AccountId: 011433970860
ContactId: 07085e12-6cab-4d75-8a27-c912fcab4305
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 679099 ms
Total Talk Time (AGENT): 267069 ms
Total Talk Time (CUSTOMER): 364461 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/07085e12-6cab-4d75-8a27-c912fcab4305_20250530T17:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi. Good morning, [PII], you said?
[AGENT][NEUTRAL] It's [PII] Good morning.
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, my name is [PII]. I got this letter, explanation of benefits, and, uh, it's saying that insured majors medical coverage providers provided full benefits, no benefits payable for this procedure. So I wanted to go over it because, um, I, you know, I got the additional APL coverage thinking that it would cover for things like this because I went to, uh, basically I had
[CUSTOMER][NEGATIVE] Um, I have glaucoma, and what it is is that I paid for my co-pay already, but the procedure, you know, it's not, uh, covered by my plan because, you know, it's, uh, you know, we have to meet our out of pocket first, or
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Or, or deductible for status and so forth. So I'm told that the APL when my, when my primary insurance doesn't cover for that I can use my APL and it's only um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, $210 for the whole procedure, and I don't know why it got, and I, you know, I, I have this benefit for, I think I bought it for 3 years now and I don't ever use it, and I don't know why it won't pay for this $210 bill. I think they only, they only some, yeah.
[AGENT][NEUTRAL] OK, Ms. [PII].
[AGENT][NEUTRAL] Right, I understand, and we, we.
[CUSTOMER][NEUTRAL] What do you need? uh, do you?
[AGENT][NEUTRAL] We can get you information.
[CUSTOMER][NEUTRAL] Do you need to pull my file up?
[AGENT][NEUTRAL] Yes, ma'am. Can I first get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, please. It's area code [PII].
[CUSTOMER][NEUTRAL] I do see a claim number on this piece, uh, explanation benefit if that helps pull me up.
[AGENT][NEUTRAL] Yes ma'am, can I get your policy number first?
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][NEUTRAL] Is that on the paper or do I need to pull up my card? Let me look for it.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So my policy number slash certification number is 02519419.
[AGENT][NEUTRAL] OK, let me pull in your policy real quick.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] You're very welcome, Ms. [PII]. OK, um, we'll need for you to verify your policy. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] So my email address is my full name, [PII] [PII]. My address is [PII]. And my, what else?
[AGENT][NEUTRAL] Your, um, your cell phone number?
[CUSTOMER][NEUTRAL] Uh, the one that I just gave you, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you very much, Ms. [PII]. I appreciate you verifying your policy.
[AGENT][NEUTRAL] OK, and then what is the claim number?
[CUSTOMER][NEUTRAL] That claim number again is, oh no, I haven't given that to you 360.
[CUSTOMER][NEUTRAL] 4043.
[AGENT][NEUTRAL] OK, let me pull up the claim real quick.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I don't know if they billed you for all three, but I see on the paper that it, it seems like they only bill you for 70 so far. I'm confused. I don't know how to read this, but basically, I, I, you know, went to my specialist, my glaucoma specialist, so I pay my $70 co-pay already, and then the procedure with the 3 session procedure is a laser uh procedure to help reduce the pressure in my eye for my glaucoma.
[CUSTOMER][NEUTRAL] And, um, uh, so each time I, I get zapped, you know, they'll, um, charge me $70 each, so the whole three procedures um for $210.
[CUSTOMER][NEUTRAL] And there's, and they've been trying to bill you since the end of the year in December, and um, you know, they said that they haven't heard back and the last time I went to visit, they said they'll try to reach out again and I guess uh we finally got this letter in the mail a few days ago.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. So I do see that $70 was paid.
[AGENT][NEUTRAL] To the facility [PII] and it was issued on [PII], so they just that payment just went out um for $70 and.
[CUSTOMER][NEUTRAL] Right. Mhm, mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Then we didn't receive the claim until [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] Oh, OK, so you, you only receive one.
[CUSTOMER][NEGATIVE] One bill and you guys did pay the $70 you guys didn't get the remaining?
[AGENT][NEUTRAL] No, there was a charge for $300.
[AGENT][NEUTRAL] And that was the charge that it stated that your insurance covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The full benefit, so no benefits are payable. So this policy only helps with deductible, co-pay and co-insurance and that $70 was paid.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so, um, they didn't, so they didn't bill you the remaining, which is, it was a total of 210. I don't know, I don't understand how they bill you, but I see here, because like I said, each time I go get zapped, it's the procedure is the, the entire procedure consists of three steps. And so I don't know why they split it up like that, but they told me that the, the last time I went for a follow up because you know how I had my first zapped at the end of the year.
[CUSTOMER][NEUTRAL] And so by the time it's all done, it was done in March or something and then so.
[CUSTOMER][NEUTRAL] Um, last a few weeks ago I went to visit them and they said that they haven't received any payment from you guys and wanted to collect the full amount of 210 from me and I said that no, it should be covered. So, um, can you do me a favor [PII], can you make a, uh, a note for in the system for me please, um, that, um, the remaining that they will be that they are billing for it's part of the same procedure, so it's not confusing.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] When they, I don't know how you how doctor's office is.
[AGENT][NEUTRAL] I can
[AGENT][NEUTRAL] Right, so what I can do, um, I can't make that note, um, because I'm not in the claims department. I'm not a claims specialist, but looking at what was sent that I can see now I can't see everything that was sent in because like I said I'm not a claims specialist the.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $70.
[AGENT][NEUTRAL] Like I said, your policy helps with deductible, co-pay, or co-insurance. That $70 was paid, the $300.
[AGENT][NEUTRAL] Um, amount for procedure 92,100 was covered by your insurance according to.
[CUSTOMER][NEGATIVE] Yeah, obviously whatever is paid by my insurance, you guys wouldn't have to pay it because that's what my insurance is for, right? But the part that I that they're not paying for is what I would like to use the APL to cover and they're telling me that I owe them 210 for the procedure.
[CUSTOMER][NEUTRAL] So, um, and they're supposed to bill you guys for the 210, but it seems like they only bill you for $70 like the instead of the $210 right? Because it shows that you guys did pay Doctor [PII] $970. OK, so should I basically can, um, so what notes can you put or can I speak to the claims department to.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, so
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Have them put a note so that when they do bill for the remaining of the 270 because you know how you guys pay 70 when they do bill the remaining 140 that it would be it would be part of the same procedure so it doesn't sound uh you know, as if it's something new.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Right, and yes, I can get you a.
[CUSTOMER][NEUTRAL] Are you able to put that in the system a note?
[AGENT][NEUTRAL] Uh, I can't put that in the note.
[AGENT][NEUTRAL] But I can get you to a claim specialist so that you can um talk to them um about the questions and statements that you have after I read the remarks on the claim for you. I can do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you. I appreciate.
[AGENT][POSITIVE] OK, you're welcome you're very welcome. It's gonna be a brief hold while I transfer you on over and I hope you have a wonderful weekend and we thank you for calling APL.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.
[CUSTOMER][POSITIVE] Thank you as well. Thank you. I'm sorry. Bye-bye.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], it's [PII] in the care team. I've got an insured on the phone. Her name is [PII].
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Um, her policy number is 251-9419, and she's been verified.
[AGENT][POSITIVE] Um, the number she's calling from is a good call back number.
[AGENT][NEUTRAL] And she's calling about claim number 3604043. I read her the remarks on the claim, and she has uh further questions about the claim so and she wanted to speak to somebody so I'm transferring her on over to you guys now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so you didn't know what she was, what her question was.
[AGENT][NEGATIVE] I am very confused about what she's wanting. She's talking about um.
[AGENT][NEUTRAL] The part of the claim that the insurance provided full benefits, but she said there's a second part to the claim that's gonna be $217 and she wants me to make notes that there's gonna be a second part, and I told her I can't do notes like that that I'm not in the claims department, that if there's a second part to the claim, it sounds like it needs to be submitted, but she's she's going all over the place with this claim.
[CUSTOMER][NEUTRAL] OK. So it sounds like there's gonna be a new, another claim that we're most likely was received down the road that we just haven't received yet.
[AGENT][NEUTRAL] That's what I'm thinking too, but she wants specific notes put in the system and I told her I cannot put those notes because I don't have that information in my hand to write those notes so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you can send it to me.
[AGENT][POSITIVE] OK. All right. Thank you so much, [PII]. bye-bye.
[CUSTOMER][POSITIVE] You're welcome.