AccountId: 011433970860
ContactId: 7f493efb-38b7-46a3-b4bb-57b2b6fff702
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1049739 ms
Total Talk Time (AGENT): 291664 ms
Total Talk Time (CUSTOMER): 495550 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/7f493efb-38b7-46a3-b4bb-57b2b6fff702_20250624T18:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Uh, yeah, I might have a claim in and they, I keep getting notices that they can't read it. But anyway, I've been dealing with them. I could be saying the wrong name, the name wrong. [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can somebody check into my status on what's going on? How come I haven't received checks?
[AGENT][POSITIVE] I can, yeah, I'm happy to check on a claim. Do we have a policy number? What do we have?
[CUSTOMER][NEUTRAL] I have no idea what you have. Um, can I give you my name?
[AGENT][POSITIVE] Yeah, absolutely. What's your first name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, thank you. And just to understand, you're checking on, is it a claim for yourself that was filed or?
[CUSTOMER][NEUTRAL] Yeah, yeah, so I was in an accident. I had insurance and for some reason, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I keep getting these letters in the mail. I think I got two checks or I got one check for $150 for $50 for 3 different people. There's outstanding checks that are big.
[CUSTOMER][NEUTRAL] For like, you know,
[CUSTOMER][NEUTRAL] Let me see what they're for.
[CUSTOMER][NEUTRAL] I think if you pull up my name you should be able to see everything.
[CUSTOMER][NEUTRAL] Uh, here we go. Let me see.
[CUSTOMER][NEUTRAL] A lot of them are, they're from Holy Redeemer Hospital. And she said she could and she wanted a um
[CUSTOMER][NEGATIVE] More itemized bill. Well, I talked to the, the hospital and they said that you as an insurance company, your company should know these codes, or they should be directing dealing directly with them. I don't know why I have to do all this work to make sure these bill that I'm gonna get paid for this stuff. So I guess I wanna know what the status is and what's going on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me find your policy here. Give me just a second.
[CUSTOMER][NEGATIVE] Yeah, I don't have that insurance anymore. I don't have your insurance anymore.
[AGENT][NEUTRAL] And your first name is [PII]
[CUSTOMER][NEUTRAL] I and and.
[CUSTOMER][NEUTRAL] Yeah, [PII] is the last name, [PII]
[AGENT][NEUTRAL] The information that's being sent to you, does it have claim numbers on it or anything like that?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] What do you mean the information of that? All I'm getting is a copy from your people saying, uh, so and so claim number is not covered. This one's not covered. This one's not covered. Can't read it's blurry.
[AGENT][NEUTRAL] OK, do you have any claim number on the sheet?
[CUSTOMER][NEUTRAL] The only claim number I have is the hospital claim number on the, the bill I have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you want that claim number?
[AGENT][NEUTRAL] No, that's not gonna pull up unfortunately on my side. What
[CUSTOMER][NEGATIVE] I, I don't understand
[CUSTOMER][NEGATIVE] But I don't understand is why you pull up my name and this should all come up. I should have some kind of file with your people.
[CUSTOMER][NEUTRAL] I don't, is there anything coming up at all?
[AGENT][NEUTRAL] What, what state do you live in, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Right, I've got you pulled up, I think here. I just need to verify your date of birth, please.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, give me just a second, let me pull this up and see.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] The plan that you had with us at the time was through, it looks like BWA. It's no longer an active medical plan. It ended back in [PII].
[AGENT][NEUTRAL] The recent information that I see on here, Holy Redeemer Health System is filing a claim from back in [PII] and so when they're
[CUSTOMER][NEUTRAL] Which I have insurance.
[CUSTOMER][NEUTRAL] I had insurance then correct with you?
[AGENT][NEUTRAL] It was active in on [PII] correct because it was effective in [PII]. So when they are sending the information to us, it's coming through and eligible any time that a claims filed on your policy on your behalf, an explanation of benefits is sent out to you and that's why you're getting that information.
[CUSTOMER][NEGATIVE] So what do we do to fix this? I, I'm so confused.
[CUSTOMER][NEUTRAL] I had insurance at the time of the accident.
[CUSTOMER][NEGATIVE] So I have a different insurance since then. So why aren't during that time I had your insurance, why are you not contacting Holy Redeemer, your company? Because the Holy Redeemer told me I they shouldn't be dealing with me.
[CUSTOMER][NEUTRAL] They you guys should be calling them.
[AGENT][NEUTRAL] Well, there's notification sent to Holy Redeemer that when they filed the claim that it was ineligible and that we were unable to read it, there is communication sent to them on an explanation of benefits to the provider, so that is explained to them.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Well, I just sent you, I just sent this Nina person, um, once again, uh, a printout of everything from Holy Redeemer.
[CUSTOMER][NEGATIVE] And I haven't, I did that last week and I did it today, still have not heard from her.
[CUSTOMER][NEUTRAL] So I don't unders[PII] what the thing is. That's the bill, that's all the little printouts, and I, you know, what do we do?
[AGENT][NEUTRAL] Who is [PII]?
[CUSTOMER][NEUTRAL] I just feel like this is a lot.
[AGENT][NEUTRAL] Does [PII] work for APL? Is that somebody that you've been speaking with? OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, well, I talked to her one time everything through email which is [PII]. She doesn't even return my, my, uh, thing. Her email is um.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I mean, it should show something in my form who I, who's been talking has to be her, [PII]
[AGENT][NEUTRAL] Well, cause you're, you're speaking with member services, which is not, that's not us.
[CUSTOMER][NEUTRAL] Well, why are member services handling this?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because the plan was taken out through Business workers association and they're the ones who manage the claims for that particular group.
[CUSTOMER][NEUTRAL] If you guys
[CUSTOMER][NEGATIVE] OK, so, so I, I just feel like I'm getting a run around. They can't help me, you can't help me, so who can help get these bills paid?
[AGENT][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] Because it's gonna be in August, it's gonna be 2 years since this accident.
[CUSTOMER][NEGATIVE] And we can't do anything, my lawyers and I, until this is done. Everything else I've settled except for this bill, and it's, it's very, very upsetting that I have to at least once a week reach out to your company to try to get through. I can never get through to anybody. Um, I sent email after email from to that other Nina girl and I get nowhere.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And according to Holy Redeemer, you got, um they, they, um, everything is being looked at on your end.
[CUSTOMER][NEUTRAL] But how long can it be looked at and who's looking at it? Is anybody really doing anything?
[CUSTOMER][NEUTRAL] You know, they told me at one time they needed more um.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, what's it called? Um.
[CUSTOMER][NEGATIVE] Oh jeez, my brain is gone um.
[CUSTOMER][NEGATIVE] They need to know exactly what these tests were for whatever, but the insurance company said you as an insurance company, your company should know what the different codes are.
[AGENT][NEUTRAL] Do you have a contact at the um provider, the Holy Redeemer Health System?
[AGENT][NEUTRAL] Anybody that you've talked to or?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] Yeah, I, um, see, I don't have a direct person because once again it's just like your company you gotta wait for somebody to call you back and let me see who, who I actually talked to. I have so many phone numbers here. I know who's who.
[CUSTOMER][NEUTRAL] Uh that uh let me just look at something.
[CUSTOMER][NEUTRAL] Um, let me look at something here, I believe.
[CUSTOMER][NEUTRAL] The number, there's 2 numbers here. Let me see um.
[CUSTOMER][NEUTRAL] I've got your number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There is another number [PII] so I don't know I think it was the [PII] number that I called.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes it was.
[AGENT][NEUTRAL] Hm, yeah, I mean, I pulled up what they sent and it's, you can't, you can't make any of it out. So, I mean, what I can try and do, Dina.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, well, so let me
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let me ask you a question. Can I, can I send it to you when I have? Because mine is spelled out clear as, uh, let me just look at something. Hold on one second, um.
[CUSTOMER][NEUTRAL] Oh, where the heck is it? Um, I'm sorry.
[CUSTOMER][NEUTRAL] Uh, I can't think, um.
[CUSTOMER][NEUTRAL] I have about that.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Hello, are you still there? Sorry.
[AGENT][NEUTRAL] Uh-huh, yeah.
[CUSTOMER][NEUTRAL] OK, um, I'm just looking at something here.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII], what's the thing that I want to tell you?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm looking at my photos. I think it's here.
[CUSTOMER][NEGATIVE] Why can I not find this phone for you that I can see here now that's not it.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] That sent to me.
[CUSTOMER][NEUTRAL] OK, let me see this. Can I send this? Let me see if I can send this directly to you. Um, so what should I send it as mail or an email?
[AGENT][NEUTRAL] Well, we unfortunately can't get any information via email. We don't accept claim information that way. So if you want.
[AGENT][NEUTRAL] Yeah, it can only be done online or fax, but I think
[AGENT][NEUTRAL] Your only option at this.
[CUSTOMER][NEUTRAL] OK, can you give me a
[AGENT][POSITIVE] Yeah, I can give you a fax number.
[CUSTOMER][NEUTRAL] Can I, can my lawyer, can my lawyer fax it to you because I don't have a fax machine.
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] OK, so what's your fax number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII] and you just mark attention claims.
[CUSTOMER][NEUTRAL] Twain.
[CUSTOMER][NEUTRAL] OK, don't directed at anybody special or?
[AGENT][NEUTRAL] Uh, just, yeah, no claims department.
[CUSTOMER][NEGATIVE] Yeah, I just feel like we send that and we're still not gonna get anywhere.
[CUSTOMER][NEGATIVE] You know, I just, uh, I just don't understand why.
[CUSTOMER][NEUTRAL] You know, it's, I don't know.
[CUSTOMER][NEUTRAL] And this is APL, right?
[AGENT][NEUTRAL] Mhm. 2 APL, yeah.
[AGENT][NEUTRAL] I mean, I did pull up, do you know what they had sent over and what was sent and you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEGATIVE] Can't make out any of the codes on it. I don't know why it came over the way it did, but I didn't, I mean, it is in fact ineligible.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] So here's what I I'm confused about how did I send that before that was an email.
[AGENT][NEUTRAL] Well again when you're speaking with [PII] that's over at member services with Business Workers Association so they're the ones that were offering you the plan and they were the ones terminating the plan making any changes, all of that.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So you, it was going through them and then coming to us and being processed. So that's why when you had said [PII], I didn't even know who that was because she works for Business Workers of America. She doesn't work for APL.
[CUSTOMER][NEUTRAL] So what, so I'm sending this to her again. This is the 3rd time I'm writing down. Please forward this bill to who should she be forwarding it to?
[CUSTOMER][NEUTRAL] Claims
[AGENT][NEUTRAL] Yeah, I mean, it goes to claims. I can give you the claim number that I have on my side also if you want that.
[CUSTOMER][NEUTRAL] OK my claim number.
[AGENT][NEUTRAL] 361.
[CUSTOMER][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Uh oops sorry, 361.
[AGENT][NEUTRAL] 635 7.
[CUSTOMER][NEUTRAL] Is it? OK.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I mean, I just, you know, I, I don't, I don't even know why she was handling it to begin with, you know, she's not the one who's gonna act, you know, I, I don't get it. I don't know.
[CUSTOMER][NEUTRAL] OK, well, I'm gonna have my lawyer fax this over to you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and uh.
[AGENT][NEUTRAL] Do you
[AGENT][POSITIVE] Yeah, absolutely. Do you need me to check on anything else or?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No, I just, you know, I wish you could reach out to the Mina and that's for, you know, member services to find out what's going on.
[AGENT][NEUTRAL] I mean I could call her I don't know do you have a number for her or just the email?
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEGATIVE] I don't even have her number now.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I mean, I have a contact number for them, but it's just an [PII] number.
[AGENT][NEUTRAL] Probably the same number you have.
[CUSTOMER][NEUTRAL] Oh, yeah.
[CUSTOMER][NEGATIVE] Yeah, you can't get anywhere.
[CUSTOMER][NEUTRAL] Yeah, so I just sent it to her again.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEGATIVE] I mean, this is, you know, it's gonna be 2 years. And like my lawyer said, they won't, they won't talk to her. I talked to the Holy Redeemer, they said that they should be contacting, you know, you guys should be working together. And I just feel like, I think it's in the wrong hands. I don't think the Mina lady should be handling it because nothing is getting done. I understand she can't read it. So I sent it to her over and over and over again. When is she going to get back to me?
[AGENT][NEUTRAL] Yeah, I don't know. Yeah.
[CUSTOMER][NEUTRAL] You know, it just feels like that's what I mean and I don't think this is right. It, it, it's, you know, so if you're in the claims department, you know, um, we'll fax this over to the claims department and see what happens, OK?
[AGENT][NEUTRAL] OK, sounds good, [PII]. I'll notate our conversation.
[CUSTOMER][POSITIVE] All right, thank you very much bye now.
[AGENT][POSITIVE] My pleasure. Bye-bye.