AccountId: 011433970860
ContactId: baf179e8-6c2d-431e-9f05-5d8a7da9cb45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1023840 ms
Total Talk Time (AGENT): 369588 ms
Total Talk Time (CUSTOMER): 366507 ms
Interruptions: 7
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/baf179e8-6c2d-431e-9f05-5d8a7da9cb45_20250506T17:01_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, is it [PII] you said?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hi [PII], um, I'm calling because I
[CUSTOMER][NEUTRAL] I am trying to figure out um what how to cover a bill that I have been trying to cover since last November um I spoke with the the billing company uh which is an anesthesia company and they informed me that my best option now would be to call both my primary and you are my secondary insurances and kind of follow up and see what your thoughts on it were.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can I have a policy number for you?
[CUSTOMER][NEUTRAL] Um, I have a member ID number.
[AGENT][NEUTRAL] It's the same as the policy number. What is it?
[CUSTOMER][NEUTRAL] OK, 1221549.
[AGENT][NEUTRAL] Are you the provider or the insurer?
[CUSTOMER][NEUTRAL] Um, we are the insured.
[AGENT][NEUTRAL] Can I have your name, mailing address, your name, date of birth, and your mailing address?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] My billing address is [PII]. I'm calling um about my husband.
[AGENT][NEUTRAL] What is your date of birth, [PII]?
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] Well, it's
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you're calling in regards to information about a client about how to submit a claim, correct?
[CUSTOMER][NEGATIVE] No, not, not really, um, I'm calling because I guess it's a claim that you guys denied and, um, the pro the the the doctor, the, the anesthesiologist provider is saying that all they can see is that it was denied. They don't know why and we're just trying to figure out why this.
[CUSTOMER][NEUTRAL] Bill keeps getting thrown around to different people saying different people are responsible for it.
[AGENT][NEUTRAL] They plant hot potato with the claim.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] And I have no gloves on and I don't appreciate it.
[AGENT][NEUTRAL] I'm trying to see if your spouse has given us permission to speak with you on your, on behalf of his claims.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] He's sitting, he's sitting right here next to me.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Can I speak to him?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] She would like to speak to you. Sure.
[AGENT][NEUTRAL] Hello, how are you doing?
[CUSTOMER][NEUTRAL] He's coming. He's across the room. Hold on. How are you doing?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm good, thanks for asking. I'm [PII]. I'm a claims adjuster at American Public Life. Could you give me your full name, mailing address, and your date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][NEUTRAL] Thank you [PII], and what is the email address that we have on file for you?
[CUSTOMER][NEUTRAL] Um, it's either [PII] or [PII].
[AGENT][NEUTRAL] We had, we had the [PII].
[CUSTOMER][NEUTRAL] We've been with you guys so long it might be the [PII]
[AGENT][NEUTRAL] Mhm, um, also what is a good call back number just in case the call is disconnected, [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I give you my wife's phone number [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and [PII], do you give APL permission to speak with your wife [PII] on behalf of your claims and any other information that's needed that's being requested on your policy?
[CUSTOMER][NEUTRAL] I should be asking you that.
[CUSTOMER][POSITIVE] Because if you wanna do with my wife, go right ahead. yes, yes ma'am.
[AGENT][POSITIVE] All righty.
[AGENT][POSITIVE] Well thank you for giving us that permission.
[AGENT][NEUTRAL] Give me one moment, [PII], let me put this in the system.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Do you have a date of service for [PII] for that claim so I can see what's going on?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And I have um the provider names too if that helps narrow it down because he had.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] So we're requesting EOBs for the um anesthesiologist.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] They haven't sent us the ELBs. I'm not sure if they know that this is your secondary insurance, but that's all we're needing from them is the primary EOB.
[CUSTOMER][NEUTRAL] Oh, OK. When I talked to them they were like all we see is zeros we don't know why, and I'm like, OK, um.
[AGENT][NEGATIVE] No, we didn't make a payment because we were requesting the primary ELBs and they haven't sent them in.
[CUSTOMER][NEUTRAL] Oh well then that would be something simple to fix, wouldn't it?
[AGENT][NEUTRAL] Mhm. It's very simple, so I'm not even sure why.
[CUSTOMER][NEUTRAL] So OK, so who can I send you?
[CUSTOMER][NEUTRAL] Can I send you the EOB?
[AGENT][NEUTRAL] Mhm. You can.
[CUSTOMER][NEUTRAL] OK, and how would I send it to you?
[AGENT][NEUTRAL] You can send it to us by fax, by mail, or, well, you can send it electronically, so you will have to send it by fax or mail.
[AGENT][NEUTRAL] But you might wanna contact them mhm go ahead what you about to say?
[CUSTOMER][NEUTRAL] OK, give me the mailing because my fax.
[CUSTOMER][NEUTRAL] I just call them and tell them that's all they need is OK well who do I call? Do I call the.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The facility
[CUSTOMER][NEUTRAL] I call Humana and tell them that they need UB or I call the the anesthesiology.
[AGENT][NEUTRAL] No, you contact the facility, the anesthesiologist billing department, like if they have an invoice that they're sending you, they've sent you in the mail and you call that number and say, hey, I have a secondary insurance that's requesting the EOB. I have, and then you can give them the claim numbers so that you can give them reference to which claims that you're talking about. I can give those to you let me know when you're ready for them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready for them.
[AGENT][NEUTRAL] The first one is 357-1313. That's 3571313.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then the second one is 3571306. That's 3571306.
[CUSTOMER][NEUTRAL] OK, I've got that.
[AGENT][NEUTRAL] And those are the two claims that we need in the EOB for.
[AGENT][NEUTRAL] The one for the one ending in 1313 is the total bill amount of $2,308.35.
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] OK, they're only asking for $315 well, a total bill of.
[AGENT][NEUTRAL] Right, that's the total bill amount.
[CUSTOMER][NEUTRAL] The total bill amount that they're asking me for is $631.26.
[AGENT][NEUTRAL] Because that's probably what went towards your deductible, but the total bill amount before it went to your primary was $2,308.35.
[CUSTOMER][NEUTRAL] Oh yeah, yeah, yeah, I see that actually on the EOB that on the claim that I have from Humana I do have that here, OK.
[AGENT][NEUTRAL] And then the other one for 3571306 is 230835 as well.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] But if you wanna submit those claims, you can submit them by mail or by fax, or you can create an online account and upload the ELBs from Humana or whomever your primary insurance company is and put the claim numbers in reference to claim numbers such and such so that that whoever pulled the claims will know that hey these are the ELBs for claims such and such and then.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And say if you upload it on the website, make sure you write on the ELB send payment to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because normally when the insurer submit a claim, we send payments to them.
[CUSTOMER][NEGATIVE] OK, the only other thing that I was having an issue with because I did try going on your website before I called you to see, you know, if I could figure out what the issue was why they were saying they were getting zeros, um, and when I click on the claim, um, which now I have the numbers, but I was just clicking because there's several claims for that day when I was trying to click on the claims for that day it was, it would just go oops, something went wrong and none of them were opening.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm not familiar with the website of what it requests from you, but you are able to log in correct? There's no issues with logging in right?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so may do it ask you the claim number?
[CUSTOMER][NEUTRAL] Yes, I can log in I can see the claims.
[CUSTOMER][NEGATIVE] I can see all the claims, you know, for the last, you know, 10 amount of years and when I go to the [PII] claim and I go to click on it to view it, it says oops and it says unable to submit your request or something like that.
[AGENT][NEUTRAL] Mm, I'm not sure.
[CUSTOMER][NEUTRAL] So I can see is like all I can see is uh you know a date and then you know uh claim number and then um.
[AGENT][NEUTRAL] Did you click on it now since you have the claim number?
[AGENT][NEUTRAL] To see
[CUSTOMER][NEUTRAL] Yeah, now I have the same number. Can you click on it, baby, and see? He, he's across the room with the computer. Hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah, because there's like several claims for that day and we didn't know which one was the anesthesiology one because it the the first one is um 3571313.
[CUSTOMER][NEUTRAL] Do you see that on there?
[CUSTOMER][NEUTRAL] And then the other one was 357-1306.
[CUSTOMER][NEUTRAL] Oops, there's an oops, there's been an error when we click on it.
[AGENT][NEUTRAL] So, um,
[AGENT][NEUTRAL] So let me see if someone is in customer service to assist you with that part because that's beyond my.
[AGENT][NEUTRAL] My knowledge. So hold one moment, OK? Is there anything else?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, you got me a little further ahead.
[AGENT][POSITIVE] Is there anything else that I could assist you with before I transfer you? OK, you're welcome. Well, thanks for calling APL and have a good day. Hold one moment.
[CUSTOMER][NEUTRAL] No, thank you, [PII].
[CUSTOMER][POSITIVE] No, [PII], thank you so much.
[CUSTOMER][NEUTRAL] You too. OK. You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, Ms. [PII], how are you doing?
[CUSTOMER][POSITIVE] Hi Ms. [PII], I'm good. How are you there?
[AGENT][NEUTRAL] I'm great, thanks for asking, Ms. [PII]. I have an insured on the phone. She says she's calling because she's she called to check the status of the claim, but then she said she went online to the online website for the insured to check the claim, but when she clicked on the claim number it's saying there's an error, call customer service.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] OK, she's trying to look at a claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what you're saying, OK, she's gonna need to go to the care team. We can't see any customer service. We cannot see any kind of, any kind of claim information. Yeah, we can't see anything, right? I can see that, oh, I mean, I can go, I can get her back on her online account but I can't see any of her information.
[AGENT][NEUTRAL] For the
[AGENT][NEUTRAL] Online and her online account?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] She's on there, but she's saying she is saying something about an error like I gave her the claim status information, but she wanted some assistance with her online account.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Is she having trouble getting into the online is that what you're saying?
[AGENT][NEUTRAL] Mm mm. No, she's able to log in, but once she click on the claim number, it says error has occurred. Oops, error has occurred.
[CUSTOMER][NEUTRAL] Or mm mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's to me that's gonna be care team because they assist now with the uh claims they handle all claims information customer service cannot see claims information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty, so I'll let her know.
[CUSTOMER][NEUTRAL] Due to HIPA, we're not allowed to.
[CUSTOMER][NEUTRAL] OK, dear, I'm sorry, Miss [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No worries. Thank you. Have a good day.
[CUSTOMER][POSITIVE] All right. Thank you, dear. You too. Bye.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hello, how are you doing, [PII]?
[CUSTOMER][POSITIVE] Good, how are you?
[AGENT][NEUTRAL] I'm great thanks for asking. This is [PII] in the claims department. I have an insured on the phone who's calling in regards to her online account. She's called, she called to check the status of a claim which I was able to assist her with that. However, she said that she wanted to view the claim online through her online account, and when she do click on the claim, it says an error has occurred, please contact customer service. I contact the customer service and they told me that this should go to the care team instead.
[CUSTOMER][NEUTRAL] OK, uh, do you have the policy number?
[AGENT][NEUTRAL] It is 1221549.
[CUSTOMER][NEUTRAL] OK, and who are you speaking with?
[AGENT][NEUTRAL] I'm speaking with [PII], however, [PII], the spouse, who's the policyholder, did give me permission to speak with [PII] on his behalf, which is his spouse.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And their callback number is the [PII], do you see it?
[CUSTOMER][NEUTRAL] OK, I can talk to her.
[CUSTOMER][NEUTRAL] Uh yes, I see that.
[AGENT][POSITIVE] Alright, so let me transfer him over to you thank you have a good day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Hello [PII], I have someone on the phone who's gonna better assist you in the care team. Well, thanks for calling APL and have a good day.
[CUSTOMER][NEUTRAL] Hello, this is [PII].
[CUSTOMER][POSITIVE] Thank you.