AccountId: 011433970860
ContactId: 278c5c7e-add9-4878-85d9-d58adc2ec9a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 499989 ms
Total Talk Time (AGENT): 230553 ms
Total Talk Time (CUSTOMER): 221793 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/278c5c7e-add9-4878-85d9-d58adc2ec9a2_20250328T14:41_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], I just wanted to call and verify um a bill with you if I could.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with your bill, and are you the insured or you're a provider?
[CUSTOMER][NEUTRAL] And the insured
[AGENT][NEUTRAL] Alright, and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, my name is [PII] and my telephone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And Ms. [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] 02552057
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And can you verify your, um, your date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] [PII]. My address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And on the bill, is it like an explanation of benefits?
[CUSTOMER][NEUTRAL] Um, no, it's not a bill from you. It's a bill that I received from, uh, it's a medical bill, and they said that they contacted you and that there was a deductible, but I just wanted to make sure that, um, that there was a part that I still have to pay.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Before I just pay them.
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] Wait, wait, so the provider contacted us and they were advised that there's a deductible and you're wanting to make sure of that before you pay them.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, um, so what type of, so your policy is kind of broken down into where you went. So what type of claim would it be that
[AGENT][NEUTRAL] The easiest thing to do would be to just let the provider file the claim and let that settle out and then if there's something left over, then I would, I wouldn't pay anything until the insurances are all settled.
[CUSTOMER][NEUTRAL] Um, this
[CUSTOMER][NEUTRAL] Right. So she just seemed uncertain as she was speaking that there was a $40 deductible for me to pay. So, you know, I don't know if I can give you the date of service or the name of the, the company that submitted the bill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that maybe we can check and you can tell me if you had, you know, turned anything down.
[AGENT][NEUTRAL] Um, so are they speaking of the primary insurance? We don't issue the co-pay. There's no co-pay on your policy here with your secondary insurance.
[CUSTOMER][NEUTRAL] That's what I'm talking about.
[CUSTOMER][NEUTRAL] So when she said that I still have to pay $40 I'm thinking our policy before was that American Public Life would pay the balance. But she said, no, American Public Life is telling, telling us that you owe $40. So I'm thinking she's confused. Um, I don't mean it in a rude way. I'm just thinking that maybe she thinks that the primary insurance, she's confusing the primary and the secondary insurance.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So if primary applies a co-pay or deductible in order for a service to be done, you would still have to pay that co-pay or deductible upfront. Once we receive the claim on the back end, that's how you're either reimbursed or you can be reimbursed and then we can still pay to the um provider if something is owed after primary, but if there's a co-pay or deductible that is required from primary, yes, you will have to pay that for the service to be done and then you can be reimbursed or
[AGENT][NEUTRAL] We'll handle that on the back and once we receive the claim.
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] I, I did, I did pay them. That's why I'm wondering why that they're asking for more money. I'm thinking that she has incorrect information. She kind of stumbled across her answer. Is there a way that we can check that a bill was submitted?
[AGENT][NEUTRAL] Sure. What's the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] I appreciate your help. Thank you for understanding.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] My curiosity with her um information was that each time that we've um applied American Public Life, we haven't had any co-pays. So I'm, that's why I'm thinking that the co-pay was probably 40 and I paid them whatever the copay was. So, um,
[CUSTOMER][NEUTRAL] I don't think that we should, I'm just thinking we shouldn't know any uh money to them.
[AGENT][NEUTRAL] So we received a claim on [PII]. Is this from Vital MD?
[CUSTOMER][NEUTRAL] This would be um the name of the company is FLGYO and robotic surgery.
[CUSTOMER][NEUTRAL] The name of the doctor is Doctor [PII]. That helps.
[AGENT][NEUTRAL] Let me look at what was submitted because it's coming over as vital MD. Let me see if this is the same thing. Hold on one second, but it's we've only received this one claim for that data service, so it could be and it's just coming over something different.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's coming up now. Hold on one moment.
[CUSTOMER][NEUTRAL] OK, cause I didn't give, I didn't give them the gap number until [PII].
[AGENT][NEUTRAL] Until [PII] of this year.
[CUSTOMER][NEUTRAL] Yeah, I gave them the gap insurance on [PII]. So if you're saying that you had received a claim from them earlier than that, they didn't have, I don't think that they had, they might have had that information, but I did call them on [PII] when they sent me a bill and um gave them the gap insurance number, and they did not say that they had submitted a claim to you at that time.
[AGENT][NEUTRAL] OK, and what's the, um, OK, wait, the doctor on this claim.
[AGENT][NEUTRAL] OK, I see. Vital MD is the biller. This is the claim. OK, so the claim was received. It's Dr. [PII].
[CUSTOMER][NEUTRAL] That's the one, yeah.
[AGENT][NEUTRAL] OK, yes. So, let me see what happened with it. The claim was denied because office visits are not covered on the policy.
[AGENT][NEUTRAL] Uh, well, the service is not covered when performed in the doctor's office or clinic, um.
[AGENT][NEUTRAL] That's your secondary policy. So yes, they did file a claim, but the claim was denied because there's no office visits on the
[AGENT][NEUTRAL] Policy.
[CUSTOMER][NEUTRAL] Mm, uh, that's weird. Um, maybe you can explain to me because I've gone to labs and had blood drawn and
[CUSTOMER][NEUTRAL] You know, had other doctor visits that.
[CUSTOMER][POSITIVE] Uh, that were covered that I thought were covered at least. I mean, Labor and Quest have both taken insurance numbers from me for you.
[CUSTOMER][NEUTRAL] Maybe I'm misunderstanding something.
[AGENT][NEUTRAL] Sure, so for your
[CUSTOMER][NEUTRAL] I mean, it's only $40. It's not like it's a big deal, but still.
[AGENT][NEUTRAL] Sure. Um, so for your secondary insurance, it's broken down into inpatient and outpatient facilities. So inpatient is gonna be anything after admission. Outpatient is outpatient surgeries, emergency room, urgent care.
[AGENT][NEUTRAL] Um, we do have like an office treatment rider with the treatment in the office could be covered up to your calendar year max, but for your policy, I don't see the office treatment rider, um, and then the policy itself already doesn't cover in office, it's just outpatient or inpatient. So that's what it's saying, um, that's why this one wasn't covered. It's because the place of service that they coded it for is the office.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or clinic.
[CUSTOMER][POSITIVE] OK. All right. I'm good with that. I understand and um I feel more comfortable now, making sure that I knew what was going on, you know, like, you don't want to just pay if you don't have to pay, because then if you found out later, you didn't have to pay and you want to ask for them for the money back, literally can take months of following up.
[AGENT][POSITIVE] I'm glad.
[AGENT][NEUTRAL] Oh Lord, it's gonna be a whole circus, right.
[CUSTOMER][POSITIVE] Right, it's right, it's almost better if it's not that much money just to lose it, but, so thank you for explaining everything to me and I'll make sure that I submit this to my husband so he can pay it.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Alrighty. Well, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] That is all. Thank you so much.
[AGENT][POSITIVE] You're very welcome. Well, again, all the information provided was a verification of benefits, not a guarantee of payment, and thank you for calling APL. I hope you all have a great weekend.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.