AccountId: 011433970860
ContactId: f6a3f608-daaf-43e9-b78f-942d315943f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 559640 ms
Total Talk Time (AGENT): 222266 ms
Total Talk Time (CUSTOMER): 295049 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/f6a3f608-daaf-43e9-b78f-942d315943f7_20250305T16:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes, hi [PII], how are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] Good. This is [PII]. Um, I am a policy holder through my husband's, uh, work, and, um, I have a question about relating a claim relating to a claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, is it on you?
[CUSTOMER][NEUTRAL] Yes, it is actually. Um, I received a bill from Baycare, um, which is where I had my imaging done.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um they always, we've always had coverage where um American Public Life covers, I think it's $200 per day of any outpatient imaging.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And uh they they've always covered everything and I received a bill the other day from Baycare and they're saying that there was a claim that was unpaid from [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] And how, uh, which is odd because there's been claims after that and those have been paid. So we're not quite sure what happened. She said it was submitted twice to American public life and it was never processed.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. What's the policy number?
[CUSTOMER][NEUTRAL] Um, our policy number, hold on one second. Is it, uh, the group number or is it at the outpatient?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Mhm. The outpatient.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, outpatient it's 02472984.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, [PII], and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, let me pull up your file.
[AGENT][NEUTRAL] And [PII], verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you said the claim is for yourself?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the service date? And I can take a look at it for you.
[CUSTOMER][NEUTRAL] Uh, November, yeah, [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Did you say you received something in the mail from American Public Life or you received something from your provider?
[CUSTOMER][NEUTRAL] No, from the provider from Daycare, um, they said it was submitted twice. Now, another interesting thing that they told me was the policy number that they have.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is different than the policy number that I just gave you, so this is, I'm not quite sure why this is, it's kind of interesting, uh, they have a policy number of 01699419 ML 8 which is not the same number that we have on our card.
[AGENT][NEUTRAL] Yeah, so both numbers are.
[CUSTOMER][NEUTRAL] So I'm not quite sure if there's something.
[AGENT][NEUTRAL] I'll explain both numbers are valid. Yeah, the 1699419 was effective [PII], so the date of service that you provided is gonna fall under that policy number.
[CUSTOMER][NEUTRAL] Say that again.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Your current policy is 2472984, but it wasn't effective until [PII], so we can't process it under that one because the date of service is prior to that date.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Right, right, right, right. Yeah, so.
[AGENT][NEUTRAL] So they they submitted it correctly.
[CUSTOMER][NEGATIVE] Yeah, I don't know what's going on and I've had multiple imaging done and they've always received payment. I mean, she went back and checked previous ones and she said, yeah, all of these have, have had no trouble. She said, so I don't understand why this particular one, it was never processed or paid.
[AGENT][NEUTRAL] So now, let me
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], you said the claim is for yourself?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so I'm looking under policy 1699419 for date of service [PII], and I don't show a claim receipt.
[CUSTOMER][NEUTRAL] I'll give you the claim number that they gave me, is S as in Sam 2521570300102.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that sounds like your major medical policy claim number.
[CUSTOMER][NEUTRAL] Oh, OK. That's what she gave me as far as the claim number.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, and so what did that claim number to know that they've submitted the claim or if they have a claim number then it.
[CUSTOMER][NEUTRAL] Yeah, she said that
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] She said that they had, they submitted it twice and uh it was paid neither time that's all she, that's all she told me.
[AGENT][NEUTRAL] OK, so it sounds like.
[CUSTOMER][NEUTRAL] So I don't know if you could call, I don't know if you could call Baycare directly and maybe they could help answer your questions or you guys between the two of you can figure it out because I, I'm the middle person and I don't really know, you know, what each uh each side is looking for.
[AGENT][NEUTRAL] OK, so let me explain, we've not received the claim, so it hasn't been processed on our end, so the claim, the claim number that you gave me is from the primary insurance so you would need to verify with the healthcare provider if they submitted it to APL because the number you gave me is for the primary.
[CUSTOMER][NEUTRAL] They did.
[CUSTOMER][NEGATIVE] Right, well, maybe they don't understand that that's what the lady gave me and she said it was submitted twice and it was not paid, so you know I.
[AGENT][NEUTRAL] The the
[AGENT][NEUTRAL] OK, so [PII], what I'm telling you is that the claim number that you provided is for your primary insurance. So I guess did they specifically state they submitted the claim to American Public Life?
[CUSTOMER][NEUTRAL] Yes, ma'am. I asked her 3 times. Was it specifically sent to American public life? She says, yes, maybe the person who was on the other side didn't know what she was talking about.
[AGENT][NEUTRAL] Uh-huh. OK.
[CUSTOMER][NEUTRAL] Yeah, I find that more and more, more and more you call these places and it's luck of the draw who you happen to speak to, but I can call back again a second time, you know, I can call back again a second time and ask and tell them that I've confirmed with you and that it was that number, that claim number they've given me is the number for the our major medical and not for American public life, and it was not submitted.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because I do feel that
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right. Correct. And I see, and I do see it.
[CUSTOMER][NEUTRAL] OK, so I'm gonna give him a call back.
[AGENT][NEUTRAL] Yeah, I do see other claims that have been submitted, so the address that they have, um, I don't think that that's the problem, um, so I don't know why we wouldn't have received this one, but I, I'm, I'm, I'm now questioning it because of the claim number that they gave you, which is not for APL, so there may be some confusion there, um, but the policy number is correct, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know either, yeah.
[CUSTOMER][NEUTRAL] OK, that's probably what's going on.
[AGENT][NEUTRAL] Um, what I can do, [PII], I'm gonna give you our fax number. Um, I don't know how they're sending it if.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have it on the back of the card. I have it on the back of the card. Is it the [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, that's correct and you may want to verify how they are submitting it. They could send it to us electronically or they can fax it or mail it.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, whatever the way they're doing it the other times it seems like it's going through. It's just this one particular time that it did not, um, it did not go through, yeah, I guess. And, and I, and it's interesting.
[AGENT][NEUTRAL] Go through.
[AGENT][NEUTRAL] Yeah, and since it's uh mhm.
[CUSTOMER][NEUTRAL] It's interesting because then do you see a claim there from [PII]?
[AGENT][NEUTRAL] [PII]. Let me look.
[AGENT][NEUTRAL] And so now under policy 2472984 for that date of service.
[AGENT][NEUTRAL] Because of the data service.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And this this claim is for you as well, [PII]?
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] OK, [PII]. I don't show that claim for you.
[CUSTOMER][NEUTRAL] OK, see, and the lady also gave me a claim number that has uh an S again S2525215703. So that's again like you said, the medical. What, what is a claim that's got, that's an APL claim? What, what kind of lettering does that have?
[AGENT][NEUTRAL] It's all numbers, no letters so for instance, you know, like one of your claim numbers just for a random claim number is 354-826-8 and it's gonna contain 123 7ven digits.
[CUSTOMER][NEGATIVE] It's all numbers, no letters.
[AGENT][NEGATIVE] And all numbers, all numbers, no letters.
[CUSTOMER][NEUTRAL] 7 digits, OK.
[CUSTOMER][NEUTRAL] OK, OK, so it's something on their end that they're doing wrong.
[AGENT][NEUTRAL] Yeah, and I would suggest because it's a 2023 claim that they fax it, we'll get it quicker usually gets in your file within 24 to 48 hours from the time it was faxed over.
[CUSTOMER][NEUTRAL] OK, I will call them and tell them that.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK. All right, [PII].
[CUSTOMER][POSITIVE] Thank you for your help. I appreciate it.
[AGENT][POSITIVE] Absolutely. Any other questions?
[CUSTOMER][POSITIVE] That's all thanks bye bye.
[AGENT][POSITIVE] OK, uh huh, thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Bye-bye. Thank you.
[AGENT][NEUTRAL] Uh bye bye.