AccountId: 011433970860
ContactId: bc89e4f8-9065-4be4-a0d6-8e58dc64809f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 686530 ms
Total Talk Time (AGENT): 296123 ms
Total Talk Time (CUSTOMER): 378750 ms
Interruptions: 4
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/bc89e4f8-9065-4be4-a0d6-8e58dc64809f_20250320T13:02_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, hello. Hi [PII]. OK, um, you're speaking with [PII]. OK, I faxed a hospital claim form yesterday. I actually did it from Staples. I was just wondering if you received it and if you did, how long is it going to take because I have a.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, um, um, I have a bill of medical imaging, um, Isburg that, um, in the amount of $2,753 amount due that it's still on [PII]. I was just wondering how long it's gonna take because in the meantime, you know, I'm gonna, I'm gonna need to pay the bill, so I don't know, so I just wanna know, yeah, OK.
[AGENT][POSITIVE] OK, I can help you.
[AGENT][POSITIVE] And um I'll be more than happy to help you with your claim and let you know if we receive the documents and and next steps. May I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] OK, my name is [PII] and the last name is [PII] and the contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. and Ms. [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Um, the policy number, where would I find it?
[AGENT][NEUTRAL] Do you have your ID card there or paperwork? You got it?
[CUSTOMER][NEUTRAL] 00 yes, yes, um, yes, the, um, that's the APL policy number, right? Yeah, I actually called up yesterday and then and they gave it to me, OK, it's 249-928-8.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I have you here and I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII] and my mailing address is [PII].
[AGENT][POSITIVE] Thank you, and then just your email.
[CUSTOMER][NEUTRAL] Oh, I'm sorry. um [PII]. That's [PII].
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So, we have received your documents, we received them yesterday. So the turnaround time is 7 to 10 business days from the day we received the claim. So, 7.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so in the meantime I just hold on to this bill because the due date is [PII], so 7 to 10 business days that would be for, you know, before that time, so, um.
[AGENT][NEUTRAL] Is this, let me ask you this, is this policy your primary insurance or you have other insurance?
[CUSTOMER][NEUTRAL] Um, the, the PHCS I had in August. I don't have that anymore. I have anthem now. I only have anthem, but this is from PHCS that I had in August, OK. Um, I had an MRI done of my pancreas, OK. I spoke with, yes.
[AGENT][NEUTRAL] The reason
[AGENT][NEUTRAL] The reason I'm asking is because you can, I was just going to let you know, you can call the provider and let them know you have an you have an insurance and you've billed it to them so that they can stop, you know, if they're, you know, trying to contact and collect, you have it billed to your insurance, so they should have done it, to be honest. So you did it and they should not contact you anymore until this claim has been processed. I was just trying to let you know that.
[CUSTOMER][NEUTRAL] OK. So my, my insurance, so I should contact my insurance that I, I um
[CUSTOMER][NEUTRAL] That I did send the form, the um um the hospital claim form. They, they should know about that. Now, so medical imaging know about it because I, I owe medical imaging $2,753 that's due on [PII].
[CUSTOMER][NEUTRAL] So should I contact medical imaging as well?
[AGENT][NEUTRAL] And that
[AGENT][NEUTRAL] Let me take a look at these documents. Hold on one moment so I can see who is I'm gonna see if I can see what you sent in. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because if you have filed the claim with us, which we have it here, everything stops until that claim is processed and they see what the outcome is, and then from there you can try to, you know, collect or something, but they shouldn't.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, yeah, but, um, yeah, medical imaging has to be contacted and THCS has to be contacted us, or, um, I don't know, only medical imaging, yes, so the fact that I sent it in that everything is, um, it's the ball is rolling now, right, so to speak, OK.
[AGENT][POSITIVE] You shouldn't have any problems.
[AGENT][NEUTRAL] Mhm. So if you like, I would just if you want it, you don't even have to because it's not due yet. So if you want it to though, just to um that billing department number there on this uh bill that you sent in, if you wanted to give them a call and say, hey, I've sent this over to my insurance company, they're processing the claim and it stops there.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK, so I sent it to an insurance company, but I, I sent it to that, that's the PHCS insurance company, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, APL is not affiliated with PHCS.
[CUSTOMER][NEUTRAL] OK, so why, why the THCS give me this number to.
[CUSTOMER][NEUTRAL] Send it over to.
[AGENT][NEUTRAL] I mean, did you have peace, I don't even know what it, did you have it previously and now you have us? I mean, you have a policy with us now.
[CUSTOMER][NEUTRAL] Yes, I
[AGENT][NEUTRAL] But we're not affiliated with that.
[CUSTOMER][NEUTRAL] With, with who?
[CUSTOMER][NEUTRAL] With who?
[AGENT][NEUTRAL] So, you're speaking with [PII]. This is American Public Life. You do have an active policy with us. The other company, I, I don't know, go ahead.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] But yeah, but how, how do I have a policy with you? I I wasn't, I, I was never affiliated with you. I'm, I'm confused.
[AGENT][NEUTRAL] So this policy has been active since [PII]. Looks like it was through um Business Workers of America.
[CUSTOMER][NEUTRAL] PHCS, no, I, I had PHCS. That's, that's when I was enrolled in PHCS [PII], and I am no longer with PHCS. I stopped PHCS. I stopped it in November.
[AGENT][NEUTRAL] So are you saying that this policy should no longer be active?
[CUSTOMER][NEUTRAL] Yeah, because I, I, I stopped PHCS. I, I, I stopped it and I, I stopped it in, um, I stopped it in November, so I automatically was in this policy because I was in THCS.
[CUSTOMER][NEUTRAL] That's the insurance that I had. [PII], yeah, yeah, I'm confused.
[AGENT][NEUTRAL] I'm not sure. I'm gonna reach out to business workers.
[AGENT][NEUTRAL] I'm gonna reach out to Business workers of America to try to get some clarity for you. So is it that this policy should not be active and you have only anthem now?
[CUSTOMER][NEUTRAL] Yes, I, I, um, I only have anthem now. Yes, I only have anthem, but PHCS told me to contact you, so I'm, you know, I'm confused about that being that I had PHCS and this is on the PHCS, you know, cause at the time that I had the MRI done, I had PHCS, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Did you get what I'm saying?
[AGENT][NEUTRAL] I do, but then we're, yeah, let me reach out to um Business workers of America. I, I understand exactly what you're saying. I'm just trying to get you some clarity because it, it, it's confusing.
[CUSTOMER][NEUTRAL] OK, yeah, yes, yes, it is a little bit confusing.
[AGENT][NEUTRAL] But I understand what you're saying because if that's the case, then, and then you reached out to PCHS and they told you or PHCS and they told you to reach out to us, right?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, yes, yes, and they told me to reach out to you. So he said that, oh, just, just, you know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You may be able to get it lower just a little bit more, she, she said, because, you know, that's a lot of money. So I said, OK, so I just listened to what she told me to, you know, that's what I did.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because this policy here with us.
[CUSTOMER][NEUTRAL] So I was just following the instructions, that's all.
[AGENT][NEUTRAL] Yes, you're totally fine. It sounds like the, I don't know if the PHCS if there's another policy here, if this is the same policy, because your policy with us is no longer active. It was active from [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Yes, yes, and then it stopped. So that means that you cannot help me. The $2,753 I just have to pay it.
[AGENT][NEUTRAL] Well, no, that's not true. Let me see what this data service is. Hold on one second.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, well then yes, your policy was, your policy didn't lapse until November.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Oh yes ma'am, you can use, you can file, you're right, you can file this, we can process it.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Yeah, you're fine.
[CUSTOMER][POSITIVE] OK, problem solved. OK.
[AGENT][NEUTRAL] So that's, so we saw it. We didn't even have to call them. So yes, ma'am, this is fine. I see the dates on here, [PII], and then there's also something on here on [PII], but it's all within this time.
[CUSTOMER][NEUTRAL] Yeah. What was the what was the [PII]? I don't, well, this is minus [PII], they, they minus $3,395 they whatever. So that works for me.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So, yes, ma'am, of the documents that we have here, we're gonna go ahead and process and then you'll receive the decision. This bill is not even due until [PII], so I don't want you to be stressed out, you have time and then once the decision comes out, you'll then know what you need to do.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Perfect. OK. So, so you're gonna be contacting me by, by, by phone or, or by email?
[AGENT][NEUTRAL] So you'll receive
[AGENT][NEUTRAL] Well, you'll receive it in the mail for sure, but I don't know if you signed up for text messages when the policy was active. Um, did you receive any notice saying, hey, we received the claim and it's not processing?
[CUSTOMER][NEUTRAL] Um, I didn't receive any notices, no.
[AGENT][NEUTRAL] OK, so then yes, you'll receive it through the mail. You'll receive it written, um, it'll be the explanation of benefits with the full decision.
[CUSTOMER][NEUTRAL] All right. OK, I'll do that. In in case it gets closer to, you know, to [PII], I'm, you know, I'm just gonna give you a phone call because I don't like to, you know, you know, to, you know, to pay things that are, you know, past due, OK?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, you are free to call whenever you like. We're here to help and we'll be more than happy to give you an update.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you so very much for all your help. OK. So, so right now, I'll just stay at ease and just, you know, and just be patient with um um with all of this.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you so very much. You're very helpful. You have a good day.
[AGENT][POSITIVE] Thank you, Ms. [PII]. You too. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] That'll be all.
[AGENT][POSITIVE] All right, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. Same to you. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.