh I think I paid for her.
[AGENT][NEUTRAL] But
[CUSTOMER][POSITIVE] And then he, she, and he said, Well, you know what, she can be on the family plan. You guys will save more money that way. And I'm like, oh, I didn't know that. And he goes, yeah, just add her because you're paying for the whole family already. I said, great. And he said, we'll make that effective next month with all four of you I'm like, Great, you know what I mean? So I, I, you know, I didn't think.
[CUSTOMER][NEUTRAL] One,
[CUSTOMER][NEUTRAL] Anything about it, you know what I mean?
[AGENT][NEUTRAL] Yes, sir. Yes, sir.
[AGENT][NEUTRAL] I see that it was billed.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Yeah, what I'm looking at is showing that it was effective [PII], but we'll get a claims specialist on the phone with you to see if you can file under this policy number for her so that you can get some answers, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so it's gonna be a brief hold while I transfer you on over.
[AGENT][NEUTRAL] And did I give you all the information that you need from me today before I transfer you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I think so.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Yeah, I think so.
[AGENT][POSITIVE] OK [PII], it's gonna be a quick hold while I transfer you on over and we thank you for calling APL sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Alright bye bye now.
[CUSTOMER][NEUTRAL] Furring
[CUSTOMER][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, Ms. [PII], it's [PII]. I've got an insured on the phone. His name is [PII]. His policy number is 253-689-6.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let me write this other policy down real quick before I forget it. Hold on.
[AGENT][NEUTRAL] I didn't have my ducks in a row, sorry about that.
[AGENT][NEUTRAL] OK, and he is calling about um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claims 253-689-6 is his policy on his wife, [PII] for part two, there's two claims there for her. He is stating that she had a policy and I did look. She has policy number 2499914.
[AGENT][NEUTRAL] The claim was denied because um.
[AGENT][NEUTRAL] Services were rendered previous to the effective date, but her policy number 2499914, he is saying.
[AGENT][NEGATIVE] That she had that policy for a month and it should be covered under it. I don't see MBQPHI where anything was paid for the policy.
[AGENT][NEUTRAL] But I'm gonna let you talk to him because he is adamant that the policy was active for a month.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] And that the claim should be filed on that policy number.
[AGENT][NEUTRAL] He said he paid it for a month himself.
[CUSTOMER][NEUTRAL] Mm, OK, that's fine you can send him over.
[AGENT][POSITIVE] All right, thanks, Ms. [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm