AccountId: 011433970860
ContactId: de4e6df9-98fa-4b77-a40d-1fb90d45116f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1413109 ms
Total Talk Time (AGENT): 463927 ms
Total Talk Time (CUSTOMER): 440862 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/de4e6df9-98fa-4b77-a40d-1fb90d45116f_20250402T20:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in customer services. How are you?
[AGENT][POSITIVE] Hey, I'm good. How are you doing?
[CUSTOMER][POSITIVE] I'm good. um.
[CUSTOMER][NEUTRAL] I have a lady on the phone that's wanting to check on a claim, and she's also uh she was transferred to me from care team to tell her to email a form to y'all so she's wanting to check to see she's already emailed it if you've received it also.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK, um, so I'm doing a claim status and telling her if a form has been received?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And was
[CUSTOMER][NEUTRAL] It's policy 768702.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so claims.
[CUSTOMER][NEUTRAL] And [PII] said she verified everything.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] I'm confused.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Why would she send the customer, what now? So.
[CUSTOMER][NEUTRAL] Me too.
[CUSTOMER][NEUTRAL] To tell her to to email the form to to care team.
[AGENT][NEUTRAL] To email the claim form to the care team?
[CUSTOMER][NEUTRAL] The uh not the claim form but the direct deposit form.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, and then, OK, so now you want me to see if the phone.
[CUSTOMER][NEUTRAL] And so now.
[AGENT][NEUTRAL] If the
[CUSTOMER][NEUTRAL] It it she's needing to check on a claim because she said it was mailed to the wrong address and we've got the address corrected and she's checking on that and she also wants to see if you received the form.
[AGENT][NEUTRAL] The direct deposit form.
[CUSTOMER][NEUTRAL] In the email.
[AGENT][POSITIVE] OK then, I'm sorry about that. I'll handle it.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] That's no problem.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Here she is, and thank, thank you so much, [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] All right, here she is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[AGENT][NEUTRAL] Hello Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm on the care team and I'll be helping you with the claim status and we're also checking to see if the direct deposit form has been received. Is that right?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you so much. I would appreciate that. I would love to get this finished.
[AGENT][NEUTRAL] OK, well, I definitely can. So for the claim, um, status, would it be like the most recent claim here or is this an older claim?
[CUSTOMER][NEUTRAL] Uh, well, it's most recent, but it's our 2 $75 yearly kind of, I call them wellness, but it's also one on the same visit from my husband, he had a, a growth or something and y'all needed a pathology report, so I had that sent to y'all.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's, it's kinda, kinda sort of three claims all the same date.
[AGENT][POSITIVE] OK, so let's start with you just because you're um number one.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] You said [PII].
[CUSTOMER][NEUTRAL] Pardon me?
[AGENT][NEUTRAL] You said the date was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] I'm just getting the claim information. Hold on one moment.
[AGENT][NEUTRAL] OK, so for the [PII], let me see, was this the $75.01 though? Are you sure it's [PII]?
[CUSTOMER][NEUTRAL] Uh, let me look. I thought it was.
[CUSTOMER][NEUTRAL] [PII], dermatologist.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Oh, so this is different from the wellness.
[CUSTOMER][NEUTRAL] Uh, well, well, I call it wellness.
[CUSTOMER][NEUTRAL] It's my yearly if I get some things done, screening, whatever you wanna call it, then they pay, yeah, [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so then this.
[AGENT][NEUTRAL] OK, [PII], there is a claim on file. It's totaling $61.60.
[CUSTOMER][NEUTRAL] OK, that's something that, uh, they've already paid that, that, that was done that day. But there should be a $75.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me look for. I was looking for 75. OK, so hold on one second.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I
[CUSTOMER][NEGATIVE] And you know what, I could have, I could have, I could have sent in after that, I could have sent in soulless mammography for me.
[CUSTOMER][NEUTRAL] Our stuff in in the
[CUSTOMER][NEUTRAL] The 57 cancer and then I sent in, I think so was just so y'all could pick whichever one y'all wanted.
[AGENT][NEUTRAL] So there's one let me check the second claim then because there's only 2 claims here so it has to be this one because that's the only other one. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Now this one says [PII] also.
[AGENT][NEUTRAL] And it does say wellness.
[AGENT][NEGATIVE] Excuse me, but it was denied because office visits aren't covered on the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, even though it's the check me everywhere for cancer?
[AGENT][NEUTRAL] I don't think they ran this, hold on one moment. You know what the difference is?
[CUSTOMER][NEUTRAL] Yeah, cause, cause they've paid it before. Uh-huh.
[AGENT][NEUTRAL] These other ones are, uh, these other ones are coming in as mamo, that is wellness, that's like your.
[CUSTOMER][NEUTRAL] Yeah, let me guess the coding.
[AGENT][NEUTRAL] And that's what you're getting the $75 for. This one here is listed as an office visit.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like you just went to the doctor.
[CUSTOMER][NEUTRAL] OK. You know what, I don't, I don't, I don't care. Yeah, I don't care. It, it actually was my scan, uh, screening for, for cancer, I mean, for skin cancer, but that's fine. They'll only pay $75 once. But is, is the, is the memo the one that they sent a $75 check to my old address?
[CUSTOMER][NEUTRAL] In March?
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Let me get the check number, see where it was sent. Hold on one moment.
[CUSTOMER][NEUTRAL] If it's in March, if it was in March, that's it.
[AGENT][NEUTRAL] Yes, this was in the service was in March or we received it in March. This is from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right. The check was in March. They sent it to my old address. I've already called once and sent in a direct deposit, which y'all somehow didn't get, even though I have the fact sheet from last Friday. That's what everything about this this year, it's usually so simple. Um, but anyway, I called last week and they were supposed to stop that check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Not wait 30 days since it was uh APL's fault for sending it to an incorrect address and go ahead and issue me a new one, but I was hoping that y'all would get the direct deposit form first so y'all could just direct deposit it to me.
[AGENT][NEUTRAL] OK. So, let me take a look at this and see what's going on with the request.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] And I just, I, I think, I don't know if she told you. I just sent the direct deposit form again. So after we finished, she's gonna
[CUSTOMER][NEUTRAL] Double check that y'all got it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, do you mind if I place you on just a brief hold? I'm looking at the notes, so I see what they did on the [PII]. I'm looking for the update of that voided check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. Um, so there's a few things I'm going to do.
[AGENT][NEUTRAL] So let me ask you this. Is the [PII] the correct address or the [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so that's been corrected.
[AGENT][NEUTRAL] And then I'm going to see.
[AGENT][NEGATIVE] Because from what I see, I, I don't see anywhere where the check was voided. So I'm getting ready to send this to my um team, team lead because I don't understand I don't understand why that's not done. So I'm getting ready to send this to my team lead um so that we can get that.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Started and sent to the right address. So [PII], this is wrong, [PII] is the old address.
[CUSTOMER][NEUTRAL] Yes, 3 years ago.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm only asking so I can get all the information together so I can get this corrected because I don't, I don't know why I don't understand. Um, so I'm gonna reach out to them and see if anyone has sent the void.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And see what they did from this, um, from this follow-up, and then I'm gonna give you a call, but you'll receive a call back from me today. I just don't want you holding while I'm doing all of this, or do you mind holding? It's up to you.
[CUSTOMER][NEUTRAL] Uh, I don't mind holding, but, but while you're checking, um, if you don't mind, I need you to check the exact same thing on my husband's because he has two claims, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That um
[CUSTOMER][NEGATIVE] That he's waiting for and it's probably the same thing that they haven't done anything.
[AGENT][NEUTRAL] Let me check one more thing.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, that's wrong. OK.
[AGENT][POSITIVE] I just, while I was looking, I, I kept questioning myself while I was looking and I'm like, I don't want her to have to wait while I'm looking through all this.
[AGENT][NEUTRAL] So I just want to check with you and make sure you are OK. So, I'm checking your husband's now.
[AGENT][NEUTRAL] Here goes his $75 from [PII].
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Is that correct? OK, let me see where that was sent. Hold on one second. What's that check number?
[CUSTOMER][NEUTRAL] If it was, yeah, if it was March, it was sent to the same place.
[AGENT][NEUTRAL] Yep. OK, so these are the two check numbers. And then what was the other, you said there was 3 for your husband, right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, right. When I, when I sent to [PII] the 57, I, I actually call myself sending it just because it was our routine cancer, uh skin cancer screening, but they picked up that he had a little, I don't know, skin tag, something cut off uh and sent in. So they were gonna look at that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] See if they would pay that, but they said they needed a pathology report to go with it. So on Thursday, I called the [PII] and they faxed over the pathology report to go with his 5/7 visit.
[CUSTOMER][NEUTRAL] So it would be two claims for him, the, the one that [PII] and [PII] and the one [PII]. So I wanted to make sure y'all have that, although I'm just kind of thinking you're gonna tell me no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] So outside of the
[CUSTOMER][NEUTRAL] The dermatologist for [PII] for [PII].
[AGENT][NEUTRAL] Outside of the, yeah, this isn't it, July. I'm just going through the
[AGENT][NEUTRAL] Do the claims, hold on one moment because it.
[AGENT][NEUTRAL] Is this all the same client number 881.
[AGENT][NEGATIVE] So the only claim we received from [PII] is just one, OK, this is [PII], but it, it, it didn't, it wasn't paid out on.
[CUSTOMER][NEUTRAL] No, because they needed a pathology report.
[AGENT][NEUTRAL] So that one, for that one, the pathology report hasn't been received yet.
[CUSTOMER][NEUTRAL] Yes, it was because I talked to the lady at [PII], I mean [PII].
[CUSTOMER][NEUTRAL] I held I held on while she faxed it.
[AGENT][NEUTRAL] OK, let me look at the other.
[AGENT][NEUTRAL] OK, I don't, I'm not saying that she didn't fax it. I'm saying we didn't receive it. After this claim is the claim in March and that's the only, those are the last two claims that we processed for you all. Before that.
[CUSTOMER][NEUTRAL] Yeah, no, no, it's the, it's the [PII] one. Do you show, do you show that y'all are waiting on a pathology report on it? Or do you even show that it's in the works?
[AGENT][NEUTRAL] So for [PII], there's several different um denial reasons. Hold on one second, let me see which one is for the pathology report. It might be this one.
[AGENT][NEUTRAL] Yes, OK, so there's a few, there's a few um lines here that are requesting the pathology report. The other ones.
[AGENT][NEUTRAL] Are like office visit not covered?
[CUSTOMER][NEUTRAL] Right. It, it also, yeah, somehow his code was not skin cancer check. But anyway, that's fine, that's fine because we both had several checks, checkups that qualified. So, so I don't care what the $75 comes for, I just want it. And also that claim on what they did that day, uh, that you need the pathology report.
[AGENT][NEUTRAL] But for
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, so, so once we receive the pathology report, they're just going to continue processing. There's nothing else to do at that point, but we haven't received it yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What number do you want to fax it to again?
[AGENT][NEUTRAL] So it's 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, and do they need to put like what number? uh claim number or whatever so they'll match it to the right.
[AGENT][NEUTRAL] Yes, ma'am, um, you can put attention APL claims department and then um the claim number is 357.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] 5881.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And then I'm going to um check back with you so that I can check on your um on these checks that were sent to the wrong address and to see if there is a void somewhere because I don't see it, but I'm going to double check it and then um I'll give you a call back with an update.
[AGENT][NEUTRAL] And it will be today.
[CUSTOMER][NEUTRAL] OK, and you're also gonna check and uh that um that y'all got the direct deposit form.
[AGENT][NEUTRAL] I can check that for you now, hold on one second.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And the direct deposit form would have been, how was it sent?
[CUSTOMER][NEUTRAL] Uh, I just texted it. It was, it was faxed on Friday, and I texted it today.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Text it, like emailed it.
[CUSTOMER][NEUTRAL] No, she said I could text it. Oh, I'm sorry, I'm sorry. Wait, wait, wait, hang on.
[CUSTOMER][NEUTRAL] It was something like public care or something.
[AGENT][NEUTRAL] Public care, I'm, I'm.
[CUSTOMER][NEUTRAL] Yeah, it yeah, yeah, it would have to be, it would have to be emailed because uh I didn't put a phone number in so yeah.
[AGENT][NEUTRAL] Oh, like care team?
[AGENT][NEUTRAL] Was it like care team at AM Public?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's it. OK, so hold on one second. Let me um
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Let me put that on my list for you. Hold on one second.
[AGENT][NEUTRAL] Email
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] And it would be so totally awesome if we could get this finished today.
[AGENT][NEUTRAL] I'm gonna call you back before I leave today.
[AGENT][POSITIVE] Yeah, we're gonna definitely um You're welcome and email direct deposit form to your team. OK. OK, so I'm getting ready to start on this and I will give you a call back in a few minutes as soon as I get the update on the void, um, the voided if they were even voided.
[CUSTOMER][POSITIVE] Thank you. I appreciate that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect and I'll, I'll be calling the dermatologist.
[CUSTOMER][NEUTRAL] I'll call, I'll call the dermatologist and get them to uh re-fax the uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Pathology report.
[CUSTOMER][NEUTRAL] Pathology report.
[AGENT][NEUTRAL] Alright, and then I'm also going to confirm the um direct deposit. I have the email team check and see if the direct deposit form uh.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] is here.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][POSITIVE] Alrighty well I will um give you a call back in just a little bit um with your updates, OK?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] You're very welcome. Bye bye.
[CUSTOMER][NEUTRAL] OK. All right. Bye-bye. Thanks. Bye-bye.