AccountId: 011433970860
ContactId: 906cd42b-1b03-4a1a-8e93-6db31fd8700d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 664010 ms
Total Talk Time (AGENT): 267472 ms
Total Talk Time (CUSTOMER): 389197 ms
Interruptions: 8
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/906cd42b-1b03-4a1a-8e93-6db31fd8700d_20250204T14:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APA. You're speaking with [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII]. I've got a couple of questions um regarding my policy and a claim that I just submitted. I have
[AGENT][NEUTRAL] OK, [PII], before you start, give me your phone number just in case we get disconnected.
[CUSTOMER][NEUTRAL] OK, it's uh [PII].
[AGENT][NEUTRAL] Alright, and give me that policy number so I can pull up your information.
[CUSTOMER][NEUTRAL] I was just looking for and I know it's 217. I'm on my phone so it's hard to read that. Let me, let me, um, throw you on speaker and log in so I can grab it real quick.
[CUSTOMER][NEUTRAL] Um, I just, let me look here. I just got a text from y'all.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Oh, shoot.
[CUSTOMER][NEUTRAL] OK, it is 217-074-9.
[AGENT][NEUTRAL] All right, thank you, [PII]. Verify your date of birth and your mailing address for verification.
[CUSTOMER][NEUTRAL] Date of birth is [PII]. My mailing address is [PII].
[AGENT][NEUTRAL] All right. And what about the email address, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you for that information.
[AGENT][NEUTRAL] All right, go ahead with your question.
[CUSTOMER][NEUTRAL] All right, I had uh my coverage was through um TW 556, and they just this year decided they were switching to colonial and my husband has had um
[CUSTOMER][NEUTRAL] Uh, metastatic bone cancer, and so I've been using my policy and it's been helping me amazing in amazing ways because I haven't been able to work. I am now working, but I haven't been able to, at any rate, um, long story short, when I called the union last week to find out what this new coverage was about and if there was any preexisting conditions, which, uh, exclusions, which there are on the new policy, she told me that I could port APL.
[CUSTOMER][NEUTRAL] And she sent me all the paperwork. And so I filled out all the paperwork and sent it back in immediately. And I, she, I only had until the [PII], well shoot, I didn't know anything about porting or anything until when I called them, which there are not open enrollment.
[CUSTOMER][NEGATIVE] Didn't start until the [PII]. So anyway, I said everything and and I haven't heard back from anybody there, and I noticed when I log on it says the policy is lapsed. Now I did ask yesterday why it says lapse. I asked the union because it shouldn't be lapsed. My coverage should have been through [PII], which is when it started.
[CUSTOMER][NEUTRAL] Previously, and the new coverage that they are offering, you know, the open enrollment begins [PII]. So I asked, you know, first of all, why it says lapse, and she said it should not say lapse. And second of all, my second question, part of that question is I did file a claim for my
[CUSTOMER][NEUTRAL] for skin cancer that I had removed in November. I just filed that as well and that claim says processed, but there's no information and closed. There's no information if you need. I, I sent the medical records from and the biopsy and the most surgery. There's no nothing indicating that you would need more or what that reason is. So my question is twofold, Bessy. Number one, what is my port status on continuing the APL and number 2, the claim.
[AGENT][NEUTRAL] OK, on the port status that would be something customer service would have to tell you because you're in the claims department and we don't do anything about uh the continuing of your policy and I will get you over to customer service when I look up anything now when did you when did you send a claim in because I don't see anything new that came in our office for you, uh, so when did you submit a new claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When we're OK.
[CUSTOMER][NEUTRAL] I submitted a new claim, uh, let me see here, um, that claim was submitted on.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Uh 31st.
[AGENT][NEUTRAL] OK, and I don't see anything new that came in our office. Let me see what this is. Something got the 3rd on it. Let's see what that is.
[CUSTOMER][NEGATIVE] Yeah, that's what I just got a notification saying it was complete. There was no payout, but it was complete and it was assigned a claim number. It's 355817, but there's no, there's nothing.
[AGENT][NEUTRAL] 812. 0, OK. Yeah, because yeah, I do see that claim. It's a they got this being an office visit. So you, if you kind of get.
[CUSTOMER][NEUTRAL] No, well, you know what, it was an office, it was an office visit but it was most surgery for skin cancer.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, but I this is not covered. So you would have to, if you send it in for skin cancer, you would have to send in the pathology report along with the itemized. OK. Well, I'm looking, OK, I'm looking at the claim and it's, we have 1234.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I, I did.
[CUSTOMER][NEUTRAL] I did.
[AGENT][NEUTRAL] Our pages including the other thing they see. So the first thing is nothing but medical information. It's a past report is gonna show the collected date when they collected, did the biopsy. So that's not on here.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Yeah, the, OK, well, I sent it. You just didn't receive it. It's all, it was all in one file and there's a pathology report. The whole thing is from Doctor [PII]'s office. So there's a pathology report and um, the whole, like I said, it's all in one file and may have to be unzipped or something like that, but.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, yeah, you might, you might encounter they they got, they just got, uh, based on know, OK, but, but, yeah.
[CUSTOMER][NEUTRAL] Maybe they didn't, maybe they didn't look because I, I have the file. I'm gonna look at the file actually real quick it's hard for me because I am on my.
[AGENT][NEUTRAL] OK, and show the and the pat and the patch report gonna have the collected date and received date. That's what they need. So yeah, that's not with this then.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So they need to collect the date. I do have the EOB.
[AGENT][NEUTRAL] OK. With itemized bills with the, uh, you know, it got to show the, the surgery code that was done. So yeah, resend it back in because like I say, this is just showing where the office is and what they told you doesn't have the collective date when they did the biopsy and they don't have the codes in order to review to see what anything be payable. The itemized code with the amount they charge you for each procedure they did.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right. OK. OK.
[CUSTOMER][NEUTRAL] OK, I'll resend that um but I like I said I.
[CUSTOMER][NEUTRAL] I did, I do have that.
[CUSTOMER][NEUTRAL] I did send that file in and it was, you know, it's hard because they send you all that stuff in a in a uh.
[CUSTOMER][NEUTRAL] Like a
[CUSTOMER][NEUTRAL] Uh, you know, on your, on your patient portal and so it's all zipped, and I have to download the file and then send it to you, but I, I know it's all on there. I'll, I'll go back and resend it though, [PII].
[AGENT][NEUTRAL] Yes, ma'am. That's all you have to do is make sure you have the itemized bill with the surgery with the procedure code and the pathology report with you want to collect the date and they can review it again from there. But this right here was just office visit notes, which was office visit not payable, and that's why I was denied as an office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it wasn't that it doesn't, it doesn't appear that you have any of the most surgery because it was an office visit, but it was most surgery done in the office and it was the diagnosis, the skin cancer. So you just need the the day the specimen was collected, the surgery is done, the, the, um, um, EOB with the.
[AGENT][NEUTRAL] Well, you have to have an itemized bill. Yeah, you have to show, yeah, yeah, yes ma'am. All right, so.
[CUSTOMER][NEUTRAL] Bill, yeah, OK.
[CUSTOMER][NEUTRAL] OK, yep, but I will, I will resend that I'm, I'm actually working and so I'm not at home and have access to those files, but I will resend that once I get home and then if you could um connect me to customer service so I can find out about when I talked to her she said that it the policy typically would just roll on I did provide all my bank information um I'm assuming and I'm gonna check my payroll information right now and see.
[CUSTOMER][NEGATIVE] You know, I, I never received a bill saying that I needed to pay anything, so my, my policy shouldn't be lapsed. I wouldn't assume.
[AGENT][NEUTRAL] OK, that that'd be all that'll be customer customer service area. So let me get you someone in customer service. Hold on, don't hang up, hold on.
[CUSTOMER][NEUTRAL] OK. OK. OK.
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Ferring
[CUSTOMER][NEUTRAL] Thank you for calling the APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, hey [PII], I have Ms. [PII] on the phone and her callback number is [PII]. Her policy number is 02170749.
[AGENT][NEUTRAL] I verified all her information. She's calling because the policy is terminated, but she's sent in some kind of paperwork, but where she can put this policy with her and she's trying to see if y'all get that and how is that gonna work?
[CUSTOMER][NEGATIVE] OK, as long as this ain't like that call you sent me yesterday, Ms. [PII], that thing was horrible.
[AGENT][NEUTRAL] 000, that Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, and I'm, I'm, I got this thing right here to pull up to see what [PII] did about it because nobody said ain't nobody sent us nothing to do anything else. So that's why I was wondering and I and I see where they took him off direct deposit so I was wondering what was going on and something about he wanted overnight, but for it to be overnight it have to be reprocessed. I thought, but they ain't still, yeah, yeah, I know.
[CUSTOMER][NEUTRAL] Oh Lord.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I don't know, girl.
[CUSTOMER][NEGATIVE] Look, I wrote down the wrong number. I'm missing a digit.
[AGENT][NEUTRAL] OK, it is 02[PII], and her name is [PII].
[CUSTOMER][NEUTRAL] And let me try one more time, make sure I always like to keep you on the phone so I have it pulled up and I know I've got the right 1, 2170749. [PII] Workers [PII]. Oh no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Is that one in funky groups? OK, maybe not, maybe not all right.
[AGENT][NEUTRAL] I don't know, but, yeah, no, I think, OK.
[CUSTOMER][NEUTRAL] Put, put Miss [PII] on for there.
[AGENT][POSITIVE] OK, I will. Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye.