AccountId: 011433970860
ContactId: 86689bb0-1dc0-40d4-a112-6cfffad82f41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 772299 ms
Total Talk Time (AGENT): 292526 ms
Total Talk Time (CUSTOMER): 454209 ms
Interruptions: 8
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/86689bb0-1dc0-40d4-a112-6cfffad82f41_20250115T17:23_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, I'm but I'm calling pertaining to a, a um a medical bill that I received from you all yes uh yesterday the American Public Life Insurance Company.
[AGENT][NEUTRAL] OK, is it, mhm, go ahead.
[CUSTOMER][NEUTRAL] And, and, uh,
[CUSTOMER][NEUTRAL] Pardon?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I, I got a claim number on it and.
[CUSTOMER][NEUTRAL] Oh, and so forth, you know.
[AGENT][NEUTRAL] OK, so it's an explanation of benefits. It says this is not a bill on the top.
[CUSTOMER][NEUTRAL] And they, they, the university, university position and they said non-covered, you know.
[AGENT][NEUTRAL] OK. Um, let me have the uh reference number that is on that claim.
[CUSTOMER][NEUTRAL] OK, do you want to pull it up? I got a number, claim number.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It's 354 8.
[CUSTOMER][NEUTRAL] 055.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK, uh, [PII]
[CUSTOMER][NEUTRAL] And this is the phone uh I'm uh my cell phone number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My house number is one.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you said the area code is 141?
[CUSTOMER][NEUTRAL] They said they, they got on here a universal position they had 4 if you pull this form up and look at non-covered service, noncover service, uh, and, and, and, uh, I'm really, you know.
[CUSTOMER][NEUTRAL] Because when they, uh, it, it, it the, uh, it is a case of cancer. So they, the, the, this is why we find that with them. I've been a member, uh, I joined uh um American public like years and years ago and the first time we had to use it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They got paid 000 4 times.
[AGENT][NEUTRAL] OK, let me see why. Um, may I have your date of birth, a mailing address on file, and an email address?
[CUSTOMER][NEUTRAL] OK, um, my, my date of birth is 2nd month.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what's the mailing address?
[CUSTOMER][POSITIVE] Now they claim that uh that was my wife [PII] S love if you can do this phone, they sent me uh [PII] S love, you see what I'm talking about.
[AGENT][NEUTRAL] Mhm. Yes, um,
[CUSTOMER][NEUTRAL] She was the claim claimant.
[AGENT][NEUTRAL] Mhm. OK. Uh, can you verify the mailing address for me, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes, it's [PII] uh uh that uh zip code is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you, Mr. [PII]. And OK, so you said that um they, they found cancer and this is a cancer claim for Miss [PII], correct?
[CUSTOMER][POSITIVE] Yes, uh, yes, yes, yes, yes.
[AGENT][NEUTRAL] OK, alright, alright, so let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so what we received on this particular claim that we sent a denial is some charges for a lab work or diagnostic testing, and those are not covered under the policy.
[CUSTOMER][NEUTRAL] Well, no, no, no, but.
[CUSTOMER][NEUTRAL] So, let me just tell you what they did and they may have to send a woman she had uh they did a mastectomy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. And the paperwork we received was for lab tests and diagnostic tests, so it was not for the surgery. We're gonna
[CUSTOMER][NEUTRAL] Yeah, there's no way that that they told me, they told me I had them to send because I talked to somebody before and they told me they needed uh uh uh uh you know, results from the lab and what have you, and that was sent to you all, you know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] That's what I, uh, uh, because I questioned these before and they told me that, uh, I needed to, so I called it later and got them just saying that, uh, you should have a the results of the a lab test. One reason they did the mastectomy, they were hoping they're hoping that they uh maybe got all of it, you know.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hello, ma'am.
[AGENT][NEUTRAL] Yes, I'm here, one moment, um.
[CUSTOMER][NEUTRAL] No, I, I, I, I haven't had this in human for, for, uh, for years.
[CUSTOMER][POSITIVE] And they told me back during that time that I've never had to use it. This is the first time I've used it.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yeah, it looks like Miss, Miss [PII] has used it in the past, but it looks like um let me check because the
[CUSTOMER][NEUTRAL] I've been, I've been a part of it for America for over 20 years.
[AGENT][NEUTRAL] Mhm. Mhm. Yes, and, and we're trying to see what's covered because not everything is, uh-huh.
[CUSTOMER][NEGATIVE] I see, I get, I can't.
[AGENT][NEUTRAL] Yeah, bear with me. Not everything is covered under the policy and based on this last claim, um, the policy doesn't cover lab work. So this right here, universal physicians, the charges that were submitted was for lab work and lab work doesn't cover, it's not covered under the policy, Mr. [PII].
[CUSTOMER][NEGATIVE] But that's what they told me. They told me to submit. They were like, I, whoever I told, they told me to submit but now you need to contact, they need to contact them and see exactly, uh, you know, uh, uh, they bother and they they now they probably supposed to have covered when I took it out.
[CUSTOMER][NEUTRAL] In the work of a physician, lab work, hospital, they would, uh, you know, uh, all of it was, you know, and this is the first time I haven't used it.
[AGENT][NEUTRAL] Mhm. Um, what I can do, Mr. Love is to get a, uh, an examiner, um, the claims department to call you and explain to you, um, why they decided to not pay that portion of it. Um, the only thing I can tell you is based on the benefits of the policy, lab work is not covered, um, but other than that, that's all the information I can give you because that's what I see on the policy.
[CUSTOMER][NEGATIVE] But now, now, now, why would they tell me, why did they tell me that now this is not, shouldn't bela they said position, university position and I have, if you got this form I have 4.
[CUSTOMER][NEGATIVE] Uh, poor thing that put him out here and he said I'm not, not getting nothing.
[CUSTOMER][NEGATIVE] How, how you, how can that not be coming and you know you, you're, you're ill and you go to the doctor.
[AGENT][NEUTRAL] Yeah, the
[CUSTOMER][NEUTRAL] First of all, that, that, that they, they gonna have to be diagnosed, you know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What it is, so what?
[AGENT][NEUTRAL] Yeah, I unders
[CUSTOMER][NEUTRAL] We were not, I, I did not, uh, uh, I was not told us in the beginning, you know.
[AGENT][NEUTRAL] OK, yeah, the policy has a certificate where it shows what's covered and what's not covered and uh part of the non-cover service is lab, lab work is not covered. Physicians, um.
[CUSTOMER][NEUTRAL] OK, well then, no, no, no, no, no, they don't have bad working. They have um a deposition on this form here, university position, university position.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] That's the name. That's, that's the name of the place that you had the service done. University physician is the, is the, the.
[CUSTOMER][NEUTRAL] That's right. That, that's where we got the service from the Universal Hospital in [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm. Yes, that's where you got the service from. Now, they're charging. The charge amounts are the coding and the charge amount is for lab work. So university physician is just a place.
[CUSTOMER][NEUTRAL] But well, no, no, no, no, that was not all lab work because the physician charged a price and then when I called they told me about, uh, they told me about uh they needed some layer they needed something from the lab.
[CUSTOMER][NEUTRAL] The verified, you know.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I called uh that how you how you talked to a bird and they told me that they were gonna send you on something.
[AGENT][NEUTRAL] OK, again, um, Mr. [PII], what I can do is have, uh, the examiner to review, um, again and give you a call back once they, they find any information to give you. I can only escalate the call to the claims department, um, because I can only give you information based on the EOB and that's what is on the explanation of benefits that you receive.
[CUSTOMER][NEUTRAL] No, no, I, I get you.
[CUSTOMER][NEUTRAL] No, that
[CUSTOMER][NEUTRAL] The position would become but that that that that they they were they were the one who in the surgery, you know, cause she had surgery.
[AGENT][NEUTRAL] Um, yes, I understand about the surgery, but the, the charges on that claim is not for the surgery. This, uh, the claim is not for the surgery. Um.
[CUSTOMER][NEUTRAL] Well, no, no, no, no, no, that's a university position that it's 4, they got it down here 4 times.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On this phone that I have today.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Man, that, that is so, that is so bogus. It's uh it doesn't sound right, you know, how are you gonna be, uh, uh, how did they gonna check.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Let me do a research and call you back, Mr. [PII]. Is that OK? Do you want an examiner to call you back, Mr. [PII]? We can do a research and call you back.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, OK, now uh you got my cell number, you got it right.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK. Let me have it one more time just to make sure I got it correctly. So let me have that number one more time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII] that's not say my house phone is.
[CUSTOMER][NEUTRAL] Area code [PII].
[CUSTOMER][NEUTRAL] [PII] and that's my home phone.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] The other number my cell number.
[AGENT][NEUTRAL] Got you. OK, so I'm gonna go ahead and send this to the claims, to an examiner. They're gonna research.
[CUSTOMER][NEGATIVE] They they like they don't, they don't pay they're not gonna pay anything, you know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. And yeah, they're gonna do a research and then they're gonna call you back with the information.
[CUSTOMER][NEUTRAL] I've been, I've been, I've been with this, I've been, uh, they, they deduct from my salary. I work 38.5 years and they were deducting that from my salary.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm I miss.
[CUSTOMER][NEUTRAL] And this is the first time I've had to use it.
[AGENT][NEUTRAL] No, OK. So let's see what we can do and, and they can call you at any time, Mr.
[CUSTOMER][POSITIVE] Oh, OK, OK, oh thank you, ma'am.
[AGENT][POSITIVE] OK. All right. Well, you have a good day and you'll be expecting a call back, OK?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Yeah, you have the rest of a blessed day.
[AGENT][POSITIVE] Thank you. You too, Mr. [PII].
[CUSTOMER][POSITIVE] And thank you, ma'am.
[AGENT][NEUTRAL] You're welcome. Mhm.