AccountId: 011433970860
ContactId: 0830ff31-0e59-41c0-9928-66e7e4e9ce77
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 573739 ms
Total Talk Time (AGENT): 163058 ms
Total Talk Time (CUSTOMER): 354180 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/0830ff31-0e59-41c0-9928-66e7e4e9ce77_20250624T15:53_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm sorry, what did you say your name was?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, I spoke with [PII].
[CUSTOMER][NEUTRAL] On [PII], uh, regarding the um.
[CUSTOMER][NEUTRAL] I procedure I had with, uh, let me give you my policy number so you can put me up, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is 02519.
[CUSTOMER][NEUTRAL] 419. That's again 02519419.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you. And [PII], may I have a good callback number for you?
[CUSTOMER][NEUTRAL] Yes, if we get disconnected, you just come back area code [PII]. Same number on file.
[AGENT][NEUTRAL] Thank you and can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] Yes, [PII]. Email is my full name [PII], and address is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised verification of coverage does not guarantee the payment of a claim, and I have you pulled up, Miss [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK, so the claim number reference.
[CUSTOMER][NEUTRAL] Uh, where's the claim number?
[CUSTOMER][NEUTRAL] It was checking just check number anyways, there's a statement that said you guys pay $70 for.
[CUSTOMER][NEUTRAL] The the the procedure, but the procedure was a 3 session procedure. It's an I uh for my glaucoma and it was, it had to be split up into 3 parts. So that's why they, they built it separately, but it's 11 procedure and um.
[CUSTOMER][NEUTRAL] But it would, I guess they don't know how to bill it to you guys correctly so that's why I had them put a note in the system, um, and then so they rebuild it for the uh the 2nd and the.
[CUSTOMER][NEUTRAL] They came back saying that benefit um benefit name not found.
[CUSTOMER][NEUTRAL] So you guys did not um.
[CUSTOMER][NEUTRAL] I guess process it to get paid.
[AGENT][NEUTRAL] OK, and it was for the same data service from [PII]?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah, so it's basically the same service except that it's a like a laser zap that they treat my eye and it had to be split into three sessions. But, you know, it's so um I guess how they do is normally.
[CUSTOMER][NEUTRAL] You know, they would, uh, split the 3 bills. So that's how they normally do because that's how they would collect from patients, but because I'm using my HL that I haven't, you know, um.
[CUSTOMER][NEGATIVE] Use any of them my benefits all year. I thought for sure it'll be covered, which it did, but it only got paid a portion of it because of the way it was built. So it should have been a total of like the, the amount of total of 20208 or something or 209.
[AGENT][NEUTRAL] OK, cause looking in history.
[CUSTOMER][NEUTRAL] Almost 20 and then
[AGENT][NEUTRAL] In history, I'm only showing that we only received that one claim.
[AGENT][NEUTRAL] And that was from Doctor [PII].
[AGENT][NEUTRAL] Nigi
[AGENT][NEGATIVE] We haven't received anything, anything else.
[CUSTOMER][NEUTRAL] Yeah, 9.
[AGENT][NEUTRAL] As of today.
[CUSTOMER][NEGATIVE] It, well, I did get uh a statement saying that it got denied. It says, it says benefit name not found and it says uh.
[CUSTOMER][NEUTRAL] Total benefit page 0 and that the explanation says office visits are not covered by the above number policy, but it's not an office visit, it's a procedure.
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] And insured primary insurance insured primary in mhm.
[AGENT][NEUTRAL] On that one?
[AGENT][NEUTRAL] I'm sorry, go ahead. I'm sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, I have 2 claim numbers that came back saying that it's not covered.
[AGENT][NEUTRAL] And those should be claim number 3612778.
[AGENT][NEUTRAL] And that is looking.
[CUSTOMER][NEUTRAL] Mhm and 786.
[AGENT][NEUTRAL] For an office visit on [PII].
[AGENT][NEUTRAL] And it looks like the office visit line was not covered, and the other two service lines, it looks like the primary insurance paid in full, so nothing was payable on those two lines.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] What, how should they bill it? Obviously, they're not billing it correctly because it's not an office visit. They try to collect the remaining of my procedure that's total for $209. You guys pay $70. So I owe a balance of $139 or something like that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And I have already instructed them to bill you guys a certain way but apparently it looks like.
[CUSTOMER][NEUTRAL] I mean, how should they bill it? Can you give me instructions? So I mean I feel like I'm gonna.
[CUSTOMER][NEUTRAL] Should I get them on the phone?
[AGENT][NEUTRAL] I mean, we can't tell the provider how to bill. It looks like their first billing that we received, it came in and processed. That one processed correctly. It looks like the for on that same claim procedure 92,100, it looks like the primary insurance paid in full, so no benefits were payable on that line. It looks like your primary, they billed $300.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the primary paid $72.92 and looks like there was an adjustment of 227.08.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So which, which one, which claim number was billed was paid so I can have them.
[CUSTOMER][NEUTRAL] Maybe word it that same way so they can collect the remaining.
[AGENT][NEUTRAL] It was processed under claim number 3604043.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's apparently um
[CUSTOMER][NEGATIVE] I don't know what they're doing. I, I, I already spoke to them on [PII] after I spoke to [PII], and I had [PII] help put a note in the system also that then, you know, my total cost for the procedure was 2009 or something like that, 210 surrounding off, and they paid for 70. I told them that they need to bill it um to collect the difference for the, you know, for that same procedure. But it, I got, which doesn't make sense because then I get these two other.
[CUSTOMER][NEUTRAL] Flames coming back that stated prior to those dates as, as visits you're saying. So I don't know what they're doing. All right. um, I'm sorry, I, I, I asked your name but I didn't jot it down. Um, what, what was it?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], um,
[CUSTOMER][POSITIVE] Yes, I got it.
[CUSTOMER][NEUTRAL] [PII], would you be able, do you see a note that [PII] put in there?
[AGENT][NEUTRAL] Uh, let me go over to that screen. One moment.
[CUSTOMER][NEUTRAL] That, that I'm trying to.
[CUSTOMER][NEUTRAL] OK. If you don't see it, will you do me the favor of updating it and putting a note that um.
[CUSTOMER][NEUTRAL] That I'm still trying to get.
[CUSTOMER][NEUTRAL] The office to bill you guys for that one procedure and that the.
[AGENT][POSITIVE] Yes, I do
[CUSTOMER][NEUTRAL] And the, you know, the balance I always.
[AGENT][NEUTRAL] Yes, ma'am, I do see that in the system. Do you have an EOB from your primary that's showing that 208 was applied to the co-pays, coinsurance and our deductibles?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, the only UOP I have is from your from ATL, the one that was paid on.
[AGENT][NEUTRAL] OK. Cause if you had that major medical EOB, you can file that yourself as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, the other two BOB is from you guys as where would it come from? You're saying my primary.
[AGENT][NEUTRAL] Yes, it will come from your primary, looks like Cigna.
[CUSTOMER][NEGATIVE] Yeah, no, I don't. They, they never sent me anything. I, yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'll, maybe I should call them. But anyhow, I'll, I'll have them, if you can do me a favor, [PII], you can just update the system that I called again today and then I'm gonna instruct Doctor [PII]'s office.
[CUSTOMER][NEUTRAL] To bill you guys the correct way for that.
[CUSTOMER][NEUTRAL] Um, one procedure I got that was broken into 3 laser zaps.
[CUSTOMER][POSITIVE] And they only, you know, I don't, I guess that's why, yeah, I appreciate it. Thank you so much, [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Ms. [PII], you're so welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Uh, no, that's all. You have a great day. I appreciate your help.
[AGENT][POSITIVE] Thank you. You as well. Thank you for calling American Public Life, [PII]. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Take care.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.