AccountId: 011433970860
ContactId: 2a3efad1-7e17-4d4a-9530-cbab632386d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 358670 ms
Total Talk Time (AGENT): 203913 ms
Total Talk Time (CUSTOMER): 132364 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/2a3efad1-7e17-4d4a-9530-cbab632386d9_20250521T20:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is.
[CUSTOMER][NEUTRAL] Uh yes ma'am. I filed a claim.
[CUSTOMER][NEUTRAL] And I do have the Medin.
[CUSTOMER][NEGATIVE] And I need to inquire about it because it's, it's what they sent to my uh checking account is not what it should be.
[AGENT][NEUTRAL] OK, I can take a look at that for you, sir. Could I get your name and a callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Call back at [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and what is your policy number with us?
[CUSTOMER][NEUTRAL] Policy number on the Medlink is 01194612.
[AGENT][NEUTRAL] OK, if you could verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII] and the mailing address is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you so much for verifying your information and you said that you received payment on a claim and it is not the correct amount.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah it's.
[CUSTOMER][NEGATIVE] No, because when it's in in hospital at least 18 hours, 3000 for the policy that I signed it and then it's an outpatient it's like 500 and then you and the in hospital you got up so many days between the previous time and I, I did exceed that by a day.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And instead of depositing, let me see, 3000.
[CUSTOMER][NEUTRAL] Hang on a minute.
[CUSTOMER][NEUTRAL] I'll tell you what, they sent 200 and something. I go, what?
[AGENT][NEUTRAL] I see it here $225. Uh, let me pull your uh documents and see, um, I show we did make some payments, uh, for your inpatient stay, uh, provider payments, uh, which would equaled up to the $225 was $75 payments.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Uh, one for [PII], 1 for [PII], and one for [PII]. Um, it looks like.
[AGENT][NEUTRAL] Based on what they paid um for your hospital, the facility stay, it.
[CUSTOMER][NEUTRAL] Well, they
[CUSTOMER][NEGATIVE] They didn't pay anything on the hospital.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Uh right, I was explaining for the hospital stay, uh, based on the information received, it shows that uh that your primary paid your hospital charges in full. But let me pull. OK, so if they pay it in full, there's nothing for us to pay.
[CUSTOMER][POSITIVE] Right, that's correct.
[CUSTOMER][NEUTRAL] That's right, so it would come to me as my understanding.
[AGENT][NEUTRAL] Well, no, if your uh primary insurance, uh, your explanation of benefits shows that your primary insurance made a payment to the hospital and there was no patient responsibility, then there's nothing for us to pay.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] That was not, I've had this policy a long time in [PII], and as always explained to me was that it would be $3000 whether we go to the hospital or to the patient itself to like me, it would come to me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, so that that's partially correct if there's $3000 worth of patient responsibility. So we pay based on what your primary um
[AGENT][NEUTRAL] Considers and if there's patient responsibility that would be applied to either your if you have a high deductible, um, if there's co-insurance or co-payment, if your primary states he owes this amount towards any of those, then yes, we will either pay the provider or we will pay you.
[AGENT][NEUTRAL] But it has to be patient responsibility. We can't pay out on on money that's not due.
[AGENT][NEUTRAL] So based on the information we received, the explanation of benefits show that you owe 2.
[AGENT][NEUTRAL] Uh, $225 in which we made a payment to you.
[CUSTOMER][NEUTRAL] Yeah, I think I sent a ton of information over and I think I'd have to go back and look at it, but I think it was more than that.
[AGENT][NEGATIVE] Uh, I do show, uh, other charges coming in, um, based on what I'm showing, they were paid in full by your primary, um, you didn't have patient responsibility.
[CUSTOMER][NEUTRAL] Um, I mean.
[AGENT][NEUTRAL] Uh, the only thing we show patient responsibility on was those three, charges that we paid.
[CUSTOMER][NEUTRAL] Yeah, because I
[CUSTOMER][NEGATIVE] Yeah, because I've met my deductible and what I'm paying for now is my out of pocket.
[AGENT][NEUTRAL] OK. Well, $225 is all that we show out of pocket for.
[CUSTOMER][NEUTRAL] Unless I show something else, right? I'll have to look at it and see, but I think I sent everything.
[AGENT][NEUTRAL] Yes, now if you have other explanation of benefits uh for this particular inpatient stay that shows that you owe money, you know, if you look at your explanation of benefits and it shows you owe uh patient responsibility like I said, towards deductible, co-pay or co-insurance, you can definitely send that information in.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yes I was for years since [PII], yeah, terribly, uh miss uh I, I guess when it was explained, it wasn't explained correctly, so, OK, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] I do apologize for that. OK, you have a wonderful day. Thank you for calling APL bye bye.
[CUSTOMER][NEUTRAL] All right, OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] All right.