AccountId: 011433970860
ContactId: 4bde0e8d-8b30-4c73-b081-1892a80401d4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 624260 ms
Total Talk Time (AGENT): 246861 ms
Total Talk Time (CUSTOMER): 218401 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/4bde0e8d-8b30-4c73-b081-1892a80401d4_20250624T14:35_UTC.wav
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[AGENT][NEUTRAL] American Public Life, this is [PII]. How may I help you?
[CUSTOMER][NEGATIVE] Hi [PII]. I'm calling about a claim that I believe should have been paid and has not been.
[AGENT][NEUTRAL] May I have a claim number?
[CUSTOMER][NEUTRAL] It is 36074008.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I have 2 claim numbers actually.
[AGENT][NEUTRAL] May I have your name and a good callback number?
[CUSTOMER][NEUTRAL] My name is [PII], but it's not for me it's.
[CUSTOMER][NEUTRAL] What else did you need?
[AGENT][NEUTRAL] A good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for verifying that information. Are you the provider?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. I'm just trying to get your association because you're not on this policy.
[CUSTOMER][NEUTRAL] Yes ma'am, I'm, I'm his girlfriend. I'm just trying to help him figure out his bill.
[AGENT][NEUTRAL] OK. Is he available to speak with me?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] She wants to talk to you babe so you can tell her it's OK. Hello?
[AGENT][NEUTRAL] Hi, [PII], this is [PII]. How are you today?
[CUSTOMER][POSITIVE] Good, I'm alright. I mean, we've been trying, we've been working on this for a couple of years now trying to get this, you know, settled.
[AGENT][POSITIVE] OK. I'll be happy to.
[CUSTOMER][NEUTRAL] I think the insurance company.
[CUSTOMER][NEUTRAL] I call on get these, but you know it's just.
[CUSTOMER][NEUTRAL] I've been getting run around so long now.
[AGENT][NEUTRAL] OK, I do apologize for that. Is it OK, do you give permission for [PII] to speak on your behalf today?
[CUSTOMER][NEUTRAL] Yeah, she, she's in the medical field, so she kinda knows a lot more about this stuff than I do.
[AGENT][POSITIVE] OK, so I'll be happy to assist you with anything you need today, [PII]. OK, [PII], how can I help you today?
[CUSTOMER][NEUTRAL] Hi there. So it looks like from what I can see in his paperwork.
[CUSTOMER][NEGATIVE] It looks like um he had a, I don't know what it's called exactly, a hemorrhoidectomy and it looks like the doctor bill was paid. The insurance did reduce that bill, but the anesthesiologist and the hospital surgery center, um, his insurance is not paying anything on that. And I also have another claim number that might be more the one I'm having trouble with.
[AGENT][NEUTRAL] OK, please be advised that verification of coverage does not guarantee the payment of a claim. So I am looking at the first claim number that you gave me. Let me get that, and it looks like they are asking for a diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like that's why the first one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They asked for a diagnosis code on that one. And then let's see on the next one.
[AGENT][NEUTRAL] It looks like.
[AGENT][NEUTRAL] 361-335-9.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, on this one.
[AGENT][NEUTRAL] Looks like the charges were prior to the effective date of the policy.
[AGENT][NEUTRAL] So it looks like
[CUSTOMER][NEUTRAL] He said he had the policy prior to going to this doctor.
[AGENT][NEUTRAL] OK, so the data service is 8-11-2023, and this policy started [PII]. Let's see if he had another policy, and I'm not showing any other policies prior to this one.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So it looks like [PII] was the effective date on this plan.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Could he have
[CUSTOMER][NEUTRAL] Initiated the policy prior to that, but it took months until you're allowed to use it or something.
[AGENT][NEUTRAL] Let me see if there's any notes in here.
[CUSTOMER][NEUTRAL] You know when I say OK now you have 12 hours you know.
[AGENT][NEUTRAL] OK. On my end, I'm not showing anything. I'm gonna get you over to the care team and see if they can show any coverage prior to what I'm seeing in my system as of [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. You're welcome. One moment. I place you on a brief hold. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Ferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Uh hi [PII], this is [PII] in claims. How are you?
[CUSTOMER][POSITIVE] Hey [PII], I'm doing well how are you?
[AGENT][NEUTRAL] I am great, thanks for asking. I have an insured along with his girlfriend who is speaking for him on my back line. They are trying to verify he is [PII] that he had a policy prior to what I'm seeing in my system. Can you help them with anything prior to what we have in line?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, ma'am, I don't know how we would be able to see anything, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Customer service.
[CUSTOMER][NEUTRAL] Unless it was something on maybe um unless there's something on on base that's the only thing I could think do they have a policy number?
[AGENT][NEUTRAL] Yes, it's 02418405.
[CUSTOMER][NEUTRAL] The only time I've ever experienced someone um that I couldn't find a a policy in our system, it was one of the old policies and it was just not in line um but um it was definitely not one of the newer policy numbers so I would just be able to see what you see.
[AGENT][POSITIVE] OK. All [PII]. Well, let me let her know that then. Thank you.
[CUSTOMER][POSITIVE] All right, sorry about that. Of course, have a great day. Bye.
[AGENT][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] OK, thanks for holding, [PII]. She advised me that there is [PII]o other policy prior to this one in our system.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so his insurance card that I have in front of me says
[CUSTOMER][NEUTRAL] It's so [PII] says um PHCS limited benefit plan effective date [PII].
[AGENT][NEUTRAL] And PHCS, would that be his primary insurance?
[AGENT][NEUTRAL] Does he have another insurance?
[CUSTOMER][NEGATIVE] He does not have another insurance. This has been, I don't, we don't know how it got to American Public Life Insurance Company. Um, this is the only insurance he's ever had.
[CUSTOMER][NEUTRAL] Unless PHCS sold it or something, I don't know.
[AGENT][NEUTRAL] OK, so the number for them, does it give you this number, our number, the [PII]?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEGATIVE] No, but that's who I'm getting. I'm getting bills from you saying that we owe it when this is the insurance that he had.
[AGENT][NEUTRAL] Yeah, I would try to give them a call and see because we did receive the bills. Let me see who submitted them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and it was submitted by the insured. So,
[AGENT][NEUTRAL] Our policy did not start until [PII]. If he had another policy that was effective, the claims need to go there.
[AGENT][NEUTRAL] To see if he can get benefits from them. So I would call the number on that card and explain to them what's going on and see if they even have those claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Why would
[CUSTOMER][NEUTRAL] Why would you have the bills?
[AGENT][NEUTRAL] They were sent over to us.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] It looks like the insured submitted them to us.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] We received one in May and one in June.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So you're saying that [PII] sent them to you?
[AGENT][NEUTRAL] Correct. Someone on his behalf sent the bills over to us because they were submitted by the insured, not the provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, let me call that other number and see what I can find out. Thank you so much for your help.
[AGENT][POSITIVE] [PII], you're so welcome and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Let me here
[CUSTOMER][NEUTRAL] You too.