AccountId: 011433970860
ContactId: 207ecf76-77dc-46b7-ae14-246ea8bea78e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 915400 ms
Total Talk Time (AGENT): 490837 ms
Total Talk Time (CUSTOMER): 380051 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/207ecf76-77dc-46b7-ae14-246ea8bea78e_20241230T14:41_UTC.wav
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[AGENT][NEUTRAL] ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. um, I'm a member and I am questioning a claim that they keep contacting me. um, I wanted to see if you could pull it up and you can talk to them again about it.
[AGENT][NEUTRAL] OK, yes, and I can help with that. [PII]. What is your policy number, please?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 02486627
[AGENT][NEUTRAL] Thank you. If I could verify your date of birth, please, and your phone number?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Now, is this for you or is it for a member of your family?
[CUSTOMER][NEUTRAL] It's for me, it's for me, but you know I gave you our policy number, but our policy number changed when we changed our plan a little bit, um and this, this bill is going back to before our plan changed in early 24, we changed in May and this claim has been going on since February.
[AGENT][NEUTRAL] I see. And what is the date of service?
[CUSTOMER][NEUTRAL] So I, I
[AGENT][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] The data service is 214 hold on 21424.
[AGENT][NEUTRAL] OK, well let me see if I can find it that way. Let's see.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] For you, OK.
[AGENT][NEUTRAL] Is this a facility bill or is it uh?
[CUSTOMER][NEUTRAL] It's um first pass.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you mentioned that you were having trouble with it. Um, what, uh,
[CUSTOMER][NEGATIVE] They said that they've, I talked to them in October when I first got a bill, and they said that I, I don't know if they had the my secondary, you know, I don't know if they had your insurance information correct. They said that they gave me something incorrect, but it looks like they might have sent it to you. I, I don't, I can't keep up with them. Anyway, I called them again today because I got another bill for 4449.
[CUSTOMER][NEGATIVE] And they said that they've submitted it a few times to my APL and they keep um not responding. I only see it submitted once and I can't tell when um.
[CUSTOMER][NEUTRAL] And it looks like you, uh, APL was asking them to send more information now they said that they sent the EOB from the primary insurance and that they sent all of the, um, I just hold on one second please. No, that's not us.
[CUSTOMER][NEUTRAL] You can ask them. I don't think that you're welcome. um, anyway, so, uh, they said that they sent it in the EOB of the primary and it has all the diagnosis codes and blah blah blah blah blah, but I don't see that they've done that and and they've said that they've sent it 3 times, which I don't see that either but um I just wanna see what's going on.
[AGENT][NEUTRAL] OK. Um, so let's look at the, uh, uh, what we do have here for uh [PII]. Um, we have uh
[AGENT][NEUTRAL] I do have a a um
[AGENT][NEUTRAL] A facility bill for Broward Health that was paid. Uh, I do have, um, let's see, there was one for um.
[CUSTOMER][NEUTRAL] Uh-huh, mhm.
[AGENT][NEUTRAL] For uh [PII].
[AGENT][NEUTRAL] Surat
[AGENT][NEUTRAL] Uh, uh, I'm sorry, not [PII], right, excuse me, um, let me see if I can get this right. I'm sorry. It's uh.
[AGENT][NEUTRAL] OK, yes, I'm sorry. Uh, it's for a North Broward radiologist, um,
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Now that's uh
[AGENT][NEUTRAL] Uh, we, they sent that to us twice, um.
[AGENT][NEUTRAL] It's just nothing is, nothing that I can see for that data service is being held for anything right now because uh we paid North Broward radiologist. Um, let's see who else there is, uh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] There's first it's on one EOB I can see from uh APL. It says Broward Health Medical, North Broward Radilogy and First Path.
[AGENT][NEUTRAL] I see, so.
[CUSTOMER][NEUTRAL] On this particular EOB it says paid 0 but you said that you paid them and I'm sure it's in here somewhere but.
[AGENT][NEUTRAL] On the, on the EOB that you received from us, does it have a policy, excuse me, does it have a claim number?
[CUSTOMER][NEUTRAL] Um, hold on, let me look, let me pull it back up.
[CUSTOMER][NEUTRAL] I'm looking on my portal um.
[AGENT][NEUTRAL] Oh right, yeah, it might still.
[CUSTOMER][NEUTRAL] Hold on one second.
[CUSTOMER][NEUTRAL] Yeah, hold on one second.
[CUSTOMER][NEUTRAL] And I only see one and it says 0, but I'm sure, yeah, I can see other ones where it says 2. I can see payments.
[CUSTOMER][NEUTRAL] But I don't see this first health one, so.
[CUSTOMER][NEUTRAL] On this particular EOB that I'm pulling up, uh, now I opened up a different one. Sorry, I gotta find the one that had all three.
[CUSTOMER][NEUTRAL] Um, 214.
[CUSTOMER][NEUTRAL] I see that one.
[CUSTOMER][NEUTRAL] Receive that one.
[CUSTOMER][NEUTRAL] Yeah, I guess the system.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Pulling up the file. I gotta find it again for the 214.
[AGENT][NEUTRAL] That's
[CUSTOMER][NEUTRAL] I had 3 of them on it um.
[CUSTOMER][NEUTRAL] Try to open this. OK, here it is. So it's got um a claim number 343-6944 that one had the first path on it and the other two that I think were already paid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK, thank you. Let me see what.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Now, um, on these, it looked like there was, uh, uh, on first, uh, on that, it looks like, um, you may have submitted these yourself, um, I'm not really sure. It's kind of what it's looking like, um.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sometimes I do when they only get frustrated because they're not doing it, but.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Right, um, so on that particular one, it looks like we, uh, uh, we were asking for an explanation, excuse me, not an explanation of benefits, but a, uh, a diagnosis code, uh, or at least to be told what the, what the event was for. But I'm not I'm not showing that they've actually sent it in themselves. So let me just see if I can't find this here and see what um.
[CUSTOMER][NEUTRAL] Yeah, they said they sent it 3 times and was it paid? was it paid to me sometimes I don't see when a smaller amount is paid to me, um, so I pay it. I don't see that.
[AGENT][NEUTRAL] Yeah, I don't, I'm not sure that it was, um, [PII], let me just see what we have here.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] And I do apologize. My computer's just a little bit slow. I'm just waiting for it to pull up. So the only thing for First pass that I see, I, I, I do see the North Broward radiologist, um, I do see Broward Heal. Now it looks like all of that was paid. But now I'm looking at First pass, um, and a billed amount of $141 and I'm not showing.
[AGENT][NEUTRAL] That they ever
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] That they ever uh submitted that to us. Now, what I can do, let me see if I can't find it again and it.
[CUSTOMER][NEGATIVE] And it's not even 141 because they sent it before they, they, I don't even know they they had it sent to, I think to APL first instead of Humana and then they send it to Humana and Humana ended up paying so there's only a small balance and I told them that after they sent that they needed but they said they've sent it 3 times which I don't I I don't see that anywhere but.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I'm just, I'm just saying.
[CUSTOMER][NEUTRAL] I'm half tempted just upload it myself because there's, but I'm always just yeah then I gotta track it so.
[AGENT][NEUTRAL] So it's, it's 44, it's $44.49. Does that sound correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, so let me just see, because I think what we're gonna do is we're gonna go, we're gonna bypass um um first pass because they have not uh submitted this at all. Uh, so let me just see. So what we were looking for was a diagnosis code and I have them from the ones that, the, the, the hospital did turn in their bill. It looks like the hospital did turn in their bill. So, um, on that bill was the diagnosis code that we're looking for. So what I'm going to do is this, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm going to go ahead and reprocess that one charge.
[AGENT][NEUTRAL] For, uh, the original, the original thing was $141 and then your deductible, uh, from, um, from your, uh, major medical is $44.49 dollars. I'm going to go ahead and uh reprocess this and pay it to you because you're the only one who has turned in a claim for this. Um, uh, first pass has not. And so I will go ahead and pay that to you. You should be getting, uh, I don't know what, do you have direct deposit with us? Let me just check it really quickly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I have it set up, yes, I have, I should have it set up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so then that way you, uh,
[AGENT][NEUTRAL] Yeah, I see where you do. OK, good. So I'll just go ahead and uh we'll just bypass uh 1st 1st pass LLC all together um because we're not, you know, there's just no telling when they're ever gonna get around to sending this in to us and um.
[CUSTOMER][NEGATIVE] I know they said that they're doing it today, but what happens if they do it? Are you gonna and I pay them today because I don't want them to turn it into collections if I pay them today I don't wanna take a chance on APL then getting their claim and paying them.
[AGENT][NEUTRAL] Well, what will happen is that, um, let's just say for, uh, just in theory that they, that they do end up sending it to us. I, I will send them back an explanation, a benefit saying that I've, that I've, uh, that we've paid you, that the benefit has gone to you and.
[CUSTOMER][NEUTRAL] OK, so you're OK, so mine, mine beat them. OK, I just wanna make sure that I don't mind you paying me. I just don't want it to because we're both doing it in the same day now, um, that it happens theirs gets ahead of mine and then you pay them, which is what I originally wanted, um, to pay them and then we turn around and now I've double paid them then I got a fight with them to get that little amount back.
[AGENT][NEUTRAL] Right, um, yes, if you, if you want to, uh, if you wanted to wait and as I mentioned before, I'm, I'm going to do this now and it should show up in your, um, in your, uh, direct deposit, uh, by tomorrow. Um, so if you wanted to see that, that it will, yeah, so it will show, if you want to, if you just wanted to wait until tomorrow, uh, to pay them, um, and just, you know, uh.
[CUSTOMER][NEUTRAL] Oh, OK, that's soon, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then that way we can, we can go ahead and get this taken care of and um then it, it will show that you've got that and uh then we can just get this done, you know.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEGATIVE] It's so difficult to deal with them in quest. Anything I have to deal with these sort of labs and quest labs, uh, I don't want them turning anything into collections, especially something this little that was easy to rectify but.
[CUSTOMER][NEGATIVE] It's been, it's been time consuming.
[AGENT][NEUTRAL] Now
[AGENT][NEUTRAL] Oh, I'm, yes, I'm sorry that you had to go through that. Yeah, it's, we get, we get tons of, of, uh, we, we get so many claims from them. So we know that, that we get the claims from them, but every once in a while, it can be quite difficult to get anything out of, of the, you know, they won't send it in or they'll say that they send it in. We get that a lot um and I guess it's just because they have so much of it. I, I don't really know what the, what the deal is, but they have so many claims, yeah, uh.
[CUSTOMER][NEGATIVE] Probably she said 3 they've submitted it 3 times. I said I don't see that I'm looking at and I said APL always reviews and processes quickly. I said I don't see anything.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] I'm thinking that they, if they actually did send it in to us now, we, uh, 4 years ago, we changed our address from um uh [PII] to uh the current address that we've got. Yes, and so I'm wondering if that is indeed what they uh sent in to us is, is that, uh.
[CUSTOMER][NEUTRAL] To the PO box mhm.
[CUSTOMER][NEUTRAL] Uh, maybe.
[AGENT][NEUTRAL] Because it's um that's.
[CUSTOMER][NEUTRAL] I confirmed the address with them this morning but who knows.
[AGENT][POSITIVE] Well, it's, let's, let's go ahead and, I, I think maybe rather than, than this is continuing on, um, if we could just uh go ahead and I'll, I'll pay this to you, um, I'm doing that right now. And then we can get this taken care of and then we just don't have to do, uh, you know, as I mentioned before, you should be getting this, um, taken, uh, it should be into your um direct deposit here in just a moment. So it's $44.49 right? And the original bill was $40.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, yes, 4449 is the balance.
[AGENT][NEUTRAL] And let me see, I have, uh, as I mentioned before that, yeah.
[CUSTOMER][NEUTRAL] The original bill was $141 and then Humana paid $96.51 dollars and left the balance of 4449.
[AGENT][NEUTRAL] Ah, right.
[AGENT][NEUTRAL] Well, you know, they turned in, when you went in [PII], they turned in a claim. So I don't know what the, well, anyway, it doesn't, it doesn't matter now, so let me just see if I can't, uh, I'm almost finished.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And thank you so much for staying on the line with me while I do this. Just, I just want to make sure that, that you know that it's been done.
[CUSTOMER][POSITIVE] No, I just wanna make sure it's handled yeah thank you.
[AGENT][NEUTRAL] OK, so, uh, now, uh, we have this.
[AGENT][NEUTRAL] So, uh, this is now going to you. Now, in just a few moments, you should show where it has been paid in you in your direct deposit, OK? Um, this will be $44.49. Um, I believe that that should, that should cover it. If not, uh, my name is [PII]. Um, please let me know if you don't, if you don't see this within your, uh, thing tomorrow, and, um.
[CUSTOMER][POSITIVE] Oh wow OK.
[AGENT][NEUTRAL] Uh, we will, we will try and get it, uh, you know, it's, I, I don't know what else to do. I mean this is the only thing I can think of. It really, it, I've just done it, so it should show up tomorrow. Now if it doesn't, then we can contact customer service and find out what the deal is, but it should be paid to you tomorrow and, and if, if you were concerned about it being paid twice, [PII], I, you know, if you don't mind waiting until tomorrow, um.
[AGENT][POSITIVE] You know, just, it'll be the last day of the year we can kick this out, get it taken care of, start [PII] rights without this bill being on, uh, you know, on the books. So if you'll just look tomorrow, make sure that it's actually done and then if it's not, again, my name is [PII], anyone will be able to help you, but I will be here tomorrow. um, just let me know and we'll see what we can do so we can get this taken care of. Now, um, is there anything else at all that I can help with?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Perfect. Thank you, [PII].
[CUSTOMER][POSITIVE] No, I think everything is pretty much done. It's just this one lingering bill, so I appreciate your help.
[AGENT][POSITIVE] Well, let's get, yeah, certainly. Thank you for contacting APL. You have a very good morning. Thank you.