AccountId: 011433970860
ContactId: 2827df04-3ec1-4987-8a2f-44d8a139c0c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1326680 ms
Total Talk Time (AGENT): 427274 ms
Total Talk Time (CUSTOMER): 189922 ms
Interruptions: 4
Overall Sentiment: AGENT=0, CUSTOMER=-2.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/2827df04-3ec1-4987-8a2f-44d8a139c0c4_20250220T14:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] with whom am I speaking and how may I help you?
[CUSTOMER][NEUTRAL] So, my name is [PII]. I'm calling on behalf of my wife, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I need to talk to a supervisor if there's one available please.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, first I have to get some information from you, Mr. [PII]. What is a good call back number for you in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what is your wife's policy number?
[CUSTOMER][NEUTRAL] Her what telephone number?
[AGENT][NEUTRAL] Her policy number policy number.
[CUSTOMER][NEUTRAL] Um, policy number is 2533255.
[AGENT][NEUTRAL] 253
[CUSTOMER][NEUTRAL] 325 5
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, and verify her mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And do you happen to know her work email address?
[CUSTOMER][NEUTRAL] I do. [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that information. It's protocol that we do that and before I get you to a supervisor, what is this regarding?
[CUSTOMER][NEGATIVE] Uh, it's regarding these damn claims that y'all won't pay.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now I'm showing a claim processed the payment on yesterday.
[CUSTOMER][NEUTRAL] Yeah, of a whopping $400.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] She said $400,000 or more.
[CUSTOMER][POSITIVE] Worth of benefits that we send in, and you guys are sending us these poppycock $400 checks.
[AGENT][NEUTRAL] OK. All right. Well,
[CUSTOMER][NEUTRAL] I've, I've been dealing with this since the day that she got sick.
[AGENT][NEUTRAL] OK. Well, I'm sorry, I'm sorry that you're going through that, Mr. [PII].
[CUSTOMER][NEUTRAL] Your kids
[CUSTOMER][NEUTRAL] I've heard that. I, I am, I know it's not your fault, but I've heard, I'm sorry from your company for two months now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I need somebody to tell me why they're not paying. Why, why are they not paying for her chemo?
[CUSTOMER][NEUTRAL] She has a benefit of up to $12,000 and your company wants me to call my, or her insurance company.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And get records and proofs and stuff. That's not my freaking responsibility. That's yours.
[CUSTOMER][NEUTRAL] Why am I having to call the insurance company? I've got the doctors, the doctors.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bill or
[CUSTOMER][NEGATIVE] Right there that says she had chemo done for $9000. We're going on her [PII] treatment. Y'all haven't paid us one penny for chemo.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, um, I apologize, you know, for, um, you know, what you're going through, but I'm not sure. First, I need to know, I'm still gonna get a supervisor for you, but I need to know, do you have a copy of your wife's policy certificate that tells you what her benefits are?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Absolutely. I've gone over this like I said for 2 months now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So you have
[CUSTOMER][NEUTRAL] And not the stuff on me. Yes, I have it.
[AGENT][NEUTRAL] OK. So, um,
[AGENT][NEUTRAL] The only thing I'm gonna let you know about uh chemo, sir, and with her benefit, and it's in that policy certificate, is that you have to provide the, the explanation of benefits from your primary insurance company. We do not pay chemo, radiation, or immunotherapy. Often an itemized bill that says it was $9000. It's only paid.
[AGENT][NEUTRAL] Based off the primary LB because for the state of [PII]'s law that we only pay actual charge and actual charge is what the insurance company pay on behalf of that insurer, so we would know that unless we have a primary LB and that policy certificate tells you chemo when you get to the section where it describes it, it says it's pay actual charge. So, uh, let me get you to a supervisor. Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Pay actual charge. Explain that to me. What do you mean? So this chemo treatment was $8,252.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That my insurance company paid.
[AGENT][NEUTRAL] OK, so then you need to provide us, you need to provide us with the primary EOB from your insurance company so you can be reimbursed that policy.
[CUSTOMER][NEUTRAL] This is just 11 of them.
[CUSTOMER][NEUTRAL] Why do I have to call the insurance company?
[AGENT][NEUTRAL] Because that's what the policy says you must provide the burden of you must provide the burden of proof, sir, that she's had these services and the information that's needed.
[CUSTOMER][NEUTRAL] It's your
[CUSTOMER][POSITIVE] That's cool.
[CUSTOMER][NEUTRAL] So this stuff from the doctors, all the other.
[AGENT][NEUTRAL] That's what all of our cancer policies.
[CUSTOMER][NEUTRAL] All the other stuff that y'all are paying.
[CUSTOMER][NEUTRAL] In regards to the cancer.
[AGENT][NEUTRAL] We don't need the primary, we don't.
[CUSTOMER][NEGATIVE] You're not gonna pay the chemo because I had the, I have, I have to.
[CUSTOMER][NEGATIVE] I have to call the goddamn hospital, the insurance company.
[AGENT][NEUTRAL] Sir, I know you, I know you, I know you're upset, but I'm gonna ask you to please refrain from using explicitive words. I'm here to help you.
[CUSTOMER][NEUTRAL] Why do I have to do that?
[CUSTOMER][NEGATIVE] Man, I'm tired of dealing with you guys. My wife is sick and dying.
[AGENT][NEUTRAL] OK. Uh, well, let me get you a supervisor. Let me get you a supervisor, OK? Thank you. One moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Thank you. You are on hold.
[AGENT][NEGATIVE] You could have flipped that
[AGENT][NEUTRAL] This needed to just be flipped.
[AGENT][NEUTRAL] I think that might be too hard.
[AGENT][NEGATIVE] That's not all good.
[AGENT][POSITIVE] I'm gonna give you this to go ahead and eat and I'll finish up another one.
[AGENT][NEUTRAL] When I get off the phone, tell him what he needs to get through.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] Good morning.
[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][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hey, [PII], I'm good. I hope you're doing well.
[AGENT][NEUTRAL] Well, I'm sorry to bother you and you just tell me what I need to do, um, gentleman on the line, Mr. [PII] called in. It's regarding the cancer policy and I see [PII] is he immediately asked to speak to a supervisor, OK, so I had to diffuse him from right there. I said, well, I understand. I said, but protocol to ask you er uh, you know, certain questions before I can get you to a supervisor.
[AGENT][NEUTRAL] So I was able to bring him down a notch, verify what I needed to verify, and then I eased into it and said, so may I ask what your, uh, this is regarding?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] And he immediately said the crappy payments y'all are making.
[AGENT][NEGATIVE] They're sick of us?
[AGENT][NEUTRAL] And that we're not making any payment on chemo at all, so I immediately looked in history and so we have been requesting the EOB. It lets me know it was the state of [PII] and it is, and we have to have that EOB to process.
[AGENT][NEUTRAL] Chemotherapy. Her chemotherapy is 9000, y'all should just be paying it. So I said, well, sir, again, I diffused that a little bit. I said, sir, I said, do you have a copy of your wife's policy certificate? Yeah, I said, well, if you go to the section where it explains chemotherapy to you, it clearly states we pay actual charge. I said now I'm gonna explain to you what actual charge. I said actual charge is the amount that the insurance company pays on behalf of that insured.
[AGENT][NEUTRAL] And plus it's their responsibility. I said, so we will that unless we had the primary EOB and that's why we have to have that.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And you know he's using some explicit of words and I asked him please refrain from using that. I said because I'm here to assist and then he just took it back up and I said I'll tell you what I'm gonna get you a supervisor as you request.
[AGENT][NEUTRAL] But um,
[AGENT][NEUTRAL] It is 253.
[AGENT][NEUTRAL] 3255.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yep.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Yeah, he's just, he's just irate and it's just like not even this is a supplemental policy. It doesn't matter what your bills say it's only gonna pay what the policy certificate says, you know, you know, and that's why I explained the actual charge to him and he said was like we, he shouldn't have a request, in his words, uh, a am thing we should be the ones that that's our responsibility. Why does he he's just, he's, he's just.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm, mhm. Yeah.
[AGENT][NEUTRAL] That's what we need uh huh. Oh, [PII] just responded. She says sorry I was on another call. Let me review.
[AGENT][NEUTRAL] So you want me to, she said, OK, yeah, yeah, I will, I will. OK, thank you [PII]. OK, bye bye.
[AGENT][POSITIVE] Maybe. OK, thank you.
[AGENT][POSITIVE] OK alright thanks bye bye.
[AGENT][NEUTRAL] Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mr. [PII], thank you for holding. I'm trying to find a supervisor, OK? And I think I found one, but I have to brief them on what you're calling about, OK? So do you mind holding just a little bit longer, OK?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] as long as long as I need to. Thank you.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Uh-huh, you're welcome. Hold on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Is that
[AGENT][NEUTRAL] Oh, he calling?
[AGENT][NEUTRAL] Oh, go ahead.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Oh shit, it's not.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for patiently holding for me, Mr. [PII] welcome. So I'm getting ready to transfer you to uh Miss [PII]. She's a supervisor, OK?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling American Public Life. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey [PII], it's me. I just wanted to let you know I think I, I, I did explain, was able to bring him down a little bit and explain to him that we need those primary LBs. I think I put that in all my little mumble jumble there just, just so you'll know, and he does have a copy of his wife's policy certificate and he did go to the section where it says we pay actual charge and I explained that and he's just.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Upset and just saying, you know, he feel like we should be the ones to ask for that, not him. Why does he have to do it?
[CUSTOMER][NEUTRAL] Right, so I mean he, he can give our information to the provider and they file the claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If he owes money and so that's right.
[AGENT][NEUTRAL] He wouldn't even, he wouldn't even let me get that far. I'm, I'm lucky I got as far as I did with him because he called in hot, so, uh, you know, at that point before it just escalate and got any higher with him using explicitive words, I just said let me get your supervisor as you asked and that, that, that takes care of that. So here he comes, his name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And um
[CUSTOMER][NEUTRAL] But real quick, do you know major medical insurance carrier is? Oh, Blue Cross Blue Shield, OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK. All right, so here he comes, one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mr. [PII]?
[CUSTOMER][NEUTRAL] Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] I have Miss [PII] on the line. She's gonna further assist you. Have a great day and take care, OK?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hello, Mr. [PII]