AccountId: 011433970860
ContactId: 8a647005-9a8d-4023-b330-8c82467dd8d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 602859 ms
Total Talk Time (AGENT): 150024 ms
Total Talk Time (CUSTOMER): 374236 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/8a647005-9a8d-4023-b330-8c82467dd8d9_20250528T18:37_UTC.wav
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[AGENT][NEUTRAL] APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], I have a reference number in front of me. Would you like it?
[AGENT][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEUTRAL] 02459878
[AGENT][POSITIVE] How can I help today?
[CUSTOMER][NEUTRAL] So I had a colonoscopy. I had an endoscopy, and I had um mammograms, and it seems like my bills right now with um Barnabas are now up to $14,000. I just got this um explanation of benefits in the mail today, so I wanna make sure I understand why they're paying such little money towards everything.
[CUSTOMER][NEUTRAL] I thought all mammograms were covered.
[AGENT][NEUTRAL] OK, uh, so first thing I'll need to do is verify the name on the policy and your date of birth, please.
[CUSTOMER][NEUTRAL] Date of birth is [PII]. Name on the policy is [PII].
[AGENT][NEUTRAL] Thank you. And then I'll need to verify your uh physical address and email address, please.
[CUSTOMER][NEUTRAL] Uh, email address [PII], two Rs, two T's and my mailing address is [PII].
[AGENT][NEUTRAL] Alright, and then do you have a claim number with the since you got an explanation of benefits?
[CUSTOMER][NEUTRAL] It just says 3603586.
[CUSTOMER][NEUTRAL] I've always been covered like I've never not like.
[CUSTOMER][NEGATIVE] Not been not covered.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] Just as you're not covering these procedures because I guess it's not part of my plan, but if I'm giving you guys $100 a week, I'd rather save the $100 a week and put it towards the bills, you know what I mean? Because it's, they're so astronomical. It's only, like I said, it's only one endoscopy, one colonoscopy, and one and a couple of mammograms. They, because my breasts are so dense, they needed me to come back a couple more times, but I never had anything done.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean that was it, and I'm up to 14 grand just in those three things.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] And then I got this thing in the mail and it just says um.
[CUSTOMER][NEUTRAL] A, you know, it just says explanation of benefits and then it says the charges submitted are not payable um because of the effective date. I don't know what that meant and then in order to complete the processing we need itemized statements. I've asked St. Barnabas a million times to give me itemized statements and I mailed them to you guys. I don't know if you got them, um, and then it says benefits payable under the certificate are limited to those outlined. This is not a covered loss under the plan. Therefore, no amount is payable for the expense.
[AGENT][NEUTRAL] Right, so I see all that and I was trying to look to see what that was coordinating with here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] OK, so it's saying endoscopy.
[CUSTOMER][NEUTRAL] So the thing was I didn't want to get the colonoscopy unless we were covered. So when, when the girl at the colonoscopy doctor's office called me up, she goes, I can't book you for your colonoscopy until I hear from your insurance company that it's covered. I said, no problem. Here's their name, here's their number, here's my policy. She said, OK. She called me back. She goes, we could book it.
[CUSTOMER][NEGATIVE] I think they only covered like like very little money. So I'm like, I wish I would have known that. I would have never have gotten the colonoscopy. I could have waited another year, you know.
[AGENT][NEUTRAL] Yeah, so I see the endoscopy on here. It looks like it's not it's showing it's not covered.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'm surprised they went ahead and told me to do it.
[CUSTOMER][NEGATIVE] Because they don't book your hospital stay for the day cause you, you do the procedure and then you're out in like an hour and I was told by my friends that work in the medical field they're not your, your, your endo endo um doctors should not have even booked it if if you weren't covered.
[CUSTOMER][NEUTRAL] I, I don't know what the rules are. I don't know. I don't work in the medical field.
[CUSTOMER][NEUTRAL] Is there something they could do to help me with with these bills?
[CUSTOMER][NEUTRAL] I'm at $14,226 from an endoscopy, a colonoscopy, and some mammograms.
[CUSTOMER][NEUTRAL] And I thought, and I thought at least the colonoscopy and the mammograms were like a must, you know. Like you don't do them cause there's something wrong, you just do them because it's preventative and you have to.
[CUSTOMER][NEUTRAL] And then the girl at Saint Barnabas said, OK, we can do a payment plan with you for $700 a month. I'm like, what? How am I gonna do that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, no, I mean, I know. I, I had, like I said, I had a, I had an ultrasound and it cost me $800 just to have an ultrasound, so.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's crazy. Um, it is asking for some itemized receipts for portions of it, um, so I mean if you.
[CUSTOMER][NEUTRAL] And then when you call up and you go, oh we need itemized receipts, they walk you through your account with St. Barnabas and then they go, OK, print this up, this is good. So I printed up what she told me to print up. is that not acceptable, the itemized bills that I mailed you, it wasn't an email I sent. It was actual postal. Does it say in my records that I got that?
[AGENT][NEUTRAL] Well, let me look at what was submitted under the claim. Give me just a second.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It must have not had any sort of procedure or diagnosis code on it, I'm guessing because that's what it's asking for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yeah, so it looks like it's just
[AGENT][NEUTRAL] The provider.
[CUSTOMER][NEUTRAL] I need itemized bills, but this.
[CUSTOMER][NEUTRAL] OK, so you mean from the hospital, not the doctor I need itemized bills with um with procedure codes.
[AGENT][NEUTRAL] Right, so the dates of service that are asking for itemized bills are [PII] and then [PII].
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] They're asking for itemized bill for 78.
[CUSTOMER][NEUTRAL] And is this all [PII]. Is this all [PII], um, is this all 2024?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] It's all 2024.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, itemized bills with procedure codes for dates [PII] and [PII] and then where should I mail that to?
[AGENT][NEUTRAL] Um, so,
[AGENT][NEUTRAL] Let me see where your claims go to on this policy. Give me just a sec.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] For the corona sign, is it this one?
[CUSTOMER][NEUTRAL] 2 by 2.
[CUSTOMER][NEUTRAL] Come over here.
[CUSTOMER][NEUTRAL] I think it's over here.
[CUSTOMER][NEUTRAL] I'm still here.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] No, no, go ahead.
[CUSTOMER][NEUTRAL] Right here
[CUSTOMER][NEGATIVE] These are the only ones that came in that's small.
[AGENT][NEUTRAL] claims for BWA go.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So you want a 24 square, right? 24 square, yeah.
[CUSTOMER][NEUTRAL] That's what I didn't know. I don't know. I don't remember. I don't remember. So if it's the 24 square, it's gonna look like this right here.
[CUSTOMER][NEUTRAL] No, he can make it. It's gonna look exactly like this. OK, then let's write up an order because when I said I have a bunch coming in, I thought you meant the little one. OK, I have to do an actual order. Sorry about that. That's my fault.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, they're 125.
[CUSTOMER][NEUTRAL] You wanna do it?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I don't know. I just wanna think. I will place the order if I wanna sign up there. Yeah, I will place it.
[CUSTOMER][POSITIVE] Yeah yeah take your time. I'm sorry.
[AGENT][NEUTRAL] That's OK. All right, so the email address.
[AGENT][NEUTRAL] Or I'm sorry, not email address no physical mailing address is gonna be [PII].
[CUSTOMER][NEUTRAL] OK, so in other words, mailing address it's gonna be mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] And how do you spell that?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK and you said [PII]?
[AGENT][NEUTRAL] Mhm. [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII] and and who would I I would be American Public Life Insurance Company?
[AGENT][NEUTRAL] You address this to actually IMA.
[CUSTOMER][NEUTRAL] New address
[CUSTOMER][NEUTRAL] I am [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, IMA that's it, just IMA?
[AGENT][NEUTRAL] Mhm, yep, and then do attention claims.
[CUSTOMER][NEUTRAL] And you just want you oh attention.
[CUSTOMER][NEUTRAL] And you guys just want uh item itemized bills with procedure codes for three dates 7-8-202463 2024 and 521 2024.
[AGENT][POSITIVE] Mhm that that's correct, yep.
[CUSTOMER][POSITIVE] All right perfect, but you have been really helpful thank you.
[AGENT][POSITIVE] You're very welcome. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye you too.