AccountId: 011433970860
ContactId: fb60ec76-f9dc-41de-8ea3-b8196a704984
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 844950 ms
Total Talk Time (AGENT): 394413 ms
Total Talk Time (CUSTOMER): 327058 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/fb60ec76-f9dc-41de-8ea3-b8196a704984_20250516T14:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, uh, good morning. My name is [PII].
[CUSTOMER][NEUTRAL] I'm calling uh regarding, I'm calling regarding the bill.
[AGENT][NEUTRAL] I'm sorry, what is
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Are you calling to check claim status?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, I can help you with that and if you could spell your name for me, please.
[CUSTOMER][NEUTRAL] My name uh [PII] Last name is [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And you have, you said you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] So far is one claim I had to check now. I don't know if I had an, I had ordered one.
[AGENT][NEUTRAL] I can help you and when you will use my name that I gave you along with today's date as your call reference number or numbers. Also, any information that is provided on any claim that I checked will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] And lastly, if we do have the claims on file once I provide you the excuse me, the claim number if you need a copy of that explanation of benefits, you should be able to print that by going to our portal which is located at [PII].
[AGENT][NEUTRAL] And [PII], what is your patient's policy number?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] The remember how do you mean?
[AGENT][NEUTRAL] I mean, the policy number. Mhm.
[CUSTOMER][NEUTRAL] No number?
[CUSTOMER][NEUTRAL] It's 680-429.
[CUSTOMER][NEUTRAL] 518.
[AGENT][NEUTRAL] OK, now that is not a policy number for our company, [PII].
[AGENT][NEUTRAL] What does the ID card show?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] What what do you mean that's the not idea I had uh from the.
[CUSTOMER][NEUTRAL] From the number they gave me, uh, they say you got it.
[AGENT][NEUTRAL] OK. [PII], are, are you the subscriber? Are you calling on behalf of a claim for yourself?
[CUSTOMER][NEUTRAL] I I cannot hear you.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Are you calling on behalf of a claim for yourself?
[CUSTOMER][NEUTRAL] Yeah, it's a claim uh yeah.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, I'm sorry. I understood.
[CUSTOMER][NEGATIVE] The doctor never uh you guys never pay the doctor.
[AGENT][NEUTRAL] I'm sorry, I thought you were calling from the doctor's office. So, first off, I will need to
[CUSTOMER][NEUTRAL] No, I'm I'm calling uh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] I'm calling for myself because you, you guys never pay the doctor bill that's what I'm calling regarding that uh bill.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information as I stated.
[CUSTOMER][NEUTRAL] I call them, they give me their number they told me I had to call you guys.
[AGENT][NEUTRAL] OK. So I will need to verify all of your information first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and also your home mailing address please.
[CUSTOMER][NEUTRAL] [PII] ZIP code [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the phone number that we have on file for you is one of them is the same as the one you gave me, so that is your cell number that you gave me, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you. And what is the date of, I'm sorry, the last piece of information to verify is your email address.
[CUSTOMER][NEUTRAL] Uh, the email address is uh.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, so we have [PII], but it does[PII] show as [PII].
[AGENT][NEUTRAL] Do you have more than one email account?
[CUSTOMER][NEUTRAL] Uh, yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service that you're calling about [PII], and the bill amount for that data service?
[CUSTOMER][NEUTRAL] The the service is uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And do you have a bill amount?
[CUSTOMER][NEUTRAL] And then the other one is, the, the other one is August, August.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 21
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] OK, do you have the billed amounts for these dates of service?
[CUSTOMER][NEUTRAL] $400?
[AGENT][NEUTRAL] For both dates?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I sent a I, I, they send me the form, I fill it. I will email it to you guys. You guys will receive it.
[AGENT][NEUTRAL] OK, so we do have one claim on file.
[CUSTOMER][NEUTRAL] If you look at NU
[AGENT][NEUTRAL] Yes sir, but the bill amounts you're giving me are different than what the claim is for, so we do show I have.
[CUSTOMER][NEUTRAL] What the
[CUSTOMER][NEUTRAL] What the bill show?
[AGENT][NEUTRAL] For the 412 data service.
[AGENT][NEUTRAL] There are two charges on there. One is for 400 and one is for 280.
[AGENT][NEUTRAL] I'm for 4, let me start over for 412, yes 400 and 280 and then it was submitted.
[AGENT][NEUTRAL] Um, for, for 12 also.
[AGENT][NEUTRAL] OK, so we have.
[AGENT][NEUTRAL] It was like it was, it looks like we received it twice, so give me just a moment it's all on one claim number but it appears to be the same information. The claim was denied, Mr. [PII].
[AGENT][NEUTRAL] And the reason for the denial states receipt of your claim is acknowledged.
[AGENT][NEUTRAL] However, in order to provide further consideration of this loss, this policy will need supporting documentation to evidence the accident or sickness.
[AGENT][NEUTRAL] Supporting documentation may include but it's not limited to itemized bills with the diagnosis codes, super bills, office notes, hospital admission and discharge summary or diagnostic testing results. So we are needing additional information for review on this claim.
[CUSTOMER][NEUTRAL] What do you mean what are the additional you need because when uh what
[AGENT][NEUTRAL] We need an, yes. We need an.
[CUSTOMER][NEGATIVE] I, I don't really understand, uh, I don't, I don't really understand people in [PII] anymore because, uh, when I'm paying $352 every month for paying, uh, paying you guys' insurance when it's time to pay the bill and I hear everything, uh, we have to tell me.
[AGENT][NEUTRAL] Not just the claim form.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] If, if you know I'm not gonna pay, pay the bill, I'm gonna have to go hire a doctor, uh, lawyer for you guys because I'm not gonna, uh, paying $352 every month for the bill when the bill coming in, everybody, uh, I'm calling here. They told me calling there when I'm calling there they told me call here. I keep calling people nobody can give me the right answer who gonna pay the bill because somebody had to pay the bill because I, when I, when I look at to go to the doctor.
[CUSTOMER][NEGATIVE] You guys give me a listed doctor to go when I go there now they told me that they not quit. They don't want to pay the bill. What I have to do now after they are paying $352 every month for the insurance past two years. Now I have, I'm the one who had to decide not to go work to pay the bill and I'm paying the insurance for.
[AGENT][NEUTRAL] I unders
[CUSTOMER][NEGATIVE] If you guys are not gonna pay it, I'm gonna have to hire a lawyer. Lawyer, you can't the guy is gonna have to talk to a lawyer about it because I can't do anything. I'm because I'm not gonna go pay all the money for the insurance. I'm gonna have to sue, uh, whoever I had to sue for it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so if you have
[AGENT][NEUTRAL] OK, so again for this claim we're needing additional information for the review in order to properly review this claim, we did not receive all of the required documentation to review this claim that we have on file for you.
[CUSTOMER][NEUTRAL] OK, what I'm gonna, what, what I'm gonna do, I'm gonna have to go to the doc.
[AGENT][NEUTRAL] So if you have any questions.
[AGENT][NEUTRAL] Uh-huh. Yes, sir.
[CUSTOMER][NEUTRAL] Listen, I'm gonna have to go to the doctor.
[CUSTOMER][NEUTRAL] Give me all the information.
[CUSTOMER][NEGATIVE] And I would mail it to you or either email it to you guys or fax it whatever you guys want me to do. Somebody gonna have to pay the bill if you guys not gonna pay the bill, I'm, I'm gonna have to lawyer have my lawyer talk to you guys.
[AGENT][NEUTRAL] You would need to fax it.
[AGENT][NEUTRAL] You would, you would need to fax your information to our claims division because we cannot accept claims information via email and I can give you that fax number that you would send it to.
[CUSTOMER][NEUTRAL] OK, give me the fax number and I, I'm gonna go back to the doctor to give me all.
[AGENT][NEUTRAL] OK. 877.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] 77
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] 365.
[AGENT][NEUTRAL] 94.
[AGENT][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] 94.
[CUSTOMER][NEUTRAL] 23.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Attention claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Attention claim support?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] And again, for this claim for further review, we're needing an itemized bill that includes your diagnosis codes.
[AGENT][NEUTRAL] Treatment codes for this date. Mhm.
[CUSTOMER][NEUTRAL] Often.
[CUSTOMER][NEUTRAL] Extension uh
[AGENT][NEUTRAL] Attention
[CUSTOMER][NEUTRAL] The what?
[AGENT][NEUTRAL] Attention claims department.
[CUSTOMER][NEUTRAL] P
[CUSTOMER][NEUTRAL] Clam Zipper.
[AGENT][NEUTRAL] Yes sir and then if you have any questions regarding the type of plan that you enrolled for there is another uh phone number and company that you would speak to regarding that Mr. [PII], and that is you would need to contact member services and I can give you their phone number and an email address for them if you have any questions on that.
[CUSTOMER][NEUTRAL] OK, I'm gonna go, I'm gonna go ahead and go back to the doctor. They're gonna give me all you guys say you, you, you guys need all the information uh uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said you guys say I have to get the diagnosis uh information.
[AGENT][NEUTRAL] Yes, sir. On this claim, and you should have received an explanation of benefits from APO in the mail.
[AGENT][NEUTRAL] That stated this information, but we're needing yes sir we need supporting documentation.
[AGENT][NEUTRAL] For these dates of service.
[CUSTOMER][NEUTRAL] OK, why don't, uh, what, why, why don't you guys send me, uh, the form what I need to go explain to do to go to the doctor. The doctor can send.
[AGENT][NEUTRAL] Yes, sir. This was mailed.
[AGENT][NEUTRAL] Yes, sir. It was mailed to you on [PII].
[AGENT][NEUTRAL] Or [PII], actually.
[CUSTOMER][NEUTRAL] Yeah, that the one the doctor.
[CUSTOMER][NEUTRAL] Did they say [PII]?
[AGENT][NEUTRAL] Is that from
[CUSTOMER][NEUTRAL] Information request.
[AGENT][NEUTRAL] This would have been from American Public Life Insurance. It would have had your claim number on it and on page 2 it has those exact remarks that I just read to you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I, I had it right in the front of my hand, right in the front of me.
[AGENT][POSITIVE] Yes. And on page 2, it gives you that remark for what we are in need of.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEGATIVE] It's only one page they send me that they don't have two pages.
[AGENT][NEUTRAL] Is there anything printed on the back of it?
[CUSTOMER][NEUTRAL] The back of it, uh.
[CUSTOMER][NEUTRAL] Probably do give me a reference number.
[CUSTOMER][NEUTRAL] Policy number
[CUSTOMER][NEUTRAL] That's the explanation benefits.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] That's the, the one I saw in the in the.
[CUSTOMER][NEUTRAL] description, uh, we see that your claim.
[CUSTOMER][NEUTRAL] Technology or whatever order provider.
[AGENT][NEUTRAL] Yes, so that's it.
[CUSTOMER][NEUTRAL] OK, I, I'll take it to the doctor, uh, by Monday to, to bring it to them. They can give me all the information and I'll fax it to you guys.
[AGENT][NEUTRAL] Yes, sir. Well, that will be fine, ma'am.
[CUSTOMER][POSITIVE] OK, thank you, bye.
[AGENT][NEUTRAL] OK. Well, you're welcome. Is there anything else that I could help you with this morning, Mr. [PII]?
[CUSTOMER][POSITIVE] That should be it, thank you.
[AGENT][POSITIVE] OK. Well, you're welcome and thank you for calling APL. I hope you have a very nice weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye-bye.