AccountId: 011433970860
ContactId: e8114d07-9ecf-4a67-9a24-5bc704a492d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 995520 ms
Total Talk Time (AGENT): 438983 ms
Total Talk Time (CUSTOMER): 417904 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/e8114d07-9ecf-4a67-9a24-5bc704a492d2_20250122T18:43_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yes, hi, um, I originally had some, uh, I went into the doctor and with for the first time with my insurance and they were having a problem trying to verify it and they couldn't verify it in time, so I went ahead and made a credit card payment of $250.
[CUSTOMER][NEUTRAL] Uh, when I got home, they, uh, someone told me to, um,
[CUSTOMER][NEUTRAL] Make a claim to get that reimbursed so I did that I I emailed or I faxed. I can't remember how I sent the information over uh to get that refund and so I was just checking to see if that had ever.
[CUSTOMER][NEGATIVE] Uh, if you guys ever, um, made that credit towards me or refund because I'm looking at a bill here and it shows my $250 credit card payment, but then it also shows a negative $500 credit card payment. I, I, I'm not, I'm, I'm not sure how this broke down, but I just wanted to make sure that.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, trying to see if that $250 credit card payment I, I made was, was is supposed to get, uh, you know, I was supposed to get reimbursed for that.
[AGENT][POSITIVE] Yeah, I can definitely help you with that.
[CUSTOMER][NEGATIVE] I don't, I never, I never, I never received anything, but I don't know if it went like a credit into my bill or how that worked out, but I'd like to figure it out.
[AGENT][NEUTRAL] Yes, OK, let's take a look at that. Do you have your policy number handy?
[CUSTOMER][NEUTRAL] Policy, oh, like my, um, insurance?
[AGENT][NEUTRAL] Yeah, that, yeah, your insurance policy number?
[CUSTOMER][NEUTRAL] Card
[CUSTOMER][NEUTRAL] Uh, yeah, give me one second, sorry.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Would would that be like my member number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Yeah, OK, give me one sec, sorry.
[CUSTOMER][NEUTRAL] Here, OK, so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, my member number is 682-239-396.
[AGENT][NEUTRAL] All right, um, is there another number on that? That one's a little too long for our policy numbers?
[CUSTOMER][NEUTRAL] Hm, let me see.
[CUSTOMER][NEUTRAL] There's a group? oh hold on.
[CUSTOMER][NEUTRAL] So that was what, 9 digits?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah I have a group number.
[AGENT][NEUTRAL] OK, I can look you up with the group ID number.
[CUSTOMER][NEUTRAL] The group ID is G for like graph.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1203273
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 1203273
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, and I just want to make sure you're looking at your APL insurance card?
[CUSTOMER][NEUTRAL] I'm looking at my PCS.
[CUSTOMER][NEUTRAL] Limited benefit plan it says PHCS.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so that's gonna be different than the American Public life one, and I guess I just wanna make sure.
[AGENT][NEUTRAL] When you called, were you trying to reach American public life or were you trying to reach the 90 degree benefits?
[CUSTOMER][NEUTRAL] Um, I'm not sure. I got this number from.
[CUSTOMER][NEUTRAL] Oh, who gave me this number? I, I thought it was um.
[CUSTOMER][NEUTRAL] When I called the the number on the back of this card for uh.
[CUSTOMER][NEUTRAL] I was trying to verify my coverage or something like that um and they gave me this number and said it was for claims.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, do you, um.
[AGENT][NEUTRAL] So sorry, I'm just trying to pull up some information I have. Was it the number that was like 833-429-6?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 83
[CUSTOMER][NEUTRAL] 833, no.
[CUSTOMER][NEUTRAL] No, it was the number on the back of my medical card, uh, PHCS limited benefit plan. It says plan name FEAmericare 200.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, they, I don't, I'm not sure, um.
[CUSTOMER][NEUTRAL] Sorry, I got kind of lost with all this yesterday. I was back and forth.
[CUSTOMER][NEUTRAL] Uh, between the hospital and the, the insurance provider, uh, and Novacare is my insurance, NovaCare 7853.
[CUSTOMER][NEUTRAL] Um, yeah, I don't know. It says a legacy account.
[CUSTOMER][NEUTRAL] Uh, it's like an older account I guess. I'm not.
[CUSTOMER][NEUTRAL] I'm super confused about where I.
[AGENT][POSITIVE] No worries. I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Understand because it seems like there's a lot, a lot of information coming at you, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So what I can do is if you have a policy with American Public Life I can search it with your social security number um PHCS is also known as multi plan um and they have another phone number I can give you if you need to reach out to them um but let me at least try while you're on the phone with me to see if you have a policy in our system, OK?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me get the search screen up, and what is, what's your social security number, sir?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your first and last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, [PII], and you do have a hospital indemnity policy with me. It looks like I just need to verify some additional information if you could verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. And uh, would you be able to verify with me your
[AGENT][NEUTRAL] Mailing address?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Wonderful and uh the email on file pretty please.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Perfect thank you I appreciate that.
[AGENT][NEUTRAL] All right, and so I do see your policy here. Um, it looks like the policy you have, I'm so sorry, hang tight, um, I don't see any claims on file. The last thing I saw came through it looks like.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] February, [PII] was the last thing I had submitted on your behalf, um.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So I'm not sure. I don't have any recent claims on file that were submitted um do you know where you where you sent that your claims to like what address?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] No, it's, it's been so long. I, I don't know, um, I am looking at my statement here though, and it shows my payment of 250 and then right below that it shows negative 500. Do you think?
[CUSTOMER][NEUTRAL] Do you think um
[CUSTOMER][NEUTRAL] Yeah, that's weird though. Why, why does it say -500? It shows credit card payment -5, 0, because they took 2.
[CUSTOMER][NEUTRAL] What they do, give me the 250 back and take 250.
[CUSTOMER][NEUTRAL] And then minus the 74, yeah, I don't understand this statement either, um.
[CUSTOMER][NEUTRAL] Yeah, I don't know, I don't know. I just know I made a $250 credit card payment to the doctor and I sent in, I sent in the receipt.
[CUSTOMER][NEUTRAL] And uh I, I send in all the information they asked me to send in.
[CUSTOMER][NEGATIVE] But I never got a, a reimbursement. How do you guys do reimbursements? Do you guys send a check to the house or something?
[AGENT][NEUTRAL] Yeah, so if it came from us what we do is if you file the claim yourself we reimburse you and if the provider sends us the claim information um we reimburse the provider.
[CUSTOMER][NEUTRAL] You probably reimburse the provider then because I think they sent all this information and then there are some adjustments here on this. I'm thinking it might have got adjusted on my bill.
[AGENT][NEUTRAL] So I'm only seeing one claim on file that came in for you, my friends and it was from a visit you had in [PII] um and but I'm not showing that any benefits were payable on that claim um it says that we had an incomplete um we had incomplete information and that we needed um.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] We need a fully itemized um like a fully itemized bill with your procedure codes and individual charges uh and then we also need your diagnosis codes to file the claim so we never submitted benefits payable for that claim because there was additional information we had needed um and then it does not look like the provider followed up and submitted a claim we just have the one that came through um but there was more information we needed on our part to process.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And who do you get that information from? The doctor or?
[AGENT][NEUTRAL] So ideally a doctor would um like your doctor's office would uh submit the claim and send all that information but because you submitted that claim um you would need to follow up and submit that information um you were and I wanna verify you weren't at a hospital, right? You were at like a doctor's office.
[CUSTOMER][NEUTRAL] The, the, the hospital
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I can give you the name of a form you can ask for for them and submit to us and then if there's any benefits payable we'll send it to you and then as far as the bill and the statement they sent you, I, I'm not really gonna lie I'm not sure what that $500 like deduction is and it might be something that their billing department can help you with.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, but if you do wanna follow up and see if you have benefits payable from your policy with us, the name of the form you wanna ask for, it's uh CMS Charlie Sierra, um, CMS 1500, and if you ask for that form, it will have all the information we need to move on with your claim and you know potentially have some benefits payable for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, because I mean on this statement that that Sharp, you know, Sharp sent me, they sent me a, they sent me a bill and on the bill it shows a bunch of multi-plan adjustments.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh, you do get discounts for being a multi plan member so that PHCS that's multi plan and they do give you discounts for being a member with them.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right, so I got everything discounted, but is that correct? Uh, is this supposed to be covered like 100% like and not just discounts?
[AGENT][NEUTRAL] So
[CUSTOMER][NEGATIVE] This is just so confusing.
[AGENT][NEUTRAL] Yeah, so I can't tell you like with certainty what's covered and what's not without the information from that claim form with your diagnosis code and your procedure codes um so I we'd have to have that on hand to like be able to tell you about the coverage on it um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] I do know that multi plan offers discounts if you see a multi plan provider um and it was really nice that they just put that on there for you because sometimes you have to outright ask for it um.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] But again, uh, if you can get that form from your provider, um, the CMS 1500 and send it into us if you have any benefits payable, um, we'll be able to pay you out for them and then you can use that money however you want to use it. I mean you could, I, I don't know you could go out to eat with it or you could pay the provider, um, but that money will come back to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And that claim form because ATL I'm not sure what APL is.
[AGENT][NEUTRAL] Oh, that's for American public life.
[CUSTOMER][NEUTRAL] But they sent me
[CUSTOMER][NEUTRAL] Oh, that's you guys. OK, yeah, you sent me a form yesterday, um, it's a hospital indiminiity and everyday solutions claim form.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, I'm not sure what this is, but they sent, they sent me a claim form yesterday. It was, uh.
[CUSTOMER][NEUTRAL] I don't, I don't see CMS 1500 on it though.
[AGENT][NEUTRAL] No, the CMS 1500 you have to get from your provider's office.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] The provider is who? The, the doctor, the hospital? Oh.
[AGENT][NEUTRAL] Sure, yeah, uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK. Let me write that down. Yeah.
[CUSTOMER][NEUTRAL] 34.
[CUSTOMER][NEUTRAL] From Sharp. OK, so I can get that from them and send it to you guys?
[AGENT][NEUTRAL] Yes, send that to us and if you have any benefits payable we'll be able to send you a check for them.
[CUSTOMER][NEUTRAL] Where do I send that to?
[AGENT][NEUTRAL] Yeah, absolutely. So once you get that you can fax it. It looks like the original one you sent us was faxed, um, you can fax it to us at [PII] or you can upload it to your online portal if you have the online log in through APL um and it looks like you do have the online um it looks like you're set up on our online account so you can just upload it.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, well I'll work on that.
[CUSTOMER][NEGATIVE] OK, um, well, that's good. I'll, I'll work on that claim form. I, I just went through all of this yesterday and I can't remember anything that where I ended, who was what I got multiple bills. This insurance seems like it's it's just been a nightmare. Every time I go in, they can't verify, then I get bills sent to my house and nobody, I'm back and forth all over the place. This is kind of just crazy, but um.
[AGENT][NEUTRAL] I'm so sorry if you give them our phone number, the [PII], they can call us directly and we will be able to verify information um with your with your provider's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Average for.
[CUSTOMER][POSITIVE] Awesome. OK. All right. Well, thank you for all your help.
[AGENT][POSITIVE] Oh it's my pleasure and if you need any more help along the way you have more questions I know it's confusing give us a call back we'll be very happy to help you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] My pleasure, take care.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.