AccountId: 011433970860
ContactId: 1dbae45e-1baf-40d1-b7e7-a990ed8bbb0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 495339 ms
Total Talk Time (AGENT): 191472 ms
Total Talk Time (CUSTOMER): 264880 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/1dbae45e-1baf-40d1-b7e7-a990ed8bbb0e_20250110T16:08_UTC.wav
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[AGENT][NEUTRAL] For contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling about.
[CUSTOMER][NEUTRAL] My claim number 31351.
[CUSTOMER][NEUTRAL] 4630
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] So, I have an outstanding bill that the gap insurance was supposed to pay for me.
[CUSTOMER][NEUTRAL] And I keep receiving a bill from um from the hospital or from the, the place where the billing department for $610 and so I've been, I've tried to send in the information before.
[CUSTOMER][NEUTRAL] On the claim and it says um
[CUSTOMER][NEUTRAL] The explanation of benefits does not list the amounts applied to the deductible, co-pay or the insurance.
[CUSTOMER][NEUTRAL] I sent in whatever information I had from the hospital, from the billing department.
[CUSTOMER][NEUTRAL] And on it it says that
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The charges, the total charges was $2,202.50.
[CUSTOMER][NEUTRAL] And the insurance pay that amount?
[CUSTOMER][NEGATIVE] And the $610 was the amount that the gap was supposed to cover, but for some reason nobody wants to pay the bill.
[AGENT][NEUTRAL] OK. So, um, uh, if I could just verify your name, uh date of birth, and a phone number, please? I just wanna make sure I have the right, uh, documentation pulled up.
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And my date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII], is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. I do appreciate that. So I'm looking at the um at uh the documentation that you submitted to us.
[AGENT][NEUTRAL] This is, uh, normally the, the, the explanation of benefits that you receive, uh, you will receive this piece of paper that says explanation of benefits. Uh, here's a summary for you, the amount billed, your discount, your plan paid, you saved, that sort of thing, and then amount you may owe. Now there's a, the very next page.
[AGENT][NEUTRAL] Tells us the deductible co-payment and co-insurance that we're supposed to pay. So you, you have page one.
[AGENT][NEUTRAL] Of what we need, but there's, there's also one more page and it's the one that's right after this one.
[CUSTOMER][NEUTRAL] No, there's no, there was not any other page. All the information that I have I sent in from [PII].
[AGENT][NEUTRAL] And so
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the other insurance was uh from
[CUSTOMER][NEUTRAL] Uh, what was my insurance at the time? I can't remember. Could you remind me what's the name of it?
[AGENT][NEUTRAL] It looks like it's a UMR.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] UMR right, so that's the, that's the um information that UMR sent to me and now I have the paper from [PII] that says they have the bill.
[CUSTOMER][NEUTRAL] Which is the actual bill and it says the type of service outpatient, total charges $2,202.50 the amount you owe $610. So I've already, I had already paid my $100 outpatient deductible.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So, the, the amount owed the $610.
[CUSTOMER][NEGATIVE] Should have been paid already. This has been almost a year now.
[AGENT][NEUTRAL] OK. So is this for your deductible, co-payment, or co-insurance? Because there, there's nothing on here lets us know what that is. And uh simply because it says that you on.
[CUSTOMER][NEUTRAL] Which part? The $610?
[AGENT][NEUTRAL] Yes, is that for your deductible, co-payment, or co-insurance?
[CUSTOMER][NEUTRAL] Co-insurance.
[AGENT][NEUTRAL] And where does it say that on this, on this document? If it, if it, if it shows that, then we can go ahead and process it.
[AGENT][NEUTRAL] So what I'm looking at is the, is the explanation of benefits that that you submitted and we need it to actually state that it's your deductible, co-payment or co-insurance. Unfortunately, we actually have to have a form showing that. So if it's, if it's listed anywhere on here.
[CUSTOMER][NEGATIVE] OK, so I don't understand why y'all can't, I don't understand why if this is not the correct form that I have sent that I received, why doesn't, why can't your billing department contact the billing department and request the correct forms because.
[CUSTOMER][NEUTRAL] I'm not in um I don't I'm not in the the medical department so I can only provide you whatever papers that I am receiving and on here it says the total charges is $2200 and the amount I owe is $610. I was in my network.
[CUSTOMER][NEUTRAL] And I, I was in my network so my services were covered 100% and so the amount I owed is $610 and that was from my co-insurance because I also had to provide the co-insurance at the time of services which I did.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Your insurance company won't give us the information.
[AGENT][NEGATIVE] They won't give it directly to us.
[AGENT][NEUTRAL] Because this is, this is was or is your insurance and so they will not provide the insurance to us. And if it were just a case of us calling them, we would certainly do so, um, but they will not provide the information to us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They will only provide it to you who who was uh who who is their insured.
[AGENT][MIXED] Now there should be an 800 number on the explanation of benefits that first page, but there is always, there is always a second page to this, and it will always show the deductible, co-payment or co-insurance. So this is when, whenever UMR sends out these bills, um, there are always two pages to it. So the page that we have is the first page, which is great, but what we need is the second page that shows the deductible, co-payment or co-insurance. Now they will provide that to you.
[AGENT][NEUTRAL] But they will not provide it to us because we are not their insured. And it doesn't, it doesn't mean that you have to be in the insurance company to get it. You, you actually have to be the insured because you, uh, you had insurance with them, they will provide that information to you, but they will not provide it to us.
[CUSTOMER][NEUTRAL] Well, let me try to give them a call and um I'll try to see whatever because I'm sure I called them first the first time I tried to resolve this um situation this bill I called UMR was the UMR was the first point of contact for me and they told me something different from what you're saying so I will call them back.
[CUSTOMER][NEUTRAL] And I will ask them for the 2nd page of the billing that has a breakdown.
[AGENT][NEUTRAL] The part that shows the the right, yeah, the deductible co-payment.
[CUSTOMER][NEUTRAL] Deductible copay.
[AGENT][NEUTRAL] Yes, ma'am. That is, that is what we're looking for and then once we get that, then, then we will be able to finish processing the bill.
[CUSTOMER][NEUTRAL] Deductible, co-pay, and what was the other one?
[AGENT][NEUTRAL] Co-insurance.
[AGENT][NEUTRAL] So it's a, it's a deductible, co-payment or co-insurance and, and then once we get that, then that's, that is exactly what we're looking for and then we can finish processing the, the claims.
[CUSTOMER][POSITIVE] OK. Well, thank you for for uh
[CUSTOMER][NEUTRAL] Explaining that. Let me try to see if I could get the information because I'm tired of this bill, uh, calling me about this bill.
[CUSTOMER][POSITIVE] OK, thank you. Bye.
[AGENT][POSITIVE] OK, thanks for contacting have a good day.