AccountId: 011433970860
ContactId: 4fe3fd06-98fd-4a04-a86b-f04d48df79bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2022160 ms
Total Talk Time (AGENT): 787003 ms
Total Talk Time (CUSTOMER): 602881 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/4fe3fd06-98fd-4a04-a86b-f04d48df79bc_20250221T16:32_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um,
[CUSTOMER][NEUTRAL] I quite don't remember my um.
[CUSTOMER][NEUTRAL] Uh, my ID or policy number?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] From uh BWA.
[CUSTOMER][NEUTRAL] But uh, I have sent some uh fax forms to you guys on those statements.
[CUSTOMER][NEUTRAL] And um supposedly uh they were gonna go through it, you know, and
[CUSTOMER][NEGATIVE] You know, I never got a hold of you guys. You know, all I got was like a check for $100 and every, everything else is like $0 on the side. I don't have the letter with me, I forgot to bring it over here at work, but uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I wanted to see, you know, what, what, what is it that you guys, you guys have on the system? What is it that it's saying, you know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You know.
[AGENT][POSITIVE] I can definitely help you with the claim status. May I have your name?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[CUSTOMER][NEUTRAL] And then last name is uh [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] Thank you for that. And um [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that and all the information that's provided is a verification of benefits, not a guarantee of payment. I'm going to um search with your name. Hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policies to come up here and you said your first name is [PII], correct? [PII]?
[CUSTOMER][NEUTRAL] No, it's [PII]
[AGENT][NEUTRAL] You OK, hold on one moment.
[AGENT][NEUTRAL] OK, I believe I just located it. It's coming up now.
[AGENT][NEUTRAL] And can you verify your date of birth?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][NEUTRAL] Thank you for that and all the information. Oh, well, sorry, I already said it, all the information provided is a verification of benefits, not a guarantee of payment. I just need you to verify your mailing address and the email address on file.
[CUSTOMER][NEUTRAL] So [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And I think you have, uh, I don't know if you have Paladares.
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] All right, hold on one moment.
[AGENT][NEUTRAL] So, do you know the, the date, um, I can try to look it up with the date, the date of service.
[CUSTOMER][NEGATIVE] Uh, not to be honest, no.
[AGENT][NEUTRAL] Because actually I'm not showing that we've processed any claims for you. It's just blank here. Was it for your APL policy or another type of insurance you may have? Because this policy hasn't been
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] It's for, it was for APL.
[AGENT][NEUTRAL] OK, because this policy hasn't been active since [PII], but there's no claims here. We haven't processed any claims for you.
[CUSTOMER][NEUTRAL] I don't get it. What do you mean? What do you mean like?
[CUSTOMER][NEUTRAL] What claims?
[AGENT][NEUTRAL] So, you said that that there were documents sent in, go ahead.
[CUSTOMER][NEUTRAL] Because I have
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, all I did was send some fax forms.
[CUSTOMER][NEUTRAL] And um
[AGENT][NEUTRAL] Are you saying tax forms or you faxed the form?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah, I faxed the forms.
[AGENT][NEUTRAL] Right, like a claim form.
[CUSTOMER][NEUTRAL] Yeah, it was like a form.
[AGENT][NEUTRAL] Like you went to the doctors or something and you were filing for your visit?
[CUSTOMER][NEUTRAL] It was uh
[CUSTOMER][NEUTRAL] It was a hospital indemnity and
[CUSTOMER][NEUTRAL] Every day it's a Lucious claim form.
[AGENT][NEUTRAL] Yes, so what I'm saying is whatever you faxed in, it it's not here, like there's nothing here for APL.
[AGENT][NEUTRAL] I would need like the, I look to see if there's another policy, but this is the only one.
[CUSTOMER][NEUTRAL] How
[AGENT][NEUTRAL] Let me see something, let me try.
[CUSTOMER][NEUTRAL] Yeah, I, I, like I said, I, I got a letter from you guys and
[CUSTOMER][NEUTRAL] I don't know, it says zero balance on the side and then.
[CUSTOMER][NEUTRAL] It was, and there, there was a check for $100.
[CUSTOMER][NEUTRAL] You know, and then, I don't know, I forgot to get the letter and, you know, but I decided just to
[CUSTOMER][NEUTRAL] Give you guys a call, see if you had any, you know, anything on the system.
[AGENT][NEUTRAL] Well, I can reach out to um BWA and see if they've processed the claim for you, um, but we don't have a claim here at APL. Did you want me to give BWA a call?
[CUSTOMER][NEUTRAL] Um, sure.
[AGENT][NEUTRAL] OK, hold on one moment, OK?
[CUSTOMER][NEUTRAL] Excuse me, ma'am.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What's the number for um BWA cause I tried to call him.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And all what I got was uh some promotions and then
[CUSTOMER][NEUTRAL] I decided not to get that promotion it just hang up on me, so.
[AGENT][NEUTRAL] OK. Um, so there's two phone numbers. The first one is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then the other
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh, OK.
[AGENT][NEUTRAL] And then the other number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and hold on one moment, I'm going to call them on the other line, OK?
[CUSTOMER][NEGATIVE] It's not.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling member services. All calls are recorded for quality assurance. Our hours of operation are Monday through Friday [PII] Central Standard Time. If you know your party's extension, please dial it now.
[CUSTOMER][NEUTRAL] For customer support, press 2. For agent support, press 3. For claim support, press 4. For provider support, press 5. Thank you. You are currently caller number 6 waiting to speak with a representative. The estimated hold time is currently 6 minutes. Thank you for your patience.
[AGENT][NEUTRAL] Sting.
[CUSTOMER][NEUTRAL] You are currently caller number 5 waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 3, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 2 waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][POSITIVE] Your call is now first in line and will be answered by the next available representative. Thank you for your patience.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm still here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is again how can I help you?
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm calling from APL. I'm sorry, I didn't get your name.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. Hey [PII], I'm calling um with a mutual patient on the line. He filed a claim, but we don't have a claim here at APL, so I'm wondering if maybe the claim was filed with you all. He's a BWA member.
[CUSTOMER][NEUTRAL] Have a member ID number.
[AGENT][NEUTRAL] Mhm. Uh, so with APL is 251-4224. I'm not sure if if BWA has another number.
[CUSTOMER][NEUTRAL] or
[AGENT][NEGATIVE] It's breaking up. Say that one more time.
[CUSTOMER][NEUTRAL] It would start with a 6 or an M.
[AGENT][NEUTRAL] This may be it, it came over as a social though, um, [PII].
[CUSTOMER][NEUTRAL] Well can you verify date of birth?
[AGENT][NEUTRAL] Mhm hold on one moment.
[AGENT][NEUTRAL] I have my notes up, sorry.
[AGENT][NEUTRAL] Mr. Has, you can give her your date of birth.
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[CUSTOMER][NEGATIVE] A claim was submitted and it was supposed to come to I'm I'm confused.
[AGENT][NEUTRAL] Right, so he said that he received a, he said he faxed in some claims forms. It is a hospital indemnity claim form, which is one of ours. He received a payment of $100 but wanted to know why the remaining, um, you know, things that he filed for was denied, but when I pulled him up in our system, there's only one policy, it is BWA, but there's no claims here like it's blank. We haven't processed one claim for him, so I was wondering if maybe BWA has processed the claim because we don't have anything.
[CUSTOMER][NEUTRAL] But um
[CUSTOMER][NEUTRAL] What would be data service and build them out?
[AGENT][NEUTRAL] I don't think he has, uh, he doesn't have, Mr. [PII], you don't have the data service or anything, right? Or the
[CUSTOMER][NEUTRAL] No, they.
[CUSTOMER][NEUTRAL] Not, not at the moment, but BWH should have to.
[CUSTOMER][NEUTRAL] Everything on file, you know, so so I would just resend it.
[AGENT][NEUTRAL] You say you will resubmit the claim?
[CUSTOMER][NEUTRAL] I don't have a claim on file for um.
[AGENT][NEUTRAL] You don't have one. Is it for you or for one of your dependents? Right.
[CUSTOMER][NEUTRAL] at all. I have one for [PII] or [PII].
[CUSTOMER][NEUTRAL] It's for, it's for both of my dependents.
[AGENT][NEUTRAL] OK, so that's different.
[CUSTOMER][NEUTRAL] Multiple here but I don't.
[CUSTOMER][NEUTRAL] Can you um can you, can you repeat the social security number because I heard something, something else.
[CUSTOMER][NEUTRAL] I haven't set a social security.
[AGENT][NEUTRAL] For me, I, so the 682 number that came over?
[CUSTOMER][NEUTRAL] That's the that's the member ID number. I'm not sure.
[AGENT][NEUTRAL] Right, I was saying that it came over as a social, but that's the member ID for BWA and we've only processed, APL has only processed one claim for [PII], but there's no claim on file for um your other dependent [PII].
[CUSTOMER][NEUTRAL] Here but it looks like.
[CUSTOMER][NEUTRAL] It's for two of them, it's for my.
[CUSTOMER][NEUTRAL] For my daughter and my son.
[CUSTOMER][NEUTRAL] Supposedly, uh. Yes.
[CUSTOMER][NEUTRAL] Yeah, supposedly, you know, I, I was told it was gonna be covered, but then the, the Green Island clinic said that, you know, they submitted the
[CUSTOMER][NEGATIVE] The documents and supposedly you guys were out of service for them.
[CUSTOMER][NEGATIVE] So now I'm getting a bill for $1,157.
[CUSTOMER][NEUTRAL] That I need to pay, you know, and.
[AGENT][NEUTRAL] What was
[CUSTOMER][NEUTRAL] That's where I'm at right now.
[AGENT][NEUTRAL] With APL there is no timely filing limit, so you can file the claim as long as the policy is active. The thing is, you've received the payment for a claim, but there's no claim.
[AGENT][NEUTRAL] On file. Now, the one for um [PII], I can see, that's the one you're talking about. There was a payment of $100 for [PII], but that's the only, there's one claim for [PII]. We haven't received anything else for [PII] and nothing for [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That's what I'm saying, becaus[PII] I fax everything into, you know, to uh, to the fax, which the fax number is [PII], it's [PII].
[CUSTOMER][NEUTRAL] 59423
[CUSTOMER][NEUTRAL] And I file all the, all the bill statements to you guys, so.
[CUSTOMER][NEUTRAL] I still have a copy through me, you know. I don't know if I need to resend this copy.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Hold on one second, Mr. [PII]. Um, [PII], I think I've figured it out. The ones, um, I'm just gonna have, I've figured it out. I'm, I'm, we're OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Alright, thank you. Have a good day.
[AGENT][NEUTRAL] OK, Mr. um [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, she just ended the line. So first, just to answer your original question, the payment of $100 was for [PII]'s claim, and let me see.
[AGENT][NEUTRAL] While the others
[CUSTOMER][NEUTRAL] But that's not gonna cover all of my.
[CUSTOMER][NEGATIVE] That's not gonna cover, you know, my $1000 and $157 that I owe.
[AGENT][NEUTRAL] Right, so your policy has benefits. So just because that's what you were billed, it depends on what your policy benefits are. So for, let me see what was used and what we billed for, I mean what we paid, hold on one second.
[CUSTOMER][NEGATIVE] Because I called the Green Island clinic and they, you know, haven't got anything from PWA or for, or from APL. They haven't got, they haven't gotten nothing at all, you know, and.
[CUSTOMER][NEUTRAL] They're still sending the bill statements at my house, so I'm just like.
[AGENT][NEUTRAL] OK, hold on one second. I do understand. I'm gonna see why the other codes were denied, why $100 was applied, and then we're gonna, the only thing to do for [PII]'s claims and the other claim for [PII] is to resubmit them because they're not here and BWA doesn't have it either.
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] So you can resubmit them and we can process, but I'm gonna see why it was only paid $100 and why the other um parts of this claim was denied. Is it OK if I place you on just a brief hold while I look into that?
[CUSTOMER][NEUTRAL] Uh, yes, but before anything, like I said, the Green Island clinic has said that, you know, BWA was out of service and that's why they couldn't.
[CUSTOMER][NEGATIVE] Get anything in it, but BWA had told me, you know, that I should be insured, you know.
[CUSTOMER][NEUTRAL] And I don't know what's, I, I don't know what's going on because.
[AGENT][NEUTRAL] OK, I'm gonna give you some clarity. Hold on one second, let me just see what all this is, OK?
[CUSTOMER][NEUTRAL] I'm just like
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So what's the max? Like, is it a per day, I mean, per visit type of thing?
[AGENT][NEUTRAL] Oh Lord.
[AGENT][POSITIVE] It would definitely help if the policy, sir was on here.
[AGENT][NEUTRAL] All right, [PII], so just figure it out.
[AGENT][NEUTRAL] This, it doesn't say a max. I'm gonna say $50.
[AGENT][NEUTRAL] Outpatient maxine benefit physician's office is $50 but then why is the max then?
[AGENT][NEUTRAL] Are these different dates of service?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right, thanks for holding. So I figured out what's what happened. OK. So for your policy, your hospital indemnity policy, any um treatment in the physician office is going to be paid up to $50 per visit.
[AGENT][NEUTRAL] Which is per um data service. So for [PII], there is [PII] and [PII]. So [PII] was paid $50 and [PII] was paid $50. The other two were denied because we can only be applied for one day. So the other two were for [PII] as well, but the $50 had already been applied. So yes, it was billed, um.
[AGENT][NEUTRAL] Like you said, the $1000 but the policy can't pay more than $50 per visit per day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So this may be all the documents that you submitted for [PII], because it's multiple days here.
[CUSTOMER][NEUTRAL] So I
[AGENT][NEUTRAL] Or do you think there's something else that needs to be?
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] No, I, I thought it was, I was gonna be um.
[CUSTOMER][NEUTRAL] You know, cover for.
[CUSTOMER][NEUTRAL] For all those, you know, I thought they were gonna be insured, you know.
[CUSTOMER][NEUTRAL] No, cause I was paying like about 300 and some bucks uh.
[CUSTOMER][NEUTRAL] A month for the, for the, for the insurance.
[CUSTOMER][POSITIVE] You know, and they had give me, they had gave me, you know, a lot of coverage on it.
[CUSTOMER][NEUTRAL] You know, but then I went through my, through my uh employment uh insurance and I had to cancel it out, you know. But I did my payments, you know, throughout those months that I was, you know, in service.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] And, but then, you know, Green Island Clinic over here in [PII] told me that.
[CUSTOMER][NEGATIVE] There were, you know, the, the network was out of service and they couldn't cover anything at all.
[CUSTOMER][NEUTRAL] So,
[AGENT][POSITIVE] Yes, so the best
[CUSTOMER][NEUTRAL] They did
[AGENT][NEUTRAL] Oh, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] No, go ahead.
[AGENT][POSITIVE] I was just gonna say the best thing to do, um,
[AGENT][NEUTRAL] Well, the only thing that we ca[PII] do at this point would be to
[AGENT][NEUTRAL] File all the claims for [PII].
[AGENT][NEUTRAL] And then if you think that there is another any other claims for [PII] that, you know, when the policy was active, you can go ahead and file those. But if you think there may be another type of policy or more or different type of benefits.
[AGENT][NEUTRAL] Um, you may want to talk to BWA to see if you can change your, um, coverage.
[AGENT][NEUTRAL] If you're going to be going to like the doctor's office more, there may be policies that cater or have more payout to like the physician's office or things like that versus the hospital.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Right, it was a physician that they were seeing.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEGATIVE] I just, I, I'm kind of lost, to be honest, because I, I don't know what what is it that I was paying. All I know was that they, you know, have provided insurance coverage and, you know, they have said that they were gonna, you know, coverage for doctor visits or whatever, you know, and I decided to go with it, you know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And like I said, I, and like I said, I was, you know, paying, I was paying like around 300 some bucks a month for the, for the insurance policy, whatever. And that's when I took my kids cause they were, they had no insurance, you know, and they were kind of sick, so I had to get insurance.
[CUSTOMER][POSITIVE] You know, and I got the insurance, I took them. They got seen, you know, and I provided everything from uh.
[CUSTOMER][NEUTRAL] From BWA which it was called it was called Nova. I think it was called the
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The insurance was called Nova or something like that.
[CUSTOMER][NEUTRAL] But then, you know.
[AGENT][NEUTRAL] I'm not familiar.
[CUSTOMER][NEGATIVE] Yeah, me neither, but uh they had said that, you know, everything that I put out of the system was sent to them. Like the bill statement was sent to them and they got denied because they were out of the network service, so.
[AGENT][NEGATIVE] Well, that's the part that I don't understand, so I'm not sure where they're sending it to. Maybe they are sending it to BWA because she did say that there were several claims there, she just needed dates of service, um, and then for, I don't know which child, for one, she said that there were several, but she needed dates of service and the other she said she didn't receive.
[AGENT][NEUTRAL] So, I'm not sure who they're filing the claim to, but APL has not denied any claims. We only paid out one claim for [PII].
[CUSTOMER][NEUTRAL] Yeah, but
[CUSTOMER][NEUTRAL] You guys said um
[CUSTOMER][NEUTRAL] They only cover $50 for that visit.
[AGENT][NEUTRAL] Yes, for any physician office visit, yes, it will be $50 per day or per visit.
[CUSTOMER][NEUTRAL] Services, so they're not gonna cover like, let's say it's like the visit cost me $372 and some cents, they're only gonna cover $50.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I guess everything is right then, you know?
[CUSTOMER][NEUTRAL] But uh,
[CUSTOMER][NEUTRAL] What did I get $100 though, you know?
[AGENT][NEUTRAL] You got $100 because of the two days, [PII] and [PII], it was $50 for both days.
[CUSTOMER][NEGATIVE] OK. And then the other ones I got denied.
[AGENT][NEUTRAL] The other two were denied because they're also for [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Like
[CUSTOMER][NEUTRAL] What about for my son?
[AGENT][NEUTRAL] There's nothing here for your son, so you can file those claims, you can send those documents back into us and we'll process the claim, but we don't have anything for Noah, just one claim for [PII].
[CUSTOMER][NEUTRAL] Are you sure? Because I send all the documents, you know.
[AGENT][NEUTRAL] I'm positive, um, under your, under your name, when we go to where when I go to where the claims are, it's completely blank. Under [PII]'s name it's completely blank, even if there was a claim from [PII], it will still show up there, um, but everything is blank. There's only one for [PII] from APL. BWA said that they had several, so it sounds like they're sending it to BWA and it's being denied. The APL does not have any denied claims. We only have one claim and we paid on it.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Do you have any fax forms that I send to you guys?
[AGENT][NEUTRAL] Yes, the documents are on [PII]'s, um, [PII]'s claim.
[CUSTOMER][NEUTRAL] Can you check on the, can you verify for me, please, if you don't mind? Checking on the fax forms on the last pages for Noah.
[AGENT][NEUTRAL] Sure, hold on one moment.
[CUSTOMER][NEUTRAL] Cause everything got sent together, you know.
[AGENT][NEUTRAL] Sure, I can check for you. It's coming up now. Hold on one moment.
[AGENT][NEUTRAL] OK, so it's a total of 11 pages. I'm just going through them. Hold on one moment.
[AGENT][NEUTRAL] Mr. [PII], I'm just gonna place you on a brief hold while I look through these pages, OK?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. You are on hold.
[AGENT][NEUTRAL] OK, so, OK, so that is for [PII].
[AGENT][NEUTRAL] And then 2.
[AGENT][NEUTRAL] That is for, oh, no, that's for [PII].
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] That is for [PII].
[AGENT][NEUTRAL] I'm not gonna be able to determine that.
[AGENT][NEUTRAL] Because I don't see any names on here.
[AGENT][NEUTRAL] The patient number is different though. [PII].
[AGENT][NEUTRAL] No, this is the same patient information.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] This is research.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right, thanks again for holding. So I do see the, um, I do see where [PII]'s name is on some of the claim form. I'm gonna reach out to claims and see if this needs to be reprocessed or how we can break it up. Do you mind if I, um, I'm gonna place you on another brief hold and call them on the other line, OK?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh, but this is hospital indemnity, so I can't help him right now.
[AGENT][NEUTRAL] You know what,
[AGENT][NEUTRAL] It's [PII] here.
[AGENT][NEUTRAL] She's in a call.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I want.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] I'm sending this back to be reprocessed because
[AGENT][POSITIVE] You know what, I'm gonna send a hug.
[AGENT][NEUTRAL] Oh, why can't we just help him now? Wait a minute. OK, I'll send a hub for a call back or call the support line, but he didn't ask to speak to somebody else.
[AGENT][NEUTRAL] But I need help because do we need additional documents or was this just processed wrong? Did they not see [PII]'s name on the claim because
[AGENT][NEUTRAL] Looks like we're gonna need more informa more dogs because this patient number is the same and if they're two different, it'll be two different patient numbers on the.
[AGENT][NEUTRAL] That's the medical record number, so both kids have to have one.
[AGENT][NEGATIVE] So he sent to claim forms, but I need somebody from claims to tell me that's right, and I can't call them, [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so what are my options?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thanks again for holding. So what I'm gonna do, because I couldn't get anybody in the claims department, I'm gonna send them uh we call it a a request to give you a call back, um, so that they can look at these documents because I do see the claim form, I see where it says [PII] and I see where it says [PII] on the documents though, like the billing with all the dollar amounts and everything. I only see one patient number, so I don't know if that patient number was only for [PII] and that's why only Zoe was processed.
[AGENT][NEUTRAL] I'm gonna have claims look into all of this and give you a call back. Now, since it's Friday, they'll probably call you either today or Monday to let you know if they're gonna go ahead and reprocess this or if additional documents are needed for [PII].
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] Alright, um, and is the [PII] the best contact number for you?
[CUSTOMER][NEUTRAL] Yeah, do you know, uh, is it you guys calling me or BWA?
[AGENT][NEUTRAL] No, it'll be one of our, um, one of APL's claims examiners.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] Alright, so I'm gonna go ahead and get this together for you now and send it over to them. I'm gonna make it urgent, so hopefully it'll be today, but it's the turnaround is 24 to 48 hours.
[CUSTOMER][NEUTRAL] That that's fine, yeah, oh, I'm just wondering what's.
[CUSTOMER][NEUTRAL] What is happening through, you know, I'm just kind of, it just kind of add that I was paying $300 and I only got, you know, $50 out of the picture that I had, but I guess I didn't recognize that, so it was, I guess it was my fault, you know.
[AGENT][POSITIVE] Well, no, it's OK and that's what we're here for to, to make it clear and to assist.
[CUSTOMER][NEUTRAL] But uh,
[CUSTOMER][POSITIVE] Right. I appreciate you so much, ma'am. Thank you.
[AGENT][POSITIVE] You're very welcome. Well thank you for calling APL. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, thank you much.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.