AccountId: 011433970860
ContactId: 6987d1d1-7e8d-415a-b259-8a038e686ce6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1660060 ms
Total Talk Time (AGENT): 556430 ms
Total Talk Time (CUSTOMER): 392363 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/6987d1d1-7e8d-415a-b259-8a038e686ce6_20250320T17:32_UTC.wav
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[CUSTOMER][POSITIVE] If you don't mind, we can actually do it.
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, can you hear me?
[CUSTOMER][NEUTRAL] I, I can barely, but let me see if I can get some more, OK.
[AGENT][NEUTRAL] Let's see, is that better?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][POSITIVE] OK, good. OK.
[AGENT][NEUTRAL] OK, how can I help you?
[CUSTOMER][NEUTRAL] Um, I wanted to check and see, uh, on a claim that I have. I don't know how long processing takes or, uh, when you know if it's approved or not reimbursement for, um, some medical, um.
[CUSTOMER][NEUTRAL] Um, issue.
[AGENT][NEUTRAL] OK, um, and is it for yourself?
[CUSTOMER][NEUTRAL] Uh, it was for my husband.
[AGENT][NEUTRAL] OK. Um, do you have the policy holder? Is that you or your husband?
[CUSTOMER][NEUTRAL] I'm the policy holder, [PII] [PII], last name is [PII].
[AGENT][NEUTRAL] And do you have your policy number handy?
[CUSTOMER][NEUTRAL] I don't. I thought it was on this.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's OK. I'll look it up.
[AGENT][NEUTRAL] And [PII] was the last name?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And I go by Brown hyphen [PII], but I don't know if they use the hyphen or not.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] or contestant for returning jobs coworkers at Shanice and Marina.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, what kind of policy was that for? Do you remember? or are you, do you currently have it? OK, OK.
[CUSTOMER][NEUTRAL] It uh-huh, yes.
[CUSTOMER][NEGATIVE] It's a it's a cancer and uh cancer heart attack.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Bear with me just one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] I'm having trouble pulling it up. What about, um, could you provide your um social for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, um, I'm sorry. Will you repeat that? I'm so sorry.
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, let me get this pulled and you said it was for your spouse.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Yes, uh-huh, [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Let me see and what date of service was that?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] You mean when the when he had the heart attack I guess I should have had my paperwork out um.
[AGENT][NEUTRAL] Uh, well, what
[CUSTOMER][NEUTRAL] It was in [PII].
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] if I can find that.
[AGENT][NEUTRAL] Do you have his date of birth?
[CUSTOMER][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then can you verify your um home address for me please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And then [PII], what's a good uh telephone.
[AGENT][NEUTRAL] Number for you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK and then last thing would be your email address.
[CUSTOMER][NEUTRAL] I'm sorry, say it again now.
[AGENT][NEUTRAL] Uh, your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I think it might be a work email. Do you know what that one might be?
[CUSTOMER][NEUTRAL] I'm sorry, what the email address is um that you all have on file?
[AGENT][NEUTRAL] Yes, the one we have on file looks like it might be a work, uh, email address.
[CUSTOMER][NEUTRAL] Oh then if it's work it's [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying everything.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK and so the
[AGENT][NEUTRAL] Claim for your spouse, let's look and see.
[AGENT][NEUTRAL] So you did file a claim for him, is that correct?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] Do you know when you filed that?
[CUSTOMER][NEUTRAL] Um, I, I got a letter from you all saying it was received on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Let me pull up and see where our correspond it is I.
[AGENT][NEUTRAL] Don't show it's been processed yet, so let me see what's happening.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, do you mind if I place you on a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Could I put you on a brief hold, please?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] OK, hold on one moment. Thank you.
[CUSTOMER][NEUTRAL] You're welcome. You are on hold.
[AGENT][NEGATIVE] Oh shit.
[AGENT][NEUTRAL] Hi
[AGENT][NEUTRAL] I'm trying to find, she said she got a letter on a claim for her spouse, but I don't see.
[AGENT][NEUTRAL] I don't see anything.
[AGENT][NEUTRAL] 25
[AGENT][NEUTRAL] 535,610.
[AGENT][NEUTRAL] She and I verified everything but.
[AGENT][NEUTRAL] I thought I'd try to help her with the claim status if I'm not getting any PHI but I don't see.
[AGENT][NEUTRAL] Yeah, for [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Darn it.
[AGENT][NEUTRAL] No, she just said that she got a letter from.
[AGENT][NEUTRAL] It's [PII]. Would it reference the date of service on it?
[AGENT][NEUTRAL] I guess I should ask her that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I see that.
[AGENT][NEUTRAL] Let me look up that
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah, I don't see anything either on the new policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can I just keep you on?
[AGENT][NEGATIVE] Or will that, will that disrupt us? I, oh hell, now I'm confused. Can I just resume the call with her?
[AGENT][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] OK, thank you for holding. Does what does the letter say? Does the letter, what is it regarding?
[CUSTOMER][NEUTRAL] Sure, uh-huh.
[CUSTOMER][NEUTRAL] It says it says uh oops I'm sorry, hold on.
[CUSTOMER][NEUTRAL] Uh, it says we received a claim on your policy.
[CUSTOMER][NEUTRAL] And a review of the claim has started. In some cases additional information must be must be requested from you or your provider of medical services for the claim to be processed. We'll contact you if more information is needed. Thank you for trusting APL with your insurance needs, as always, feel free to contact us with any questions or concerns sincerely claims department.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm trying to figure out. I don't see a claim on file, but there's another place that I can check so if you, if you'll just bear with me, I'm so sorry, thank you for your patience, um.
[CUSTOMER][NEUTRAL] It seems
[CUSTOMER][NEUTRAL] And it and it and it seems like when I when I called on this initially they gave me a different policy number they said this is the policy number that this claim is under which is different from the current policy.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, what policy number did they give you? Do you have that available?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, cause that, I was at work when I, when I looked that up. It just seems like I remember uh them saying that.
[AGENT][POSITIVE] Oh, OK, no worries.
[AGENT][NEUTRAL] Sure. OK.
[AGENT][NEUTRAL] Um, give me one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So do I just tell her the claims in process and it's being reviewed?
[AGENT][NEUTRAL] Well, that's what's weird. I don't, I mean.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Because it should pull up an on base right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Why am I? I'm getting weird ones.
[AGENT][NEUTRAL] 128
[AGENT][NEUTRAL] 9262
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Maybe I could check that. Let me ask her real quick.
[AGENT][NEUTRAL] OK, thank you for holding sorry this is taking so long. um, does your husband by chance have a policy under his own name or is this just strictly under your name? He doesn't? OK, OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] It's strictly under mine now I did get, uh, I did get uh a letter from, from you all, uh telling me that uh the policy was portable and asking if I wanted uh uh uh they gave me a option uh you know to uh for a plan, and they have a certain number I don't know if that what if that means anything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, if that's considered a.
[AGENT][POSITIVE] Yeah, you, you can go, yeah, go ahead and give that one to me.
[CUSTOMER][NEUTRAL] Uh, OK, so.
[CUSTOMER][NEUTRAL] It's 02535610.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I see that one, but I don't see a claim on file so let me, if you don't, I'm so sorry, but if you don't mind, if you can hold just one more moment, I'm gonna see if I can find it somewhere else. OK, thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] OK, I see that and so we're paying $50 to her.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] Claim information received but could be processed any additional information to complete. I don't know what that means.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We need additional information please submit the follow.
[AGENT][NEUTRAL] an itemized bill with procedure codes, dates of service, and charge amounts and itemized surgery bill with.
[AGENT][NEUTRAL] Um, the cardio
[AGENT][NEUTRAL] I'll let you notes test. So do I read her all of this information?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Where is my deal at?
[AGENT][POSITIVE] Yeah that makes sense. OK, OK.
[AGENT][NEUTRAL] All right bye.
[AGENT][POSITIVE] OK, thank you so much for holding. I figured I figured out what's happened so we've got, we did receive a claim, OK, um, it looks like we did make a payment of $50 so you should be receiving that shortly, but there are two other.
[CUSTOMER][NEUTRAL] Uh-huh, sure.
[AGENT][NEUTRAL] Charges on here um that we need additional information on.
[AGENT][NEUTRAL] Looks like.
[AGENT][NEUTRAL] We need um an itemized bill with procedure codes, date of service and charge amounts or the itemized surgery bill with procedure codes.
[AGENT][NEUTRAL] Date of service and charge amounts.
[AGENT][NEUTRAL] Um, also, what could work is the cardiologist notes, test results from EKGs, ECGs, MRI's.
[AGENT][NEUTRAL] Um, so that's, that's for the, um, go back and see what charge that's for.
[AGENT][NEUTRAL] Can't let's see
[AGENT][NEUTRAL] We did pay the $50 for a preventative service.
[AGENT][NEUTRAL] And then the other two things that were submitted, that's what we needed that additional information.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I haven't, did they send something to me or they sent that to the doctor?
[AGENT][NEUTRAL] Uh, no, that you, you submitted this correct for yourself on the, on the, OK, yeah.
[CUSTOMER][NEUTRAL] Yes, I said, yeah, I got, I got all the, all of his medical reports from the doctor, and, and it included EKGs and all of that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you did? OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Um, yeah, they will be sending that directly to you along with that $50 payment. There'll be correspondence that explains exactly what's still needed.
[AGENT][NEUTRAL] So, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then one there's, it looks like there's 3 charges submitted one was paid for the $50 and then the other 21 was non-covered and then the other one.
[AGENT][NEUTRAL] Was one that we needed that additional information that I just mentioned.
[AGENT][NEUTRAL] And you'll you'll be receiving that.
[CUSTOMER][NEUTRAL] OK, and what was.
[CUSTOMER][NEUTRAL] And what was the, does it show the dollar amount of that one because I haven't.
[CUSTOMER][NEUTRAL] Looked at this in a while.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Let me pull that up real.
[AGENT][NEUTRAL] Um, let's see it was.
[AGENT][NEUTRAL] Um, we actually, let's see, hold on one moment, let me check something if you don't mind.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Are you there?
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, because if she's.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] If she's saying OK if she's saying she submitted all that though, what do I do then?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, OK, OK, perfect, I'll do that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, OK, perfect. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, I'm so sorry about that, just trying to get clarification, yeah.
[CUSTOMER][NEUTRAL] Uh-huh, sure.
[AGENT][NEUTRAL] So it, it appears we did receive everything you submitted, but from what we've submitted we still are needing additional information, um, and you will be receiving this EOB that says this the explanation that.
[AGENT][NEUTRAL] Is what I'm gonna read verbatim as well so we don't have the itemized bill with procedure codes, dates of service and charge amounts.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now that needs to include specific diagnosis codes and procedure codes and that's what's missing um so we we can do there's itemized surgery bill with procedure codes, dates of service and charge amounts, there's the hospital admission and discharge summary.
[AGENT][NEUTRAL] And then the hospital history and physical.
[AGENT][NEUTRAL] Cardiologist notes, test results, and then CTs for test results which.
[AGENT][NEUTRAL] Gonna comprised of EKGs, ECGs, MRI CTs for hospital admission, so it, it appears we're missing some of those critical pieces, the procedure codes and the um diagnosis codes.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so it's the codes that you're missing.
[AGENT][NEUTRAL] Yeah, yeah, it's the codes, but you'll be in receipt of that explanation of benefits that way you can call your healthcare provider and read off that information that way they know exactly.
[AGENT][NEUTRAL] What they need to provide to you.
[CUSTOMER][NEUTRAL] OK, that is that is that the doctor's office or the hospital?
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Which, which, which
[AGENT][NEUTRAL] It would be for both.
[AGENT][NEUTRAL] So because I believe did you submit whatever you submitted if it was a hospital claim then you.
[AGENT][NEUTRAL] You would need to contact the hospital.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK. So it'll come from the, from the medical insurance side.
[CUSTOMER][NEUTRAL] With the, the uh like the uh um like the EOB.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, the EOBs though, a lot of the times they don't have that specific information, so you'll actually have to call the hospital and request specifically the diagnosis and procedure codes, yeah, so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm just trying to see where I, I, I would go to get the information that they need.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, medical records for the hospital, they should be able to just be sure and be real specific.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] With them that way they get you what you need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right. Then I'll wait for, and you said I should get a, a letter from you all, it's saying all that.
[AGENT][POSITIVE] Yes, it's in, it's en route right now to you, so you should get that um hopefully in the next couple business days and then from there you can contact the hospital for what we specifically need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what is, what is, what, what is, what am I, what's being paid out from uh from all the essentials.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] Right now, based on what we've received, we've been able to pay out $50 for a preventative service, so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's what we've paid out on this claim, but potentially we could pay out more if we receive the requested information.
[CUSTOMER][NEUTRAL] OK, alright, OK, um, I'll wait to get the letter so I can see what I need to do.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] OK, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, I, I was just checking on that and uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, and uh because my husband's deceased at this point but uh uh but I so I was trying to get the uh get the uh plane settled. OK, thank you for your help I appreciate it.
[AGENT][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] OK, OK.
[AGENT][POSITIVE] OK, thank you for calling APL you too thank you bye.
[CUSTOMER][POSITIVE] All right. Have a good day.
[CUSTOMER][NEUTRAL] All right. All right. Bye-bye.