AccountId: 011433970860
ContactId: 2ddaf01d-c849-494d-b398-bad3625916b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 956039 ms
Total Talk Time (AGENT): 447184 ms
Total Talk Time (CUSTOMER): 419444 ms
Interruptions: 7
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/2ddaf01d-c849-494d-b398-bad3625916b9_20250310T19:53_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh, my name is one of your folks.
[CUSTOMER][NEUTRAL] And I got a letter in the mail saying talking about explanation explaining the explanation of benefits.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEGATIVE] And they're saying that these labor bills weren't covered.
[AGENT][NEUTRAL] OK, so you have a question regarding.
[CUSTOMER][NEUTRAL] So I'm trying to figure out.
[AGENT][NEUTRAL] Uh-huh. Go ahead.
[CUSTOMER][NEUTRAL] I'm trying to figure out why this stuff isn't covered when I first bought when I first acquired this plan, the gentleman, I wish I knew who he was because.
[CUSTOMER][NEGATIVE] I, I would really like to talk to him because the misinformation was horrible. I mean, he told me Labor bills are gonna be paid. He said my my scripts were gonna be paid. He also told me that any bills would be paid.
[CUSTOMER][NEUTRAL] I asked him about my doctors said they were all there. Nothing, nothing he said was true. So,
[CUSTOMER][NEGATIVE] I got this explanation today that says that Labor bills aren't being paid, so I, I wanna know why they're not paying.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, I can help you as far as looking at the up the claims information, Ms. [PII], and go over that with you. So what is the
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] So that's, oh, I said the opposite.
[AGENT][POSITIVE] Good. That's OK. What is a good callback number for you, please, in case we're disconnected?
[CUSTOMER][NEUTRAL] Go ahead, ma'am, sorry.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your policy number please, Ms. [PII]?
[CUSTOMER][NEUTRAL] Oh man, the old policy number was, because I don't have it anymore.
[CUSTOMER][NEUTRAL] It was 682.
[CUSTOMER][NEUTRAL] 260.
[CUSTOMER][NEUTRAL] 167.
[AGENT][NEUTRAL] Let me see if I can is that your member ID?
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think I gave that to you right [PII].
[AGENT][NEUTRAL] Yes ma'am, that is what you gave me. So give me just a moment to see if I can locate your information with that number. You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII], I'm on the phone. I can't listen to that, that and this too.
[CUSTOMER][NEUTRAL] Well, I'm on the phone. I can't hear your phone and the TV just be considerate and let me talk on the phone.
[AGENT][NEUTRAL] OK, so assault.
[CUSTOMER][NEUTRAL] I can't hear.
[AGENT][NEUTRAL] Oh, OK, so I do need to verify several things with you first, for security purposes, Miss [PII] and any information that I do provide is a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and the next piece of information to verify will be your I'm sorry, your mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have for you is the same as the one that you gave me, so that again, that is your best contact number. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. And lastly, your uh phone number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry. No, I'm so I'm so sorry, Ms. [PII]. That's not what I meant to say. I just said that your phone number was the same as we have. What is your email address, please?
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][POSITIVE] OK, OK, thank you.
[AGENT][NEUTRAL] So I see that we have one claim on file for you um.
[AGENT][NEUTRAL] Is your claim number that you're referencing 3,571,800?
[CUSTOMER][NEUTRAL] Mhm, cause I have a.
[CUSTOMER][NEUTRAL] Yeah, 357-1800, yes.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, so yes ma'am, I can see that this claim was denied.
[AGENT][NEUTRAL] And the remarks
[CUSTOMER][NEUTRAL] What claim was done? OK, go ahead.
[AGENT][NEGATIVE] The claim that you're referring to, yes, it was denied.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now, on the [PII], there were multiple dates of service on here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So one of the codes for an 116 data service.
[AGENT][NEUTRAL] States in order to complete the processing of your claim, we need itemized statements of services provided listing the diagnosis code.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I thought I sent that.
[CUSTOMER][NEUTRAL] I did send an automatic bill. I did send that.
[AGENT][NEUTRAL] OK. This is stating that it's the diagnosis code that we're missing.
[CUSTOMER][NEUTRAL] A diagnosis code.
[AGENT][NEUTRAL] Mhm. The, not the procedure codes, but the diagnosis code.
[CUSTOMER][NEUTRAL] So what I went in for.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] Which was bronchitis.
[CUSTOMER][NEUTRAL] Acute bronchitis. OK, so what do I need to get from the hospital then because this bill has been outstanding since November.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that is, you would contact them and ask them to explain that you need to get an itemized bill that includes your diagnosis code.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] Oh my gosh, I sent all this stuff to these people and every time I call it's something different.
[AGENT][NEUTRAL] On it
[CUSTOMER][NEUTRAL] Every single time.
[CUSTOMER][NEUTRAL] Uh let me use your pen for a second.
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] And the other codes, I can see you had made a reference to your, to lab work.
[AGENT][NEUTRAL] Um, yes, ma'am.
[AGENT][NEUTRAL] I do show that that was also denied because it states benefits are payable under the certificate are limited to those outlined in the schedule of benefits. This is not a covered loss under this plan.
[CUSTOMER][NEGATIVE] You know what, these people, you know, I'm so sick of this, you know, because, you know, I, I was given the wrong information.
[AGENT][NEUTRAL] Have you spoken to someone at member services?
[CUSTOMER][NEGATIVE] And I got I have to suffer for it.
[AGENT][NEUTRAL] Yes, ma'am, the company.
[CUSTOMER][NEGATIVE] I have to suffer for it. I've been calling them and calling them and calling them and they're saying oh we're pro we're trying to process it, we're processing then today.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You received that from us?
[CUSTOMER][NEUTRAL] A lot of you're saying.
[CUSTOMER][POSITIVE] Ma'am, I'm sorry.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] That's
[CUSTOMER][NEGATIVE] I'm not talking to you. I'm talking to the person on the phone.
[CUSTOMER][NEUTRAL] Ma'am, I need it.
[CUSTOMER][POSITIVE] There's a fan right up there.
[CUSTOMER][NEUTRAL] Alright ma'am. I'm sorry I'm going to another room so I can talk to you.
[AGENT][NEUTRAL] That's OK. No, I was just saying, so you have reached out to member services, which is the, where you enrolled for this coverage?
[CUSTOMER][NEGATIVE] Yeah, and they told me all this stuff when I, when I first obtained this, this, and I'm not, I'm not mad at you, ma'am. It's just, I'm just frustrated because these people told me that all this stuff, I asked them before I even purchased it, was this stuff covered from the doctors down to the labs, to, to the subscriptions. And the only thing that was covered.
[AGENT][NEUTRAL] I understand, ma'am, I understand your frustrating.
[CUSTOMER][NEGATIVE] Was my regular doctor's visits, which, um, I'm always getting a bill from those. So I now got an $18,000 bill that they don't wanna pay, which is gonna involve a lawyer at that point. I'm not, I'm not mad at you, but I'm not gonna sit up here and, and, and try and pay a $18,000 bill when I was told.
[AGENT][NEUTRAL] Oh, I understand.
[CUSTOMER][NEUTRAL] That all this stuff was covered. Emergency room, all this stuff was supposedly covered.
[CUSTOMER][NEGATIVE] And I've been on the phone with these people for the last 4 months trying to get this resolved. And every time I call them it's something different every single time.
[AGENT][POSITIVE] Oh my goodness. I'm so sorry. I'm sorry.
[AGENT][NEUTRAL] And that's member services that you've been trying to speak to or have been speaking to Ms. [PII]?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEGATIVE] Yeah, I'm, I'm just, I'm just frustrated right now because you know this is gonna go on my credit. I don't need this on my credit.
[CUSTOMER][NEUTRAL] If it goes into collection.
[AGENT][NEUTRAL] I understand. Yes, ma'am, I understand.
[CUSTOMER][POSITIVE] Because it's been outstanding since [PII].
[CUSTOMER][NEGATIVE] And nobody wants to take responsibility for it. It's just ridiculous.
[AGENT][NEUTRAL] Because I can see that this claim as far we didn't we just received and processed your claims information, Ms. [PII], we received it on [PII] here at APL.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] And it was processed on the [PII].
[CUSTOMER][NEGATIVE] And this young lady that told me about this was, oh, you can submit it to them and they, they, they'll issue a check and I'm like as I'm listening to her and I'm saying that doesn't even make sense what you're telling me.
[AGENT][NEUTRAL] Now, I'm not uh, yes, ma'am. I, I don't wanna speak on that because I would not, I don't know.
[CUSTOMER][NEUTRAL] Now are you, are you the, the place I should be calling this or is this just some kind of service or something?
[AGENT][NEUTRAL] I should have told you that.
[CUSTOMER][NEUTRAL] That I, I, I sent the information to, because I sent them.
[AGENT][NEUTRAL] The claims, yes ma'am, the claims get processed by APL.
[AGENT][NEUTRAL] So you can contact us if you have any questions regarding, you know, like you've done today about this EOB that you received and what type of information that we're needing to further review your claim that we received, um, yes, you would contact us now any questions regarding you know like the type of plan you enrolled for the premium you were paying can.
[AGENT][NEUTRAL] Fling anything like that, then that's that member services that you said you've been trying to communicate with.
[CUSTOMER][NEGATIVE] Mhm. Well, that's a, that's a lost cause right there because all they do is make up excuses.
[CUSTOMER][NEGATIVE] And put you on just keep telling the same old bullshit every time I call.
[AGENT][POSITIVE] Mm, I'm very sorry.
[CUSTOMER][NEUTRAL] Oh, we're working on it. Oh, it took 4 it's been 4 months. Oh, we still, we're still working on it.
[CUSTOMER][NEGATIVE] And then I get this today saying that the all those Labor bills which comes to like $2000 they're not gonna pay.
[AGENT][NEUTRAL] Now, on your policy that you have with us, this limited benefit plan, Ms. Folks, lab work is not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But that's what I'm saying, ma'am. I was not told that that that the lab work wasn't, so somebody's got to take responsibility for this, you know, because I was told different.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I'm gonna have to somehow I don't know if I can find out who the guy was that sold me the insurance.
[AGENT][NEUTRAL] And I would be
[CUSTOMER][NEUTRAL] But I need to find out who he is because.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You know, he just slapped me into a plan.
[CUSTOMER][NEUTRAL] And I ask these questions and.
[CUSTOMER][NEUTRAL] He said everything was covered from the doctors down, like I said, and
[CUSTOMER][NEGATIVE] I, I don't know what to do at this point. I guess I, I might have to get a lawyer because I'm not paying this. I'm not paying this because I was not informed.
[AGENT][NEUTRAL] When you have spoken.
[CUSTOMER][NEUTRAL] Of lab tests not being.
[AGENT][NEUTRAL] When you have spoken with member services, um, the folks, have you asked them to have that agent to contact you?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] I, I would recommend trying to do that.
[AGENT][NEUTRAL] And see if they will have that individual contact you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He, all he's gonna do, ma'am, is deny it, but, you know.
[CUSTOMER][NEGATIVE] But they should have stuff recorded on a recorded line and I don't, he never told me nothing.
[AGENT][NEUTRAL] Yes, ma'am. All of our calls are.
[AGENT][NEUTRAL] So I mean, I can't speak to them. I mean, our calls are.
[CUSTOMER][NEUTRAL] I don't remember him saying nothing about lab.
[CUSTOMER][NEGATIVE] But see that should have been, that should have been, that should have been told to me when I obtained the insurance that lab wasn't included and I wouldn't have taken the insurance.
[AGENT][NEUTRAL] Yes, ma'am. This particular policy that you did have with us, again, it was a limited benefit plan and it only had benefits if you were admitted to the hospital or went to an ER urgent care, physician's office, or had either physical speech or some type of or occupational therapy at a therapy facility.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] What I need to know is what do I need to get from the hospital because they I I've already sent an itemized bill it had everything on it so let me just get an itemized bill from them.
[AGENT][NEUTRAL] Now, make sure the key, yes, make sure though to tell them that you have to have the diagnosis code included. A lot of the itemized bills, Ms. Folks does not have that. It has the procedure codes of everything they did to you, but it doesn't have the why it was done.
[CUSTOMER][NEUTRAL] Front and back
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we have to have that.
[AGENT][POSITIVE] What I would recommend is, yes.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Is reading them.
[CUSTOMER][NEUTRAL] So what kind of code is it again? It's an itemized, you need an itemized statement with the code on it.
[AGENT][NEUTRAL] With a diagnosis code.
[CUSTOMER][NEUTRAL] Oh, diagnosis sorry.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because again, a lot of them have the procedure codes or the CPT codes as they're called, but they don't have the diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll have to call the billing department and see if I can get that done.
[AGENT][NEUTRAL] Yes, ma'am. That
[CUSTOMER][NEUTRAL] And then what do I call? Do I, do I, do I call you guys back or where do I?
[AGENT][NEUTRAL] Once they've provided, once they've sent you that information, I can give you our claims fax number.
[CUSTOMER][NEUTRAL] Yup.
[AGENT][NEUTRAL] It's a secured fax line that that can be sent to, that you can fax that to. Now once you do fax it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, can I have the fax number?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] You can reference that claim number when you do send it, Ms. [PII], and I'm also going to give you a, a little different number. I was able to locate it with your member number that you gave me, but I'm gonna give you another number as well for your policy number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm, policy number, OK.
[AGENT][NEUTRAL] 256.
[AGENT][NEUTRAL] 079 5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can reference that on there as well. And once you do fax it to us, Ms. Folks, do allow 48 hours for us to get that, you know, received and processed on your, you know, on on your profile.
[CUSTOMER][NEUTRAL] All right, ma'am.
[CUSTOMER][NEUTRAL] should be
[AGENT][NEUTRAL] If you want to follow up on it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To verify that it was received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And like I said, ma'am, I apologize if I got upset, but that should, that should have been, that should have been told to me that it was a limited plan and what it did not pay for because everything I asked him for, he said, oh your doctors are on there. And oh, the emerg he just told me everything I guess I wanted to hear, but he never said it was a limited plan.
[AGENT][NEUTRAL] No, it's OK.
[AGENT][NEUTRAL] Yes, ma'am. This was a limited, a hospital indemnity limited benefit plan.
[AGENT][NEUTRAL] For what you the coverage you have with our company.
[CUSTOMER][NEUTRAL] OK, alright ma'am, let me, let me take care of this and then like I said I'll see if I can get that information and then I will get it to you.
[AGENT][NEUTRAL] And if you have
[AGENT][POSITIVE] Yes, ma'am. If you have any other questions, please give us a call and we'll be more than happy to try and help you.
[CUSTOMER][POSITIVE] Appreciate it thank you.
[AGENT][POSITIVE] Well, you're very welcome. And can I help you with anything else today, Ms. [PII]?
[CUSTOMER][POSITIVE] No ma'am, you've been very helpful thank you.
[AGENT][POSITIVE] Well, you're very welcome. I'm sorry, I couldn't do more for you, but again, if there is something else that we can help you with, please give us a call.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome and thank you again for calling APL. I hope you have a nice evening.
[CUSTOMER][NEUTRAL] You too, ma'am.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][POSITIVE] Thank you.