AccountId: 011433970860
ContactId: b9fd8ef4-745e-44be-ae6b-a0a545f773b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2976909 ms
Total Talk Time (AGENT): 1313939 ms
Total Talk Time (CUSTOMER): 1142980 ms
Interruptions: 16
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/b9fd8ef4-745e-44be-ae6b-a0a545f773b4_20250620T15:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], this is [PII]. I have submitted a claim twice. Uh, it started back in uh August of last year.
[CUSTOMER][NEUTRAL] I still have heard nothing.
[CUSTOMER][NEUTRAL] I don't know
[CUSTOMER][NEUTRAL] Who to call, where to go? Anything. Could you help me?
[AGENT][NEUTRAL] OK, Ms. [PII], so you're trying to see if we've received a claim that you said you submitted to APL, is that correct?
[CUSTOMER][NEGATIVE] Yes, twice, twice. My husband passed away.
[AGENT][POSITIVE] Yes, ma'am, I can.
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] In July of last year from cancer, had the policy paid on it faithfully. And it's almost a year. And I, I spent hours at the hospital collecting all the information they needed, submitted it.
[CUSTOMER][NEGATIVE] I called about it. They said they never received it.
[AGENT][POSITIVE] OK, Ms. [PII]. Well, I'll be happy to.
[CUSTOMER][NEUTRAL] I gathered it all.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I gathered it all once again. My attorney sent it with a letter.
[CUSTOMER][NEGATIVE] Still have heard nothing.
[AGENT][NEUTRAL] OK, so I'll be happy to check that for you to see if we indeed actually received the claim. Uh, first off, what's a good callback number for you, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you. And what is your policy number, please, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh, would it be my husband's social?
[AGENT][NEUTRAL] Um, it should be a different number, but I can try and look it up by his social. Was he the primary policy holder?
[CUSTOMER][NEUTRAL] I am looking
[CUSTOMER][NEUTRAL] Yes, it was.
[AGENT][NEUTRAL] OK. All right. So yes, ma'am. What is his social?
[CUSTOMER][NEUTRAL] OK, just just a sec.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I found the policy number.
[AGENT][NEUTRAL] OK, is it OK, so first off, Miss [PII], um, I need to verify some things with you for security and any information that's provided would be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Certain
[AGENT][NEUTRAL] So first off, if you could please verify his name and date of birth and then your date of birth.
[CUSTOMER][NEUTRAL] Certainly.
[CUSTOMER][NEUTRAL] OK, um, his name is [PII]. His, uh, date of birth was [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just had a birthday last week. Uh, my date of birth, uh, my name is [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And my date of birth is [PII].
[AGENT][POSITIVE] OK, thank you. And the whole mailing address please.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. Thank you. And
[AGENT][NEUTRAL] That will be all the information that I need to verify. So, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment to look at a few things on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so I can see Ms. [PII] you had called in and spoken with some representatives earlier this year. Yes, ma'am, and
[CUSTOMER][NEUTRAL] Oh, several. Yeah.
[AGENT][NEUTRAL] They went over, OK, so.
[AGENT][NEUTRAL] You said that he passed away when?
[CUSTOMER][NEUTRAL] [PII] [PII] of last year, [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, alright, thank you.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Of cancer.
[AGENT][NEUTRAL] OK, and I see that when and we did mail explanation of benefits out related to the.
[CUSTOMER][NEUTRAL] And I received it. Uh.
[AGENT][NEUTRAL] OK, and on page 2, it listed the reason, the remarks of what was needed.
[AGENT][NEUTRAL] On each of those. Now, we have not received any additional information.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] That, do you know what address?
[AGENT][NEUTRAL] This is being mailed to it's possible that maybe you, you or the attorney had an incorrect address.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEGATIVE] No, I've mailed it twice.
[AGENT][NEUTRAL] Yes, ma'am. What address are you sending it to?
[CUSTOMER][NEUTRAL] I, uh, I
[CUSTOMER][NEUTRAL] Well, the APL address that uh was given to me, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I'm, I'm so frustrated. It's [PII].
[AGENT][NEUTRAL] [PII]. So yes, ma'am, that is the correct, that is the correct address, but we have not, for whatever reason, I mean, unfortunately, I, I can't answer that, um, but that has not, we, we have not received anything on this policy since that last review back.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was completed on [PII].
[CUSTOMER][NEGATIVE] How can that be? I am so frustrated, you know, he made monthly payments on this and
[AGENT][NEGATIVE] Yes, ma'am. But again, we haven't received, we just.
[CUSTOMER][NEUTRAL] I spent
[AGENT][NEUTRAL] Now, have you asked?
[AGENT][NEUTRAL] I see when when you called back in February, um.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] That it was discussed that maybe you could have his providers to send us that information.
[AGENT][NEGATIVE] That was missing
[AGENT][NEUTRAL] For review
[AGENT][POSITIVE] They, it can even be faxed. I mean, they could fax it.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So, I mean, unfortunately, yes, ma'am, I'm sure that you are and I completely understand that. I don't.
[CUSTOMER][NEGATIVE] I'm so frustrated.
[AGENT][NEGATIVE] Again, I'm sorry, but I mean, there's no way to know why it's not being received in the mail.
[CUSTOMER][NEUTRAL] Why? Why, you know, I had a friend worked for Atlas.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Her job was to stall people.
[CUSTOMER][NEGATIVE] And then hopefully, eventually, they just give up.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] The fight for it.
[CUSTOMER][NEUTRAL] It's almost been a year.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And you, I don't know.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] How else to get it to you if I drive down there and put it in your hand.
[AGENT][NEUTRAL] Again, it can be faxed. Yes, ma'am. It can be, but we, we, we're gonna review any information that's received, but we just haven't received it for whatever reason. Have you asked the provider if they can fax it for you or you could fax it, and they've not, and they said they won't do that.
[CUSTOMER][NEUTRAL] There would still be, I'm still.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, but I
[CUSTOMER][NEUTRAL] No, they did.
[AGENT][NEUTRAL] Faxed it or mailed it?
[CUSTOMER][NEUTRAL] And I sent it in, yes, they faxed it, and then I took it physically, mailed it to you. And then the last time I was at the attorney, I was telling them about it and he said, you bring everything to me. I will put a letter with it. We will send it to them once again.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And when was that sent? On what date?
[CUSTOMER][NEUTRAL] I don't know the date. I know it was uh uh.
[CUSTOMER][NEUTRAL] Maybe the first part of May, April, it was April. It was April because it was about 2 weeks before [PII].
[CUSTOMER][NEUTRAL] Took everything once again.
[CUSTOMER][NEUTRAL] The secretary did make a complete
[CUSTOMER][NEUTRAL] copy of everything once again and said, just in case they lose this, I, I've been to the hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Twice.
[CUSTOMER][NEGATIVE] And spent 3 hours gathering up information. Well, then I called and one of the times, well, they, they lacked this, so I went and got that.
[CUSTOMER][NEGATIVE] I don't know what else more to do. I am so frustrated with your company.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] If [PII] hadn't made, you know, a monthly payment.
[CUSTOMER][NEUTRAL] On this every month.
[CUSTOMER][NEUTRAL] You would have been calling.
[CUSTOMER][NEUTRAL] Uh, you know, threatening to cancel the policy, but he did it in good faith.
[AGENT][NEUTRAL] Yes, ma'am, but
[AGENT][NEGATIVE] And again, Ms. [PII], we're not trying to not review information, but we haven't received it for whatever reason, unfortunately. So I can't I can't explain why we haven't received it. I just like I'm sure you can explain why it's not been received.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Why?
[AGENT][POSITIVE] But what I can suggest is to have them fax it to our fax number again and I'll be happy to give you that to make sure that they have the correct fax number.
[CUSTOMER][NEUTRAL] I have it
[CUSTOMER][NEUTRAL] I have it [PII].
[AGENT][NEUTRAL] Yes, ma'am. Attention claims department.
[CUSTOMER][NEUTRAL] I've talked
[CUSTOMER][NEUTRAL] Yup. I have [PII]. I've talked to her. I've talked to [PII]. Uh,
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I, I'm.
[AGENT][NEUTRAL] Yes, ma'am. I can, I can see all of that.
[CUSTOMER][NEUTRAL] Beyond
[AGENT][NEUTRAL] Yes, ma'am. I can see those notes from when you have called in.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And every time I have called and my I was telling the attorney this and that's why he said I'll write them a letter, we'll send it in and I said, OK.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] It's hard enough getting through the grief.
[CUSTOMER][NEUTRAL] And then to have it compounded.
[CUSTOMER][NEUTRAL] By situations like this.
[AGENT][POSITIVE] Yes, ma'am. I do. My heart goes out to you and I do understand that.
[AGENT][NEUTRAL] On a very personal level.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Gosh.
[CUSTOMER][NEGATIVE] I'll tell you this, I would never, never recommend anybody using an APL. Never.
[AGENT][NEUTRAL] Well, I am very
[CUSTOMER][NEGATIVE] Every time I've called, it's been on the desk. It's being worked on, it's on the desk. Those are the answers that I've gotten. The last one was, they hadn't received anything.
[CUSTOMER][NEGATIVE] Now how could that be either it's on the desk being worked on or they've never received it.
[AGENT][NEGATIVE] So we received 2 claims last year.
[CUSTOMER][NEUTRAL] Which
[AGENT][NEUTRAL] And the, the last several times that you have called in.
[CUSTOMER][NEGATIVE] Then they lied. They, somebody lied about it because they said they never received it.
[AGENT][NEUTRAL] Correct. Yes, that is correct. We haven't received anything since, we haven't received anything since [PII].
[CUSTOMER][NEUTRAL] And I had sent it.
[AGENT][NEUTRAL] On this particular on the claim.
[AGENT][NEUTRAL] That's the last claims.
[CUSTOMER][NEUTRAL] But you said you received it.
[AGENT][NEUTRAL] There was claims information which you said you received an explanation of benefits for?
[AGENT][NEUTRAL] And that claim was reviewed on it was received on excuse me, [PII] and it was reviewed and processed on [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that explanation of benefits for that particular claim was 34.
[AGENT][NEUTRAL] 99
[AGENT][NEUTRAL] 837.
[AGENT][NEUTRAL] And then, and that was the most recent information that was received and processed. Since that point, for whatever reason, Ms. [PII], we haven't received information.
[AGENT][NEUTRAL] Any additional information.
[CUSTOMER][NEUTRAL] I don't know how that happens. If I have to get it and personally walk down there and put it in your hands.
[CUSTOMER][POSITIVE] I will do that, and you will have everything you need.
[CUSTOMER][NEUTRAL] It will be the 3rd time.
[CUSTOMER][NEUTRAL] That I have submitted.
[CUSTOMER][NEUTRAL] The information to you.
[CUSTOMER][NEGATIVE] Don't you find that a little ridiculous?
[CUSTOMER][NEUTRAL] If it were you,
[CUSTOMER][NEUTRAL] And you just lost your husband to lung cancer?
[CUSTOMER][NEUTRAL] And he bought the policy years in advance.
[AGENT][POSITIVE] Yes, ma'am. I understand. As I said, I understand this on a very personal level. I do.
[CUSTOMER][NEUTRAL] It is very
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Very.
[AGENT][NEUTRAL] And I can see what you had spoken.
[CUSTOMER][NEUTRAL] And I have all the dates where I
[AGENT][NEUTRAL] Yes ma'am, and I can see where [PII] explained that we were needing the itemized bills from the providers.
[AGENT][NEGATIVE] I, I can see all of those notes, but we haven't received it, is the problem. We just haven't received it to review it.
[CUSTOMER][NEUTRAL] And we did that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I don't know. I can't, you know, I can't say if they're telling you they sent it and didn't send it, if it was lost in the mail. I'm, I'm just, you know, I, I don't know. I, I can just tell you that we have not received anything, um, additional since we processed this claim back in September. There's been a lot of calls regarding.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] The why was I.
[CUSTOMER][NEUTRAL] Why wasn't I notified?
[AGENT][NEUTRAL] Did you
[CUSTOMER][NEGATIVE] I, I, no, I've received nothing. I have heard nothing, received nothing.
[AGENT][NEUTRAL] OK, now you have.
[AGENT][NEUTRAL] OK, initially, you said that you did receive the explanation of benefits explaining what all was needed.
[CUSTOMER][NEUTRAL] Before I sent it off in uh April.
[AGENT][NEUTRAL] Yes, and that's been.
[AGENT][NEUTRAL] Right, and because there would not have been any more correspondence to send.
[AGENT][NEUTRAL] Beyond that since we haven't received anything else to review.
[CUSTOMER][NEUTRAL] Well, I'll get in touch with my attorney.
[CUSTOMER][NEUTRAL] And uh give all this information.
[AGENT][NEUTRAL] OK, and if he would like to fax it, yes, ma'am, and, and he can fax it, he can fax that to that you do have the correct claims fax number.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Mhm. I've got all of it.
[AGENT][NEUTRAL] And to make, you know, just make sure he receives a confirmation page. And let me give you the policy number since you didn't have that handy, Ms [PII], to put on the information.
[CUSTOMER][NEUTRAL] Is it 417,340?
[AGENT][POSITIVE] Yes, ma'am, that is correct. It is.
[CUSTOMER][NEUTRAL] 417,340. I've got it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And you know, this money goes to his children, who are adults.
[CUSTOMER][NEUTRAL] could certainly use the money.
[CUSTOMER][NEGATIVE] I'm, I'm fighting for it for them. It's gonna be a drop in the bucket for me, but for his children.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It will mean.
[CUSTOMER][NEUTRAL] You know, several $1000 will mean everything to them.
[AGENT][NEUTRAL] Yes, ma'am. I understand that.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEGATIVE] It, it doesn't speak highly of your company.
[CUSTOMER][NEUTRAL] And I would tell anybody that works for APL the same thing.
[CUSTOMER][NEGATIVE] I have received nothing, and I have fought, tried.
[CUSTOMER][NEUTRAL] And I'm a Christian. I have tried every way. I know how.
[CUSTOMER][NEUTRAL] To handle this in a dignified way.
[CUSTOMER][NEUTRAL] I'm so
[CUSTOMER][NEUTRAL] Against this.
[CUSTOMER][NEUTRAL] Company. I'll tell anybody that.
[AGENT][POSITIVE] Well, I'm very sorry that you, you feel that way. Um, again, we
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I do.
[AGENT][POSITIVE] I'm, well, I'm very sorry to hear that.
[CUSTOMER][NEUTRAL] Well, your reputation precedes itself.
[CUSTOMER][NEUTRAL] You know, and that's what I believe in.
[AGENT][POSITIVE] I, no, I'm sorry.
[CUSTOMER][NEUTRAL] And I'm sorry you are to him.
[CUSTOMER][NEGATIVE] Um, but I will contact my attorney, have them rescind it.
[CUSTOMER][NEUTRAL] And if that doesn't work,
[CUSTOMER][NEUTRAL] I will get the information. I will come down there personally and hand it to whoever I need to.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEGATIVE] I'm so disappointed.
[AGENT][NEUTRAL] Excuse me, well, I'm very sorry, but again, you do know, you do have your explanation of benefits that has the remarks on it for the specific information that we are in need of, is that correct?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't even know. It's been almost a year and
[CUSTOMER][POSITIVE] You know, I, every day, I just kept thinking they're working on it, they're gonna get it together and you and send it and um it's all gonna be taken care of. Explain to me the explanation of benefits that you need.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, there's multiple things that's needed. That's why I was asking you initially.
[CUSTOMER][NEUTRAL] Like what?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for data service [PII].
[AGENT][NEUTRAL] Those charges for that date, one was denied because laboratory tests are not covered under the policy.
[CUSTOMER][NEUTRAL] What isn't covered?
[AGENT][NEUTRAL] Laboratory testing.
[CUSTOMER][NEUTRAL] See, and I was told I needed all of that.
[AGENT][NEUTRAL] OK. So what I can do, since you've spoken to other representatives, Ms. [PII], if you would like for me to connect you with someone who can go over that, you know, again with you since.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You're not clear as, you know, or
[AGENT][POSITIVE] Not sure what is needed. I can read you each of these remarks and I will be very happy to do that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because there were certain charges for the
[CUSTOMER][NEUTRAL] Read them to me.
[AGENT][NEUTRAL] Uh-huh, OK, we'll just.
[CUSTOMER][NEUTRAL] OK, read them to me and I'll make a note of it.
[AGENT][NEUTRAL] On [PII], laboratory tests are not covered.
[AGENT][NEUTRAL] There was also another charge.
[CUSTOMER][NEUTRAL] 24. OK.
[CUSTOMER][NEUTRAL] Just a sec.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] The next one.
[AGENT][NEUTRAL] One of the charges states the charges for the listed treatment date is not covered under this policy.
[CUSTOMER][NEUTRAL] OK. What
[AGENT][NEUTRAL] That was for 31. We're still on 31.
[CUSTOMER][NEUTRAL] What is it?
[CUSTOMER][NEUTRAL] OK. And then tell me that again.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The chart, this one line item states the charges for the listed treatment.
[CUSTOMER][NEUTRAL] A chart
[CUSTOMER][NEUTRAL] I listed treatments.
[AGENT][NEUTRAL] Treatment dates are not covered under this policy.
[CUSTOMER][POSITIVE] You know, and I, I laughed because that all of that was needed.
[AGENT][NEUTRAL] Then there was the next.
[CUSTOMER][NEUTRAL] You know, that, that was one thing and I have it on the paper here, uh, you know, of all the things that they needed and
[AGENT][NEUTRAL] Also for
[AGENT][NEUTRAL] OK, oh, so you already have that, OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I'm reading some old notes here.
[CUSTOMER][NEUTRAL] And that the pathology report.
[CUSTOMER][NEUTRAL] Uh, this is on [PII] they needed. I sent that.
[CUSTOMER][NEUTRAL] Have you ever been to the hospital and tried to collect all this information?
[AGENT][NEUTRAL] I have, yes, ma'am.
[CUSTOMER][NEUTRAL] Tough, isn't it?
[AGENT][NEUTRAL] So that's why I said, I, I, I personally know the challenges.
[CUSTOMER][NEUTRAL] Yeah, I sat over there 3 hours.
[AGENT][POSITIVE] Yes, I, I do personally understand the struggle.
[CUSTOMER][NEUTRAL] OK. I've got that.
[CUSTOMER][NEUTRAL] OK. I've got a chart of listed treatments are not covered.
[CUSTOMER][NEUTRAL] On 3124.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, one of the line items, yes, ma'am. That is the remark for it. So give me just one moment to go back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I think what I need to do.
[AGENT][NEUTRAL] Really miss [PII], since you have spoken to one of the claims examiners on this policy to go over these remarks with you again is to see if I can connect you with one of them.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Fantastic.
[AGENT][NEUTRAL] And so that I can just
[AGENT][NEUTRAL] Go over it with you one more time because for there's multiple dates of service. I can see that one of the charges also on 31 states that we were in need of the hospital's itemized billing.
[CUSTOMER][POSITIVE] Sounds great.
[CUSTOMER][NEUTRAL] Uh-huh, I had that. I submitted that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is part of the information that you said was submitted but we never received. Is that correct?
[CUSTOMER][POSITIVE] Yep. Yeah, that's right.
[AGENT][NEUTRAL] OK. OK. So, and you and you did keep copies.
[AGENT][NEUTRAL] Of all of that information.
[CUSTOMER][NEUTRAL] Certainly, yes, my sec.
[AGENT][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] The secretary at the attorney made a copy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of everything.
[AGENT][NEUTRAL] OK, so they still have that. So if you, I'll be happy to keep going through these remarks with you. The next day the service on this claim after 31 was 56.
[CUSTOMER][NEUTRAL] It's just
[AGENT][NEUTRAL] And this one, we also needed an itemized bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] From the facility, a fully itemized bill with all charges fully identified. OK. Also for 56.
[CUSTOMER][NEUTRAL] Of what?
[CUSTOMER][NEUTRAL] Yeah, that was in there.
[AGENT][NEUTRAL] OK, it states there was an incomplete claim we were needing additional information that's just one of the remarks.
[AGENT][NEUTRAL] And we needed the primary insurance company's explanation of benefits. That was also for 56.
[AGENT][NEUTRAL] Uh, there was one line item this waiting for 52.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that was for a surgery and it states in order to give consideration to your claim, we will need a fully itemized surgery bill.
[AGENT][NEUTRAL] That includes the procedure code and diagnosis code.
[AGENT][NEUTRAL] And that was again for 52.
[AGENT][NEUTRAL] For 63 2023.
[AGENT][NEUTRAL] That one states in order to give consideration to this data service we will need a fully itemized hospital slash facility billing with all charges fully identified.
[CUSTOMER][NEUTRAL] Ha
[AGENT][NEUTRAL] Again, that was for 6323.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And also for that same data service it uh we are needing the copies of your, the primary insurance company.
[AGENT][NEUTRAL] Explanation of benefits.
[AGENT][NEUTRAL] The next data service um is.
[CUSTOMER][NEUTRAL] Just, just a second, please.
[AGENT][NEUTRAL] Oh, OK, sorry. Mhm.
[CUSTOMER][NEUTRAL] I'm writing it down.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Again, that was still for the 63-2023.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, then the next data service, let's see, we've already done 52 and 5624 would be 6.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] 72 of 2024.
[AGENT][NEUTRAL] And that one also states in order to give consideration to this state of service, we will need a fully itemized hospital slash facilities bill with all charges fully identified.
[AGENT][NEUTRAL] Again, that's a fully itemized deal.
[AGENT][NEUTRAL] And there's one more line item for that data service for 72-2024.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And that's asking for the same thing, an itemized bill from the provider's office.
[AGENT][NEUTRAL] Showing the procedure codes and charge amounts.
[AGENT][NEUTRAL] For each service rendered.
[AGENT][NEUTRAL] Again, that was on 72.
[AGENT][NEUTRAL] 2024.
[CUSTOMER][NEUTRAL] Are are you telling me that they have received.
[CUSTOMER][NEUTRAL] Nothing
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] They have received none of this.
[AGENT][NEUTRAL] Nothing.
[AGENT][NEUTRAL] No, ma'am. We have not.
[CUSTOMER][NEUTRAL] How, I don't, I, I just am in awe.
[CUSTOMER][NEUTRAL] of this company. I, I'm
[CUSTOMER][NEUTRAL] I'm in all.
[CUSTOMER][NEGATIVE] It's not good.
[CUSTOMER][NEUTRAL] I will not take it any more of your time. I am going to call my attorney. I am going to have them fax the information to you once again.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And I have a hard copy of it, and my son lives in [PII].
[CUSTOMER][NEUTRAL] I will come to [PII]. What are your hours?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] You're not going to be able to handle liver because that's, I don't think you can drop off any types of information. It would either have to be.
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] That uh
[CUSTOMER][NEGATIVE] I need to get off here because that upsets me a great deal.
[CUSTOMER][NEGATIVE] I it's your, you all keep saying you don't receive anything.
[CUSTOMER][NEGATIVE] I don't know what if we keep sending it and you keep delaying by saying you never received it.
[CUSTOMER][NEGATIVE] The it's asinine to me. I don't understand.
[AGENT][NEUTRAL] Miss, Miss [PII] now I'm.
[AGENT][POSITIVE] Miss [PII], I, I completely understand your frustration and I am sorry for all of this that you're going through.
[AGENT][NEUTRAL] But I can only see what I can, what we have received in the system. As to why things have not been received, I wish that I had that answer for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] But unfortunately,
[AGENT][NEUTRAL] I, I don't have that answer.
[CUSTOMER][NEGATIVE] Do you see how easy it is for your company to keep saying we never got it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] We just never received that.
[CUSTOMER][NEUTRAL] No matter how many times I send it.
[CUSTOMER][NEUTRAL] Yep, we just didn't get it.
[CUSTOMER][NEUTRAL] What would your company do if that was on the other end?
[CUSTOMER][NEUTRAL] And I owe you $120 a month.
[CUSTOMER][NEGATIVE] And I could just say, but I never received it.
[CUSTOMER][NEUTRAL] Do you see?
[CUSTOMER][NEUTRAL] You know, uh
[CUSTOMER][NEUTRAL] I wouldn't want anybody I love or know.
[CUSTOMER][NEUTRAL] To go through this.
[CUSTOMER][NEUTRAL] Because like I said, going through.
[CUSTOMER][NEUTRAL] The grief is hard enough.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] It means you have trust in your company that you're going to
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] And, and you don't because you,
[CUSTOMER][NEGATIVE] You know y'all never receive anything.
[CUSTOMER][NEGATIVE] I once, maybe once, you could say you never received anything. Twice?
[CUSTOMER][NEUTRAL] Don't you find that hard to believe yourself?
[AGENT][NEUTRAL] If I had not had the same experience, Ms. [PII] personally with other companies.
[AGENT][NEGATIVE] Uh, but unfortunately, it can happen where we send things and they're not received for whatever the reason.
[AGENT][POSITIVE] But I assure you that
[AGENT][POSITIVE] If we can receive the information, we will most definitely review it and provide any benefits that we possibly can.
[CUSTOMER][NEUTRAL] I will call my attorney.
[CUSTOMER][NEUTRAL] I will have them resend it. They will fax it.
[AGENT][NEUTRAL] That will be fine and then.
[CUSTOMER][NEUTRAL] And like I said,
[AGENT][POSITIVE] Yes, ma'am, I'm sorry. I did not mean to interrupt you, Miss [PII]. Go ahead.
[CUSTOMER][NEUTRAL] This is for his children.
[CUSTOMER][NEUTRAL] And I will fight.
[CUSTOMER][NEGATIVE] Till I can't any longer to get that money to give to his kids.
[AGENT][NEUTRAL] Miss [PII], can I place you on a brief hold for just a moment? yes ma'am, can I place you on, OK, thank you very much, because I was gonna see if someone that you had spoken to before who it's documented that she gave you her email address.
[CUSTOMER][NEUTRAL] But if I did
[CUSTOMER][NEUTRAL] Certainly.
[AGENT][NEUTRAL] To correspond with her related to this.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When you talked to her before?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is it someone? I don't know. Could you tell me a name?
[AGENT][NEUTRAL] Uh, let me, I'm trying to go back to that.
[CUSTOMER][NEUTRAL] I had [PII].
[AGENT][NEUTRAL] Yes, yes, ma'am, you've spoken to several people. I know. Hold on just a moment.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] That was back in December.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] OK, I'm gonna place you on just the, OK, do you mind holding for me, Ms. [PII]?
[CUSTOMER][NEUTRAL] I don't have a clue.
[CUSTOMER][NEUTRAL] No, I don't mind.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, Miss [PII], this is still [PII]. Thank you very much for holding for me. So I'm going to connect you with [PII]. She is someone you spoke to in December and she is the examiner that had given you her email address.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For you all to stay in contact with, so she's gonna, she is going, she is available and I am going to connect you with her so that see if she can provide you any additional information again Miss [PII], I have provided you what I am able to see as far as the remarks on the on the claim, the most recent one that we received, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can try and assist you with or help you with before I connect you with her?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, there's nothing.
[AGENT][POSITIVE] OK, Ms [PII], well thank you for calling APL and I do hope that you have a nice weekend, OK?
[CUSTOMER][POSITIVE] Thank you, you as well.
[AGENT][NEUTRAL] Yes. Yes, ma'am. So one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Good morning and thanks for calling PL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hey, [PII], it's [PII].
[AGENT][NEUTRAL] OK, so I have been on the phone with her for almost
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEGATIVE] Well, at least 45 minutes getting an earful on how terrible this company is and that she would never recommend. And anyway, long story short before I release her to you, I have gone over every remark on that claim. I have explained to her, you know, she's called a bunch of times, you can see your notes.
[AGENT][NEGATIVE] I've told her that you know we haven't received. No, no, she's saying that we are just basically getting it and not doing anything with it to try to avoid paying the claim um she says that it's been mailed multiple times she said the provider has sent it to us and she says her attorney sent it with a letter.
[CUSTOMER][NEUTRAL] So is she just calling and not sending us any documents?
[AGENT][NEGATIVE] And she doesn't understand how she can send all of that, all of that correct, that all of that has been sent to us so many times that
[CUSTOMER][NEUTRAL] So she's saying that she sent stuff since September.
[AGENT][NEGATIVE] There's just no way that we haven't received it.
[CUSTOMER][NEUTRAL] So, [PII], she's saying that she has sent [PII]. Can you hear me?
[AGENT][POSITIVE] She does have the correct.
[AGENT][NEUTRAL] Can you hear me, [PII]?
[CUSTOMER][NEUTRAL] [PII], can you hear me?
[AGENT][NEUTRAL] Um, I can't. Hello, [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII], can you hear me?
[AGENT][NEUTRAL] [PII], I think
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Can you not hear me?
[AGENT][NEUTRAL] [PII], I can hear you. Can you hear me?
[CUSTOMER][NEUTRAL] Yes, I, I can hear you. Can you hear me?
[AGENT][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so no, I just wanted to see, so she's saying that she has sent us documents since since September of last year?
[AGENT][POSITIVE] That is correct, multiple times.
[CUSTOMER][NEUTRAL] And have we confirmed the address, fax number everything with her?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, give me just a second, let me.
[AGENT][POSITIVE] She has the correct address. She has the correct PO box. She has the correct claims number.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEGATIVE] Upset that no one has, you know, anyway. Yeah. All that's been verified and gone over the same information.
[AGENT][NEUTRAL] 15 or 20 times.
[AGENT][NEUTRAL] And she's just continuing to say now, you know, no matter what I try to do to appease her.
[AGENT][POSITIVE] I've tried to be very empathetic and sympathetic to the situation.
[AGENT][NEGATIVE] But she is just continually asking, so how, how can you sit there and tell me that y'all haven't received it? I had a friend who worked for a company and that was her job was to stall people. I mean, what.
[AGENT][NEUTRAL] Yeah, it's been close to an hour on this call.
[CUSTOMER][NEUTRAL] OK, I mean, only thing else I can think of is if she's not wanting to remail it or fax it, I mean, can't she email it to the care team?
[AGENT][NEUTRAL] Oh we, well, we can't accept claims via email unless y'all have something.
[AGENT][NEUTRAL] Special.
[AGENT][NEUTRAL] I mean, planes aren't supposed to be, yeah.
[CUSTOMER][NEUTRAL] I'm just trying to think of a different options.
[AGENT][NEUTRAL] I mean,
[AGENT][NEGATIVE] Technically no, they're not supposed to email claims.
[AGENT][NEUTRAL] And I'm not on the email team. I know we still get them and they're getting processed um so I don't know if you know if there's a way you can.
[CUSTOMER][NEUTRAL] OK, so let me see.
[AGENT][NEUTRAL] Approved to make an exception or whatever, but.
[AGENT][NEUTRAL] I mean, I did not give her an email address.
[CUSTOMER][NEGATIVE] I would probably need to go through a supervisor.
[AGENT][NEUTRAL] Yeah, I didn't give her the email address because we're not supposed to receive claims via email.
[CUSTOMER][NEUTRAL] Um, can you maybe, can you get like I do like a call back for her so I can check with the supervisor just so I can see what our options are and then we can give her a call back.
[CUSTOMER][NEUTRAL] Because they're all in a meeting right now so I won't get a response from a supervisor, but I would like to at least if we're able to give her an email address as a as another option.
[CUSTOMER][NEUTRAL] And I would like to at least give that information to her at that time and, and if not, then I would just have to tell her just to, you know, send them again is the only thing I can tell her um but can you go ahead, can you?
[AGENT][NEUTRAL] Yeah, and that's what I've told her multiple times.
[CUSTOMER][NEUTRAL] Yeah, it doesn't seem like she's accepting that. So let me see if I can get like another option if you can, um, get like a call back for her and and let them know we'll give her a call back once we once we do some more research and maybe I can also reach out to [PII] to see if there's any lost mail or anything like that for her.
[AGENT][NEUTRAL] OK. Do I, she's gonna ask me when you're gonna be calling her back.
[AGENT][NEUTRAL] Or do you want to
[CUSTOMER][NEUTRAL] As soon as I can, I can't give an exact time.
[CUSTOMER][NEUTRAL] As soon as we can.
[AGENT][NEUTRAL] OK, do I need to send you an email or do you, or you just have you made a note of this? I mean, I've got to make my note and I was, yeah.
[CUSTOMER][NEUTRAL] Yeah I'll make a note but if you don't mind um and I'll just look if you can just put her callback number in your notes and then I'll just go from there.
[AGENT][NEUTRAL] Oh, it is. Mhm.
[AGENT][NEUTRAL] Yeah, it is. OK.
[CUSTOMER][NEUTRAL] OK, yeah, then that that's what we'll do then.
[AGENT][NEUTRAL] OK. All right. Well, I'll, I'll get back on the line with her even though I told her I was transferring her to you. So, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] She is gonna be mad, even more mad.
[CUSTOMER][NEUTRAL] OK, yeah, sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I mean, or I can tell her I mean regardless because I just I don't have any other answer to give her right at this moment without being able to look to review with the supervisor because if that's our if we can't give uh let her email then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know that for sure. I'll get reaching out to a supervisor is all I'm saying.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure. All right. I'll, I'll just, I'll just uh
[AGENT][NEUTRAL] I'll let her know that, OK?
[CUSTOMER][NEUTRAL] OK, if she give you any more trouble, [PII], just go, you can just go ahead and then call me back and um then I'll take it from there.
[AGENT][NEUTRAL] Yeah, it's cause yeah, I've been on the phone with her for 45 minutes.
[AGENT][NEUTRAL] So, um, but yeah, I'll tell her that.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you. Bye bye.
[AGENT][NEUTRAL] OK, I'm so sorry, Ms. [PII], this is still [PII].
[AGENT][NEUTRAL] So [PII] is going to look into a few things for you. She was actually in a meeting and I'm very sorry I did not realize that initially, um, so she is going to call you back if that is OK, and the [PII] is your best number, correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Certain.
[CUSTOMER][NEUTRAL] It is, yes.
[AGENT][NEUTRAL] OK, so yes, she's going to check with on a few different things she's also going to reach out to her supervisor who is also not available they're in meetings, um.
[AGENT][NEUTRAL] I can't give you a specific time frame, Ms. [PII], as if that's gonna be today or if it could be Monday, but she was going to look at a few things and said that she will call you back. And again, her name is [PII].
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, yes, thank you so much.
[AGENT][POSITIVE] OK, you're very welcome and again, is there anything else that I could try and help you with at the moment?
[AGENT][NEUTRAL] Mhm. I've, I've tried my best to, yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, yeah, find that information that they
[CUSTOMER][NEGATIVE] Uh, uh, you know, I'm just so frustrated with the whole mess. And like I said, if it was just for me, you know what, they could keep their $4000 that's coming to me and maybe apply it to somebody that really needs it, but it's the kids.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure. I understand.
[CUSTOMER][NEUTRAL] And I, they're adults, but I will fight tooth and nail for his children.
[AGENT][NEUTRAL] Well,
[AGENT][POSITIVE] Yes, ma'am, and I, I know that he would appreciate that.
[CUSTOMER][NEUTRAL] And I will do it again.
[CUSTOMER][NEUTRAL] And again and again and again until there's nothing left.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEGATIVE] It is so sad to me that a huge company like this
[CUSTOMER][NEGATIVE] Can claim they've never received the information.
[CUSTOMER][NEUTRAL] Not once, I understood. It was frustrating, but I understood. So I went back to [PII], spent hours over at the hospital waiting on all this information.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] You know, and
[CUSTOMER][NEUTRAL] Like I said, if it were uh
[CUSTOMER][NEUTRAL] [PII] paying a bill, he'd have been hounded or dropped.
[CUSTOMER][NEUTRAL] But he's not here to fight for it. So I will fight for him. I will fight for what's right.
[AGENT][NEUTRAL] Yes, ma'am. I
[CUSTOMER][NEGATIVE] This isn't right.
[AGENT][NEUTRAL] And when you're
[CUSTOMER][NEUTRAL] Uh, I'm a Christian.
[CUSTOMER][NEGATIVE] I would never, never.
[CUSTOMER][NEUTRAL] Treat
[CUSTOMER][NEUTRAL] Someone like this, never. If something is due to them, it's due.
[CUSTOMER][NEUTRAL] You know, he paid on it for years.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And that's what makes me so darn.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And it's almost a year since he's gone.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And, and again,
[CUSTOMER][NEUTRAL] And
[AGENT][POSITIVE] Uh, my heart goes out to you and I, I, I, I know that it is. And I assure you that we will do everything we can to try and help you and [PII] is going to look into some things, um, and speak with her supervisor, and then she said that she would call you.
[CUSTOMER][NEGATIVE] It's pathetic.
[CUSTOMER][NEUTRAL] OK. And I will call my a[PII] once again.
[AGENT][NEUTRAL] OK. And you do have the correct fax number. Yes, ma'am. So we, right, because we're gonna check to see if there was any, you know.
[CUSTOMER][NEUTRAL] And uh have them resend everything.
[AGENT][NEUTRAL] Uh, well, I don't know exactly what all [PII] is going to look into because we didn't have, weren't able to, to get into all of that, um, but I expressed to her what your concerns were and what you and I have discussed and that we went over, you know, the explanation of benefits for the most recently reviewed claim and that you had stated that this information was sent to us multiple times via fax and via mail and that you do have the correct.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] mailing address and you do have the correct claims fax number so that's when she just asked if she could please give you a call back to do some research and to call you back.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Certainly.
[CUSTOMER][POSITIVE] Yes, certainly, thank you so much.
[AGENT][POSITIVE] OK. Well, you're welcome, Ms. [PII], and again, thank you for calling APL and I, I do hope that you have a nice weekend, OK?
[CUSTOMER][POSITIVE] Uh, thank you very much.
[AGENT][POSITIVE] Yes, ma'am. You're welcome.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Um, bye bye.