AccountId: 011433970860
ContactId: 54597f1f-79df-4973-bc6c-fa1afc27e2cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 838369 ms
Total Talk Time (AGENT): 523430 ms
Total Talk Time (CUSTOMER): 203946 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/54597f1f-79df-4973-bc6c-fa1afc27e2cc_20250617T12:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, good morning [PII], how are you doing?
[AGENT][POSITIVE] I'm good and yourself?
[CUSTOMER][POSITIVE] Pretty good.
[CUSTOMER][NEGATIVE] are confused.
[AGENT][POSITIVE] I'm so sorry. What did you say?
[CUSTOMER][NEUTRAL] I received the
[CUSTOMER][NEUTRAL] Confused, confused. Can you hear me? I'm reaching this off.
[AGENT][NEGATIVE] You're confused.
[CUSTOMER][NEUTRAL] Just 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I have received an invoice from APL.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's not a bill like an invoice, but I was never admitted to any hospital at all in my lifetime at all.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] OK, so you've received.
[CUSTOMER][NEGATIVE] I don't know why I received this.
[AGENT][NEUTRAL] OK, so when you say a bill, is it like, are you talking about an explanation of benefits?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. And so you said this is like, it's showing that you were hospitalized. that we process the claim for you being in the hospital, but you've never been. Is that correct?
[CUSTOMER][POSITIVE] That is correct. This is the 2nd 1 I received.
[AGENT][POSITIVE] OK, yes, well I'll be happy to look at that for you and see if I can help you with this. So who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you, Mr. [PII]. What is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what is your policy number, please? It should be on that explanation of benefits.
[AGENT][NEUTRAL] If
[CUSTOMER][NEUTRAL] HR.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Like what?
[CUSTOMER][NEUTRAL] I'm sorry, go ahead, ma'am.
[AGENT][NEUTRAL] What is your policy number?
[CUSTOMER][NEUTRAL] Uh, the number you have here is 02.
[CUSTOMER][NEUTRAL] 501263
[AGENT][NEUTRAL] OK, Mr. [PII], thank you. Give me a moment to get this information pulled up. Once I get your your information pulled up, I will have to verify some things with you first for security purposes and also any information that is provided would be a verification of benefits and not a guarantee of payment. So first off, um, Mr. [PII], if you could please verify, excuse me, verify your date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, also your home mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and your zip code?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you and the phone number that we have on file for you is different than the one you gave me. What is another phone number we could have for you?
[CUSTOMER][NEUTRAL] There isn't anymore. That's it.
[CUSTOMER][NEUTRAL] I, I would need a phone number.
[AGENT][NEUTRAL] So just a moment.
[AGENT][NEUTRAL] And you said your correct phone number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Now, I can see that there's someone else on this policy with you. Would it by chance be their phone number that we have because it's definitely not what you gave me.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so we'll just, we'll come back to that. What is your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So what I'm gonna recommend is that you get with your HR department because we have a completely different number for you ending in [PII].
[AGENT][NEUTRAL] So I will remove that, but because of the.
[CUSTOMER][NEUTRAL] That phone number has been that same been that's my old old number back in [PII].
[AGENT][NEUTRAL] OK. Well, they still have that on file for you and that's what we received for your enrollment. Yeah, that's what, um,
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] So yeah, you will need to most definitely get that updated with them because if they, if that comes over on our file for the enrollments for your employer, it's gonna override my change and put that number back in the system.
[CUSTOMER][NEGATIVE] I shouldn't be.
[CUSTOMER][NEGATIVE] That's not good. I'll talk to him as soon as I can.
[AGENT][NEUTRAL] So just, yeah, so just make sure they get that updated for you, OK, so the is the claim for you, Mr. [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, for me.
[AGENT][NEUTRAL] OK, so let me just give me a moment.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Oh, so I, I'm gonna let you know that just recently, your phone number changed from
[AGENT][NEUTRAL] From your phone number that you gave me, the [PII] back to that [PII] because that's what that's what had the file has on it and it's overriding the change.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so just a moment.
[CUSTOMER][POSITIVE] I got you.
[AGENT][NEUTRAL] OK, and what is the claim number that you received the claim on, uh, it has a claim number on that explanation of benefits.
[CUSTOMER][NEUTRAL] 360.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2645
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, Mr. [PII], so that claim we we received a claim for you with this policy, I mean, uh, yes, with this policy number from Plantation.
[AGENT][NEUTRAL] General Hospital. I see that you had also called before about this.
[AGENT][NEUTRAL] Because this shows
[CUSTOMER][NEUTRAL] Yeah, this is the same plan I got.
[AGENT][NEUTRAL] Right. And did you reach, uh, and I can see that we advise you to contact your primary insurance and plantation Hospital.
[CUSTOMER][NEUTRAL] I did both. Yep, I keep getting a runaround.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I can't get no help from anybody.
[AGENT][NEGATIVE] Now, on this claim for us, I can see that it was denied.
[AGENT][NEUTRAL] Um, and the reason for the denial.
[AGENT][NEUTRAL] Let me read that. Well, if it, it's on your explanation of benefits also just so you know, Mr. [PII], on page 2, receipt of your claim is acknowledged. OK.
[CUSTOMER][NEUTRAL] Yeah, I read the whole thing on the back. Yeah, I read the whole thing. I don't know. My question is, why was the claim filed if I've never been to this hospital, I was never hospitalized. I've never had anything done to me. That's my question.
[AGENT][NEUTRAL] So I don't know if they just.
[AGENT][NEUTRAL] Yes, sir. Right. Well, I can't, I'm so sorry, but unfortunately, I would not, because they are the ones that file that with your, did they also file it with your primary insurance? Do you know?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] I don't have this. I don't know who this insurance company is. I don't have this insurance.
[AGENT][NEUTRAL] What insurance?
[CUSTOMER][NEUTRAL] That's, that's that United Health where they they claimed it.
[AGENT][NEUTRAL] OK. So you need, OK, so you're not, if your primary insurance is not.
[AGENT][NEUTRAL] United Healthcare, you're gonna need to contact them as well because it looks like they did pay on that claim and I can see that when you call back in April, we explain that to you. If they paid on it, you need to request a copy of, you know, your information, that information be sent to you, but first, you would need to reach out to the hospital and explain that you've never been there.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And you're and find out what happened on their end, how they even came to file that.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah, this is the 2nd time I got this once for $100,000 and now for $30,000.
[AGENT][NEUTRAL] Yes, sir. So I don't know if maybe they just obviously got a number wrong uh uh in, in filing everything, but yes, sir. I mean,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It started with plantation because they would have had to file the claims with.
[AGENT][NEUTRAL] The United Healthcare and then with APL.
[CUSTOMER][NEGATIVE] And they keep getting around. They tell me, no, you gotta call APL to get straight. I don't know where the heck I'm gonna go now. HR tells the same thing.
[CUSTOMER][NEUTRAL] You gotta go through APL. They're gonna send you the um the notice.
[AGENT][NEUTRAL] We sent a notice because the hot.
[CUSTOMER][NEUTRAL] I'm just doing, I'm playing on the tennis ball going back and forth.
[AGENT][NEUTRAL] OK. So I'm, I'm just trying to explain the process. The hospital is what is the, is who initiated everything.
[CUSTOMER][NEUTRAL] Yeah, yeah, I understand, I understand.
[AGENT][NEUTRAL] It started with that hospital.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then they filed claims with United Healthcare and with APL.
[CUSTOMER][NEUTRAL] I'm kind of confused. If a hospital's gonna file a claim, won't they make for sure for sure that their person that they are seeing are properly identified?
[CUSTOMER][NEUTRAL] With ID or something.
[AGENT][NEUTRAL] Uh, yes, so they should with your ID cards and for your
[CUSTOMER][NEUTRAL] That is that and a photo ID.
[AGENT][NEUTRAL] Yeah, with your primary health care insurance card. And for you didn't have, I mean, I'm asking you some personal questions, but you haven't had your wallet stolen or any kind of, yeah, you haven't had any type of identity theft that you were aware of like a lost wallet or compromise.
[CUSTOMER][NEUTRAL] No, that's fine, that's fine. I'm just trying to get this figured out.
[CUSTOMER][NEGATIVE] None, none at all, none at all. I checked my, my driver's license at DMV that was compromised. My Social security was never compromised.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] My all my credit cards not compromised at all, so I'm trying to figure out how the heck this happened. That's what I'm confused about.
[AGENT][NEUTRAL] Yes, sir. And since Plantation Hospital.
[CUSTOMER][NEUTRAL] That's not the conclusion.
[AGENT][NEUTRAL] Their billing department is who initiated it all.
[AGENT][NEUTRAL] So they need to provide you with a copy of their
[CUSTOMER][NEGATIVE] And they're garbage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, you know, of what they show on file for you because it sounds like they just some somewhere in error had your information.
[AGENT][POSITIVE] Well, they definitely had your information.
[CUSTOMER][NEUTRAL] And half I've never been to.
[AGENT][NEUTRAL] Uh yes, sir. I.
[CUSTOMER][NEGATIVE] I've never been in a hospital. Let me go yell out to them again.
[AGENT][POSITIVE] I'm I'm so sorry that you're going through this cause yeah, I can say, you know, we talked to you before and uh I've even, I even spoke to you as well back in April, Mr. [PII]. I remember this conversation.
[CUSTOMER][NEUTRAL] Oh, you're the one? OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, I'm one of the people. I talked to you and then you called and talked to call back and talk to someone else again because in my note, it does state.
[CUSTOMER][NEUTRAL] I thought I recognized that voice.
[AGENT][NEUTRAL] That we received that explanation of benefits from UnitedHealthcare.
[AGENT][NEUTRAL] Um, now, on the
[CUSTOMER][NEGATIVE] I don't know why now I got 2 invoices, 2 different values on them.
[AGENT][NEUTRAL] Now, as I told, as I explained to you what we've received.
[AGENT][NEUTRAL] You know, it had a different number on it.
[AGENT][NEUTRAL] The EOB from UHC from UnitedHealthcare, and your member number on your ID card were not the same.
[AGENT][NEUTRAL] So that's why we didn't pay it.
[AGENT][NEUTRAL] But it started with plantation.
[CUSTOMER][NEUTRAL] OK, I gotta go back to plantation as well.
[AGENT][NEUTRAL] Yes, it, it started there and you need to ask for them to
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] You know.
[AGENT][NEUTRAL] Correct that, but
[CUSTOMER][POSITIVE] What's going on, for sure, for sure. OK.
[AGENT][NEUTRAL] Right. Yes, sir.
[AGENT][NEUTRAL] OK, and then.
[CUSTOMER][POSITIVE] No worries. Well, thanks for all your help. I really appreciate it.
[AGENT][NEUTRAL] Oh, well, you're welcome. And then one last thing, Mr. [PII], have you ever set up your profile in our portal called the online service center so you can also see this information online.
[CUSTOMER][NEUTRAL] No, not yet, but I guess I should.
[AGENT][NEUTRAL] Do you remember doing that?
[AGENT][POSITIVE] OK, what I'll do is um if you'll give me just a few minutes, I will be happy to email you some user guides that explains how to set up your profile and then also um.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] How to use it, it'll be two separate user guides and the email that you're gonna receive from me will come from [PII].
[AGENT][NEUTRAL] And I will put APL in your subject line so that that's easy for you to recognize.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A and I get home.
[AGENT][NEUTRAL] I'm sorry, I couldn't, I couldn't understand you on that last part.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] But I can chase here when I get home because I'm at work right now. That'd be great.
[AGENT][NEUTRAL] Oh, OK. Well, that'll be fine, but yeah, so you could look for it, you know, around this time of the morning in your emails, and you should see it. If you don't see it in your regular inbox, uh, I would check your junk or spam folder if we've not emailed you something before. Cause it might would go there. I don't really think it will, but anyway. So is there anything else that I can help you with this morning, Mr. [PII]?
[CUSTOMER][POSITIVE] Most definitely.
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] OK. All right. Well, good luck in getting this issue resolved and uh if that is all that I can help you with this morning, it was nice speaking with you and I hope that you have a wonderful day.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][POSITIVE] Thank you as well.
[AGENT][POSITIVE] Yes, sir. Thank you so much. Uh-huh, thank you too. Bye-bye.
[CUSTOMER][POSITIVE] We likely thank you bye bye.