AccountId: 011433970860
ContactId: f8a6560c-ee12-4a6e-8a0c-3b8eeec442ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 751489 ms
Total Talk Time (AGENT): 383148 ms
Total Talk Time (CUSTOMER): 276696 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/f8a6560c-ee12-4a6e-8a0c-3b8eeec442ba_20250115T16:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am. What is your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I need to check the status on some uh claims.
[CUSTOMER][NEUTRAL] Um, that was submitted for my wife.
[AGENT][NEUTRAL] OK, uh, may I please have your name and your callback number in case we get disconnected and I can call you back please.
[CUSTOMER][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have your policy number handy or you need me to look it up?
[CUSTOMER][NEUTRAL] No, I got it, I think, um.
[CUSTOMER][NEUTRAL] Let's see 02533255.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And just give me one moment please. I'll pull up that policy and I'll have you verify some information for me if you don't mind.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We didn't put it to my card on your computer.
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] OK, now I see this policy is listed under is this um go ahead and verify the insured, uh huh, the insured's name and date of birth.
[CUSTOMER][NEUTRAL] for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] No, I thought, um, is, is Ms. [PII] available to give us permission to
[CUSTOMER][NEGATIVE] No, I'm not going through this again with y'all. This is the 10th time I've done this. Y'all have my power of attorney form, the forms that I filled out to be able to talk to y'all about her account.
[CUSTOMER][NEUTRAL] And all that, every bit of that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me just check for that. My apologies.
[CUSTOMER][NEUTRAL] All of it to you.
[CUSTOMER][POSITIVE] You're good.
[CUSTOMER][NEUTRAL] Every time.
[CUSTOMER][NEUTRAL] On the point.
[AGENT][NEUTRAL] Well, I do see that there was some claim information received. um, it is currently in line for profit and it's not been assigned to an, uh, it's not been assigned just yet, um, we are working toward that date, uh.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Ma'am, how long does this take?
[CUSTOMER][NEUTRAL] I mean, we've been in the hospital for 2 or for a month now.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEGATIVE] Trying to get from all the way back from the [PII], no, [PII] is when I started submitting claims. We haven't been paid out.
[CUSTOMER][NEGATIVE] She's been paid out nothing.
[CUSTOMER][NEGATIVE] We're stuck in a hotel room, we've racked up a bill of $250 million already with hospital bills.
[CUSTOMER][NEGATIVE] Trying to get claims and every time I call, I know it's not your fault. Every time I call, I get the same thing. We're looking at it, we're looking at it, we're looking at it. I mean,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, it's been received and that's just it it's not and it's not been reviewed yet. It's not been assigned, so there is a 10 to 15 day turnaround time for these type of claims.
[CUSTOMER][NEUTRAL] We're
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] So, um, we are currently working toward that date but the received date for the information received, um, it started on [PII], so, um, we're almost to that date within that time period like I said, there is uh a protocol when the mail comes in and claims come in.
[CUSTOMER][NEUTRAL] I understand that.
[AGENT][NEUTRAL] They're put in by date order they're received and then um like I said there is a processing time that it takes for these claims to be reviewed usually um this type of claim it takes a little bit longer and the reason for that is because sometimes the information that comes in it's quite uh a bit of uh information so they are given a little bit longer uh turnaround time to get the claims, um, you know, reviewed and processed um but again we are.
[CUSTOMER][NEUTRAL] 100
[AGENT][NEUTRAL] We're almost to that date, um, so I would say it would be assigned within the next uh day or so it should be assigned to an adjuster and then they'll begin the process of reviewing the claim.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So, um, do you, I see that it was set up through the online portal where you set up for those text alerts to get uh.
[AGENT][NEUTRAL] Uh, notice when the claim is, is being processed.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I haven't heard
[CUSTOMER][NEGATIVE] Anything from you guys. Nothing. I mean, I've been literally dealing with this for 2 weeks.
[CUSTOMER][NEGATIVE] We're in a hotel that we're having to pay $150 a night for out of pocket.
[CUSTOMER][NEGATIVE] I lost my job, got to take care of my wife.
[AGENT][NEUTRAL] I understand. I'm.
[CUSTOMER][NEGATIVE] She's sitting here with 4 cancer and we can't, we can't get her paid. This is stuff that she's been paying on for 25 years.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Y'all take our money every month, but when it's time to pay, you don't understand.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] Have you had anybody that's been terminally, I mean, diagnosed with cancer and you're having to go through all this and not get insurance and stuff paid?
[AGENT][NEUTRAL] Well, I'm, I'm.
[CUSTOMER][NEUTRAL] No, so don't say you understand. I'm sorry that I'm being that way, but
[AGENT][NEUTRAL] Um, you might, I mean, I'm not going to, right, I understand your, I understand your situation. I understand that, but unfortunately, there is a process and um it's not the claim is not being held up for any, any reason that um I can see like I said, we're just going by that received date, um which was received on [PII], so.
[CUSTOMER][NEUTRAL] So all these claims I've submitted from the [PII], but you're saying it takes 15 days for each one of these that I submit?
[AGENT][NEUTRAL] No, so what's gonna happen is because there is additional claim information that came in, um, after the [PII], I see some received dates of [PII] the [PII] and the [PII] as well. So once the claim is assigned, all the information will be reviewed at the same time, even though the those other dates that came in are.
[AGENT][NEUTRAL] Further out once the claim is like I said, assigned, um, they'll look and review all that mail so no it won't be an additional delay unless there's for some reason in additional information that's needed, but then at this time we don't know that because it's not been reviewed yet by the adjuster.
[CUSTOMER][NEGATIVE] So the adjuster calls and says, oh, this is not sufficient, and I got to start all over and send them more information. It's like every time we call, there's a reason or an excuse to why.
[CUSTOMER][NEUTRAL] It's typical instrument.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But our first claim was done on [PII]. So why wouldn't it retro back to 1222? Y'all paid us the $5000.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] In 2 days
[CUSTOMER][NEUTRAL] That was reviewed, but now it's taking.
[CUSTOMER][NEUTRAL] I mean, the first claim was 11222. That's more than 15 days.
[AGENT][NEUTRAL] Well, like I said, it
[AGENT][NEUTRAL] Um, let me see because it looks like there's, well.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, I don't see that particular information, uh.
[CUSTOMER][NEUTRAL] It's right under the one that says 17 for 1222 claim number 354481 amount paid 505296. So if I send everything in on the [PII].
[AGENT][NEUTRAL] Yes, I do see that mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] We actually have
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Why are we having to wait from the [PII], and that's longer than the 15 days.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] OK, well there was this additional information that needed to be reviewed, then we would need that information, uh, if we requested that then that's what we're waiting for is that additional information if there was an addition.
[CUSTOMER][NEUTRAL] You'll have it requested.
[AGENT][NEUTRAL] It
[CUSTOMER][NEGATIVE] I've got I've got no emails, no texts, no calls, no.
[CUSTOMER][NEUTRAL] Nothing.
[AGENT][NEUTRAL] Right, so what's gonna happen is when they review this mail that came in on the [PII] when we get to that date, which like I said will be in the next day or so, it will be assigned to that adjuster, they'll go back and review the information that was previously sent on that other claim.
[AGENT][NEUTRAL] Um, that we did pay out on, uh, in December, so there's additional information that we requested if you were trying to file, um, you know, for those benefits we needed that itemized billing information which is what it was requested and so I'm assuming that that's what is sent in under this new information that was received starting on the [PII] and like I said, once that's assigned.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEGATIVE] No, y'all never requested anything.
[CUSTOMER][NEGATIVE] Y'all have never requested anything after the [PII]. All these invoices and all this information, power of attorney forms, all that, I've had to do myself.
[CUSTOMER][NEUTRAL] Nobody's asked for any additional information.
[CUSTOMER][NEUTRAL] The only thing I was told to send in the claims.
[AGENT][NEUTRAL] It was included on that explanation of benefits that um about the hospitalization, and then it looks like there's some anesthesia benefit um that was um also we requested itemized bill for and as well as um the transportation. That was on the explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To who?
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEGATIVE] But where did that information go? Because I have never received anything from you guys, not one email, not one text, not one phone call. So you say you, y'all requested that. Where's it being requested from?
[AGENT][NEUTRAL] It's on the explanation of benefits that was sent with the payment that was uh previously processed for the $5000 informa that that check that was received.
[AGENT][NEUTRAL] There was a request
[CUSTOMER][NEUTRAL] I didn't
[AGENT][NEUTRAL] That would be the explanation of benefits letter.
[AGENT][NEUTRAL] So the, the
[CUSTOMER][NEUTRAL] From where though? Did you mail it or did y'all email it?
[AGENT][NEUTRAL] It would be mailed, sir.
[CUSTOMER][NEUTRAL] Why would y'all mail something?
[CUSTOMER][NEUTRAL] Like that instead of email.
[CUSTOMER][NEGATIVE] I'm not even home. I'm 8 hours from home.
[AGENT][NEUTRAL] Well, my apologies sir. I, it, it should be on the explanation of benefits if you're able to view that online on the online portal, you would see those additional codes that were included, um, as well as the dates of service that were processed with that claim 354-4481.
[CUSTOMER][NEGATIVE] I can't get in a car and go to my, my.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] We don't, we, we are, we have to mail it, um, we, we do have to send it out by mail, but it is available on the portal if you're looking on the portal that information would have been included on that claim form on that claim excuse me.
[CUSTOMER][NEUTRAL] I'm looking
[CUSTOMER][NEUTRAL] My [PII], I'm looking at the portal.
[CUSTOMER][NEUTRAL] Where do I look to see what information you need?
[CUSTOMER][NEUTRAL] Man, how come the last 5 people couldn't have told me this?
[AGENT][NEUTRAL] It would have been if you open up that explanation of benefits that shows the payment that was made.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In December.
[CUSTOMER][NEUTRAL] Yes, I'm looking at it. Yes, and it says the lump sum, the calendar year maximum.
[CUSTOMER][NEUTRAL] If you're doing this hospital confinement required service of a physician in order to give consideration to this data service, we need a fully itemized hospital bill, which I'll have.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That's all it says. There's nothing in here about needing additional information.
[AGENT][NEUTRAL] Well, that's the information I was referring to, sir.
[AGENT][NEUTRAL] That that that's the information.
[CUSTOMER][NEUTRAL] OK, that don't, they don't tell me anything. I've seen already.
[AGENT][NEUTRAL] OK, and that's what I said it's not been reviewed yet and that's what I'm I'm trying to explain to you.
[CUSTOMER][NEUTRAL] Gosh, I mean.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I mean we're not trying to, we're um we're not trying to hold up your claim like I said it has not been assigned yet so it's not been reviewed, but if that's the information that was forwarded to us then then once the claim is um assigned, it will be reviewed.
[CUSTOMER][POSITIVE] Alright thanks.