AccountId: 011433970860 ContactId: 1e9d88ef-edaf-4819-b400-ee2adffa2fbf Channel: VOICE LanguageCode: en-US Total Conversation Duration: 2534179 ms Total Talk Time (AGENT): 464100 ms Total Talk Time (CUSTOMER): 715505 ms Interruptions: 0 Overall Sentiment: AGENT=0.5, CUSTOMER=-0.5 Redaction Types: PII Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/1e9d88ef-edaf-4819-b400-ee2adffa2fbf_20250324T21:04_UTC.wav -------------------------------------------- [AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I help you? [CUSTOMER][NEUTRAL] Uh, hi. My name is [PII]. [AGENT][NEUTRAL] Hello. And how can I help you, sir? [CUSTOMER][NEUTRAL] Yes. [CUSTOMER][NEUTRAL] Yes, uh, I received the bill. [CUSTOMER][NEUTRAL] Can you help me give me translate to Arabic? [AGENT][NEUTRAL] Um, what is your policy number? [CUSTOMER][NEUTRAL] Uh, OK, one second. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Uh, policy number 02544684. [AGENT][NEUTRAL] OK, let me, I'm sorry, was that 02544684? [CUSTOMER][NEUTRAL] Yes. [AGENT][NEUTRAL] OK thank you one moment. [AGENT][NEUTRAL] May I have your date of birth? [AGENT][NEUTRAL] The a [CUSTOMER][NEUTRAL] Uh, on [PII]. [CUSTOMER][NEUTRAL] [PII]. [AGENT][POSITIVE] Thank you very much and your callback number if disconnected? [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Yeah. [AGENT][NEUTRAL] What is your callback number? [CUSTOMER][NEUTRAL] What? [AGENT][NEUTRAL] Your callback number, your phone number? [CUSTOMER][NEUTRAL] [PII] [AGENT][NEUTRAL] Verify your complete mailing address. [CUSTOMER][NEUTRAL] [PII]. [AGENT][POSITIVE] And your email address. Thank you. [CUSTOMER][NEUTRAL] [PII] [CUSTOMER][NEUTRAL] Uh, first name [PII] [PII]. [AGENT][POSITIVE] OK, thank you for the verification process. OK, I have your policy pulled up. How can I assist you? [CUSTOMER][NEUTRAL] Uh. [CUSTOMER][NEUTRAL] Yes, I received uh [CUSTOMER][NEUTRAL] Bill from uh [CUSTOMER][NEUTRAL] Up to [AGENT][NEUTRAL] From Uptown, OK. [AGENT][NEUTRAL] Um, is this bill for you? [CUSTOMER][NEUTRAL] Yes. [CUSTOMER][NEUTRAL] Yes. [AGENT][NEUTRAL] OK, thank you. um, what is the date of service of the bill? [CUSTOMER][NEUTRAL] Get a bill of data service. [AGENT][NEUTRAL] I need the date of service, please. [CUSTOMER][NEUTRAL] Uh, [PII]. [AGENT][NEUTRAL] OK, January. [CUSTOMER][NEUTRAL] On [PII]. [AGENT][NEUTRAL] On [PII]. OK, thank you, one moment. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] And that was for this year, is that correct? [AGENT][NEUTRAL] [PII]. [CUSTOMER][NEUTRAL] What? [AGENT][NEUTRAL] Is it for this year or last year? [CUSTOMER][NEUTRAL] This year. [AGENT][POSITIVE] OK, thank you. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] One moment and [PII] or [PII]. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] One moment, sir. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] OK. I do show a bill from American Health Network. [CUSTOMER][NEUTRAL] Yeah. [AGENT][NEUTRAL] Um, OK, OK. Thank you. Just wanna make sure that. OK. So that claim was received and it shows that it denied, and it denied as there are no benefits payable for conditions other than a sickness or illness. It shows that this was a wellness. [AGENT][NEUTRAL] Visit or preventative. [CUSTOMER][NEUTRAL] No, I understand you, can you help me give me translate to translate to Arabic. [CUSTOMER][NEUTRAL] I speak a little English. [AGENT][NEUTRAL] I'm just [AGENT][NEUTRAL] OK, you want a translator. OK, one moment, let me check just so I can find someone for you if you could hold please. OK, thank you. [CUSTOMER][NEUTRAL] Yes. [CUSTOMER][NEGATIVE] You are on hold. [AGENT][NEUTRAL] Mr. [PII] [CUSTOMER][NEUTRAL] Yes. [AGENT][NEUTRAL] OK, and I apologize for having to ask what uh you said a translator, what um what language? [CUSTOMER][NEUTRAL] Arabic. [AGENT][NEUTRAL] Arabic. OK, now let's see. [AGENT][NEUTRAL] OK, I'm gonna place you on hold again, OK? One moment. [CUSTOMER][NEUTRAL] OK, OK. [AGENT][POSITIVE] Thank you. [CUSTOMER][NEGATIVE] You are on hold. [AGENT][NEUTRAL] Uh, let's see. [AGENT][NEUTRAL] Ah [CUSTOMER][NEGATIVE] You are on hold. [AGENT][NEUTRAL] Oh [CUSTOMER][NEGATIVE] You are on hold. [CUSTOMER][NEGATIVE] You are on hold. [CUSTOMER][NEGATIVE] You are on hold. [CUSTOMER][NEGATIVE] You are on hold. [AGENT][NEUTRAL] Mr. hello, sir. [CUSTOMER][NEUTRAL] Hello? [AGENT][NEUTRAL] Hello, I am still trying to find um your assistance, OK? [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] OK. [AGENT][POSITIVE] So bear with me please sorry about that. [CUSTOMER][NEUTRAL] I call on the telephone. [AGENT][NEUTRAL] Yeah. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] I'm gonna have to place you back on hold, OK, please bear with me again. I apologize, OK? Just bear with me. [AGENT][NEUTRAL] OK, please, if you could bear with me, I am still trying to find a translator for you. [CUSTOMER][NEUTRAL] Uh. [AGENT][NEUTRAL] If you could please give me be patient with me, OK? [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] OK, thank you. I'm placing you back on hold. Hold please. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEGATIVE] You are on hold. [CUSTOMER][NEGATIVE] You are on hold. [CUSTOMER][NEGATIVE] You are on hold. [CUSTOMER][NEGATIVE] You are on hold. [CUSTOMER][NEUTRAL] Welcome to Language Line Solutions. Please enter your six digit client ID. [AGENT][NEUTRAL] I [AGENT][NEUTRAL] I verify. Oh my God. [AGENT][NEUTRAL] Hm [AGENT][NEUTRAL] Jesus [AGENT][NEGATIVE] This has to be a joke. [AGENT][NEUTRAL] Please verify. [AGENT][POSITIVE] Oh my goodness. [AGENT][NEUTRAL] You be on all access. [AGENT][NEUTRAL] Oh my God. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] Um [AGENT][NEUTRAL] OK, 734. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] OK, so here we go. 877245-0386. [CUSTOMER][NEUTRAL] Welcome to Language Line Solutions. Please enter your six digit client ID. [AGENT][NEUTRAL] OK 34237. [CUSTOMER][NEUTRAL] For Spanish, press 1. For other press 2. [CUSTOMER][NEUTRAL] Please speak the name of the desired language. [AGENT][NEUTRAL] Arabic [CUSTOMER][NEUTRAL] I understood Arabic. If this is correct, say yes or press 1. If this is incorrect, say no. [CUSTOMER][NEUTRAL] We [CUSTOMER][NEUTRAL] Thank you for calling Language Line Solutions. My name is [PII]. ID 436-457. I'll be on week interview today in a process review. This call may be monitored for training and quality assurance purposes. May I please have your business united initials? [AGENT][POSITIVE] Yes, I'm so sorry. [CUSTOMER][NEUTRAL] Units and it shows [AGENT][NEUTRAL] I'm so sorry, what is your name again? [CUSTOMER][NEUTRAL] My name is [PII]. [CUSTOMER][NEUTRAL] [PII] [AGENT][NEUTRAL] OK, thank you and your you said your number is [PII]? [CUSTOMER][NEUTRAL] Yes it is. [AGENT][NEUTRAL] OK, yes sir, thank you and what information do you need from me? I'm sorry. [CUSTOMER][NEUTRAL] your business unit initials. [AGENT][NEUTRAL] OK, um, APL Insurance Company. [AGENT][NEUTRAL] My name is [PII]. [AGENT][NEUTRAL] My last initials, uh, you're welcome. [CUSTOMER][POSITIVE] OK, thank you and is the client with you? [AGENT][NEUTRAL] Yes, he's on the other line. [CUSTOMER][NEUTRAL] OK, so, uh, I just want to know that your business initial unit initials are APL or what exactly? [AGENT][NEUTRAL] OK, I'm sorry, um, APL OC. [CUSTOMER][POSITIVE] OK I see. OK, thank you. [CUSTOMER][POSITIVE] So I'm ready for you, sir, for uh assisting you. [AGENT][POSITIVE] OK, alright, so I'm gonna join the call, please. Thank you so much. One moment, OK? [CUSTOMER][NEUTRAL] OK, sure. [AGENT][POSITIVE] Thank you. [AGENT][NEUTRAL] OK, Mr. [PII]. [CUSTOMER][NEUTRAL] Yes. [AGENT][POSITIVE] Thank you so much for your everlasting patience. I have a young man on the line, [PII]. [AGENT][NEUTRAL] I hope I'm pronouncing it correctly. [CUSTOMER][POSITIVE] Yes ma'am, OK, yes sir. [AGENT][NEUTRAL] OK, yes, OK. [CUSTOMER][NEUTRAL] I know. [CUSTOMER][NEUTRAL] Can I do this myself? [AGENT][NEUTRAL] Yes, you actually can I explain to you what what's going on first, um, please, I'm sorry before I should have done it before I transferred the call, but um. [CUSTOMER][POSITIVE] No worries. [AGENT][NEUTRAL] OK, he, the, the insured calling in regards to a claim that we have that it denied it denied as a non-covered service. So he was calling in regards to two dates of service, one date of service of [PII]. We have that and that was denied as noncovered, but we do not have the [PII] date on file. [CUSTOMER][NEUTRAL] OK, sure. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] So should I introduce yourself now or you want to proceed first with him? [AGENT][NEUTRAL] You can uh go ahead and proceed with Ms. [PII], please. Thank you. [CUSTOMER][NEUTRAL] Thank you, but how about? [CUSTOMER][NEUTRAL] [PII]. [CUSTOMER][NEGATIVE] Yeah I don't like. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][POSITIVE] Just OK, ready for instructions. [AGENT][NEUTRAL] OK, um, again, um, as a result of the type of service it was performed, it's not covered by the policy. [CUSTOMER][NEUTRAL] OK, he, uh, until like no, uh, another one the, uh, no ed me and modeme for a 30 year rememle, uh, polia I will. [CUSTOMER][NEUTRAL] And no, I talk to. [CUSTOMER][NEUTRAL] Has a morphine. [CUSTOMER][NEUTRAL] I [CUSTOMER][NEUTRAL] No, I thought that we very much small question. [CUSTOMER][NEUTRAL] Uh, what do you mean exactly by the, uh, coverage is not, uh, or the service is not covered? [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] It was due, per the policy, it pays for services due to a sickness or an illness, and it shows that for the diagnosis, it shows it was not due to a sickness or injury. It was related to a preventative or a wellness visit. [CUSTOMER][NEUTRAL] A Haibel [PII] or [PII]. [CUSTOMER][NEUTRAL] Uh, has [PII] for her name no how does she can, uh, lessa be [PII] is can it [PII] be [PII] with her [PII] and [PII]. [CUSTOMER][NEUTRAL] There you are. [CUSTOMER][NEUTRAL] Yeah. [CUSTOMER][NEUTRAL] before [CUSTOMER][NEUTRAL] Ambassador say [PII]. [CUSTOMER][NEUTRAL] How we see [PII] kind of [PII] I [PII]. [CUSTOMER][NEUTRAL] and [PII] and me. [CUSTOMER][NEUTRAL] [PII]. [CUSTOMER][NEUTRAL] [PII]. [CUSTOMER][NEUTRAL] I can go. [CUSTOMER][NEUTRAL] Uh, the thing is they give me the number to call to ask if this center is uh insured or covered in the network of the insurance that it can be covered. So when I called, I called Doctor [PII], um. [CUSTOMER][NEUTRAL] I and they told me that he told me that this center is one of the centers that are covered from this service. [CUSTOMER][NEUTRAL] And this service or this story was not only wellness, it was for health concern or for health. [CUSTOMER][NEUTRAL] Reason [AGENT][NEUTRAL] OK. Now, if the insurer feels like the claim was submitted, it's not. [AGENT][NEGATIVE] More or less the place of service where he had the service performed. It was the reason why he um was seen by the provider. It does not show it was a [AGENT][NEUTRAL] Due to a sickness or an injury, that is why it denied. [CUSTOMER][NEUTRAL] It is a shi it did that mean? [CUSTOMER][NEUTRAL] Um, [CUSTOMER][NEUTRAL] The mo that mean in here uh hat and a mode uh lessan hit me da la uh uh moka ayani issue uh hadhima with her and no can be sababat or be isabe finally had a sabab uh them and car and that is about is. [CUSTOMER][NEUTRAL] Uh, what is, uh, and I'm going to marriot and the uh and marsh uh Margildi. [CUSTOMER][NEUTRAL] Before what Ross on the victor go to [PII] like I got. [CUSTOMER][NEUTRAL] Uh, it was this I was. [CUSTOMER][NEUTRAL] It was a sickness. I was having uh uh kind of uh issue in the, the skin of my head in the scalp, and I give me some medications and I'm using it now. [AGENT][POSITIVE] I'm so sorry. If you could repeat that again. [CUSTOMER][NEUTRAL] Sure, uh, the, the visit is for, um, is was, was for the. [CUSTOMER][NEGATIVE] Sickness reason. [CUSTOMER][NEUTRAL] Uh, it was about uh sickness in the scalp area and uh he gave me medication for that and I using this treatments. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] Um, according to how the claim was submitted by the provider, it's not a covered service. If the insured wants to submit an appeal, he can do that. I can give you the information to provide to him. [AGENT][NEUTRAL] [PII]ease. [CUSTOMER][NEUTRAL] Ok, no. [CUSTOMER][NEUTRAL] Uh [CUSTOMER][NEUTRAL] Wolf Wolf at the gas. OK, Wolflim away for the end they have made and them is enough we had a she had she and Maluma uh lahata Tamil is enough. [CUSTOMER][NEUTRAL] You do, OK. [CUSTOMER][POSITIVE] Yes please. [AGENT][NEUTRAL] OK, thank you. The appeals information, OK, if you would please tell him he has 180 days from the time that the claim was processed. The claim was processed on. [AGENT][NEUTRAL] [PII]. [AGENT][NEUTRAL] The claim number is [AGENT][NEUTRAL] 355-5598. [AGENT][NEUTRAL] He would need to submit in writing. [AGENT][NEUTRAL] The reason why he wants to appeal, give a detailed. [AGENT][NEUTRAL] Explanation as to why he wants to appeal, he would need to send that to. [AGENT][NEUTRAL] APL claims. [AGENT][NEUTRAL] [PII] [AGENT][NEUTRAL] [PII]. [AGENT][NEUTRAL] 950. [AGENT][NEUTRAL] [PII]. [AGENT][NEUTRAL] [PII]. [AGENT][NEUTRAL] And please attention appeals department. [CUSTOMER][POSITIVE] OK, um, have fun. I was she in the, uh, fema, uh, midmia with myinon when elm motala Fahil motalaweit maleta, uh, tari arbor shrine wahidelvino hams so shrine. [CUSTOMER][NEUTRAL] bus. [CUSTOMER][NEUTRAL] OK [CUSTOMER][NEUTRAL] And did you go over there. [CUSTOMER][NEUTRAL] Yeah, I just want to bring a pen and paper to write down this information. [CUSTOMER][NEUTRAL] You got on here now. [AGENT][NEUTRAL] May I also please, may I add something, please? [CUSTOMER][NEUTRAL] Then I'm gonna [CUSTOMER][NEUTRAL] Yes, yes, sure. [AGENT][NEUTRAL] OK, thank you. We also have a fax number please if he if he has. [AGENT][NEUTRAL] If you can fax it to us, I can provide you the fax number. [CUSTOMER][NEUTRAL] You you may give it to me, ma'am. I will give it to him if he can. [AGENT][NEUTRAL] OK, yes, it is 877. [AGENT][NEUTRAL] 3659423. [CUSTOMER][NEUTRAL] It [CUSTOMER][NEUTRAL] OK [CUSTOMER][NEUTRAL] OK, yes. [CUSTOMER][NEUTRAL] OK Rahamili claim or talabelatihasehase. [CUSTOMER][NEUTRAL] The, the, the one. [CUSTOMER][NEUTRAL] A hamsa hamsa. [CUSTOMER][NEUTRAL] The Hamsahamza. [CUSTOMER][NEUTRAL] Hamza hamsa, are you done? [CUSTOMER][NEUTRAL] Come, sir, come, sir. [CUSTOMER][NEUTRAL] These are the menu. [CUSTOMER][NEUTRAL] Teasemania Talata hamshasa hamsa hamsa Dia tamania. [CUSTOMER][NEUTRAL] Come on for and they, uh, doesn't pick up, uh, Hitab awaaka uh the Shafi has shu sabba less into habi with this time with a uh shoot with [PII] uh Bakukitabibihaani. [CUSTOMER][NEUTRAL] Uh, with a mufasalla is enough. [CUSTOMER][NEUTRAL] There's Tshailmotalabe [PII]. [CUSTOMER][NEUTRAL] Uh [CUSTOMER][NEUTRAL] APL APL. [CUSTOMER][NEUTRAL] APL [CUSTOMER][NEUTRAL] I, uh, Sanduk Bari Raham. [CUSTOMER][NEUTRAL] Oh PO box. [CUSTOMER][NEUTRAL] Its name Arbasemana. [CUSTOMER][NEUTRAL] Then the mania. [CUSTOMER][NEUTRAL] This Aham sir soar. [CUSTOMER][NEUTRAL] Pizza hamsa written orba is a hamsa. [CUSTOMER][NEUTRAL] Oklahoma City. [CUSTOMER][NEUTRAL] Oklahoma. [CUSTOMER][NEUTRAL] City. [CUSTOMER][NEUTRAL] Mm. [CUSTOMER][NEUTRAL] OK, I done, Oklahoma Marratai and it's me on. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Sabalawa arbaharidi Sabala. [CUSTOMER][NEUTRAL] About the letter. [CUSTOMER][NEUTRAL] Wait Arba. [CUSTOMER][POSITIVE] Yeah, not a problem. Mm. [CUSTOMER][NEUTRAL] I don't know. [CUSTOMER][NEGATIVE] Yeah, I, uh, no. [CUSTOMER][NEUTRAL] Haajaha osam is enough. [CUSTOMER][NEUTRAL] With English one. [CUSTOMER][NEUTRAL] Pizza. [CUSTOMER][NEUTRAL] A. [CUSTOMER][NEUTRAL] Feels very biryani. [CUSTOMER][NEUTRAL] OK, uh, sorry, uh, when he writes, uh, please, uh, when he write the attention appeals department, this one should be write it on the envelope from outside or in the letter itself. [AGENT][NEUTRAL] Yes. [AGENT][NEUTRAL] Oh, on the letter, please, on the letter. [CUSTOMER][NEUTRAL] No, yes, I resale juan of sottofia suburb or totofiavida. [CUSTOMER][NEUTRAL] Uh, and enough now. [CUSTOMER][NEUTRAL] Mm hella [PII] the home. [CUSTOMER][NEUTRAL] Hm. [CUSTOMER][NEUTRAL] The money is about about. [CUSTOMER][NEUTRAL] Mm. [CUSTOMER][NEUTRAL] Hello [PII]. [CUSTOMER][NEUTRAL] No. [CUSTOMER][NEUTRAL] This Arba is named [PII]. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK, he got the details, ma'am. [AGENT][POSITIVE] OK. OK. And if there isn't anything else I can assist you with, um, if you could just tell him thank you so much for calling APL and have a good day. [CUSTOMER][NEUTRAL] And the kakushi is the case attanifahukratisalak the uh APL with theleum sites. [CUSTOMER][NEUTRAL] And what's that are with Doctor [PII] and male well uh at you know is a ashithaibole motalaba you know and. [CUSTOMER][NEUTRAL] Uh, so I just want to know exactly, uh, Doctor [PII], uh, should I stop going there or is it OK if I go go there again to visit him? I mean, is there any claim again or any, uh, uh. [CUSTOMER][NEUTRAL] Responsibility anything I had to claim again. [CUSTOMER][NEUTRAL] If I go there one more time. [AGENT][NEUTRAL] Well [AGENT][NEUTRAL] Um, again, it's not the reason, it's not because of where he went, it's because of how, what he went there for. It was the diagnosis code. So it was not showing there was a sickness. Um, it all depends on what he goes there for, but this particular claim did not because it was not due to a sickness or an illness. It shows that it was due for preventative or wellness. [CUSTOMER][NEUTRAL] I can. [CUSTOMER][NEUTRAL] Yeah, and for that with that lima as well I I had satnamariakegani and Mari well you. [CUSTOMER][NEUTRAL] Uh, the thing is it was written on the paper, lab work test or lab or lab work reason visits. [AGENT][NEGATIVE] Yes, that's what it shows and it was denied because it was not due to a sickness or an injury. [CUSTOMER][NEGATIVE] No, I'm how did you hear you been and you like in thabi up in [PII] and it sad or isabe. [CUSTOMER][NEUTRAL] Well la like and I know I know la but [PII] or not with [PII] yet case. [CUSTOMER][NEUTRAL] Because I'm gonna, that is. [CUSTOMER][NEUTRAL] Sorry, um, he said, uh, it's uh quite, uh, it's quite funny. I'm the one who's sick here. I'm the one who is, uh, uh, sickness. I have the sickness. I don't know why. [AGENT][NEUTRAL] OK. [AGENT][NEGATIVE] Um, the policy that he has is a limited policy and it did not cover this particular visit because it was not due to sickness or injury. That's why I denied it's noncovered. [CUSTOMER][NEUTRAL] Is our police ha yeah policea Madura we had his yara tahadanta beat or isabe you had a rat uh had a. [CUSTOMER][NEUTRAL] OK, OK, so. [CUSTOMER][NEUTRAL] OK, understood. [CUSTOMER][NEUTRAL] So [CUSTOMER][NEUTRAL] OK, I ask him anything else he said uh nothing. [AGENT][POSITIVE] OK. Well, thank you so much. Thank you both for your patience and your time with me and, and again, thanks you for translating for me. I appreciate that and thank you for calling APL. Have a good day. Mm bye. [CUSTOMER][POSITIVE] My pleasure. Thank you, thank you for reaching our service. Have a good day, man. Bye bye. [AGENT][NEUTRAL] Bye bye.