AccountId: 011433970860
ContactId: 2c4fc60b-5c1e-48b1-b8ae-ac9e9f9a95fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1681569 ms
Total Talk Time (AGENT): 570401 ms
Total Talk Time (CUSTOMER): 407114 ms
Interruptions: 6
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/2c4fc60b-5c1e-48b1-b8ae-ac9e9f9a95fb_20250505T21:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi. Um, I am um calling to check. I have gap insurance, um, through you, and I wanted to see, I've been getting some messages of, um, some
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Invoices that have been sent your way but I don't know if they've been processed or not. I, I kept getting an error through my portal, so I wanted to go through it and see what I need to do.
[AGENT][NEUTRAL] OK, what is your policy number?
[CUSTOMER][NEUTRAL] Um, OK, let me get it to you, so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Policy number, I don't see it on my card, um, group number 15821.
[AGENT][NEUTRAL] It would say policy certificate number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The what? I'm sorry?
[AGENT][NEUTRAL] The policy certificate number it may say inpatient outpatient.
[CUSTOMER][NEUTRAL] Benefits certificate?
[CUSTOMER][NEUTRAL] Uh, in hospital or outpatient. OK. Um, 026079.
[CUSTOMER][NEUTRAL] 44
[CUSTOMER][NEUTRAL] ML 7 or ML 8.
[AGENT][NEUTRAL] OK, that was 02607944 ML 7 or 8. Give me one moment please.
[AGENT][NEUTRAL] OK, may I have your name and date of birth?
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yes. It's um [PII] and um date of birth, [PII].
[AGENT][NEUTRAL] Thank you and may I have your call back number before we disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, verify your mailing address.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Verify your mailing address?
[CUSTOMER][NEUTRAL] Mailing address [PII].
[AGENT][NEUTRAL] Thank you and the last thing to verify is your email address.
[CUSTOMER][NEUTRAL] Um, sure, it's [PII].
[AGENT][POSITIVE] Thank you so much for the verification process and you're calling to check to see what we have received claims for you is that correct, please?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the date of service so I can check that for you.
[CUSTOMER][NEUTRAL] Um, all of anything this year.
[AGENT][NEUTRAL] I see [PII] we received a claim for [PII]. Let me start by telling what your benefits are. One moment.
[CUSTOMER][NEUTRAL] Sure. And I think your headset or something is just clicking. I, I can't hear when you talk.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] I'm gonna place you on a brief hold please? Thank you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] See the first one.
[AGENT][POSITIVE] OK, Ms. [PII], thank you for your patience. OK, hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The last claim, OK, thank you. The last claim we received was for [PII]. It was.
[AGENT][NEUTRAL] Cleveland Clinic Florida.
[AGENT][NEUTRAL] We made a payment of $30.13.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And prior to that.
[CUSTOMER][NEUTRAL] How much? I'm sorry?
[AGENT][NEUTRAL] $30.13.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And prior to that.
[CUSTOMER][NEUTRAL] That was the last one, and then.
[CUSTOMER][NEUTRAL] Before that. And do you know what it was for?
[AGENT][NEUTRAL] Yes, that was the last one.
[AGENT][NEUTRAL] Um, it was a Cleveland clinic visit. Um, give me one second, uh, to see what that is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, looks like it was an MRI.
[AGENT][NEUTRAL] MRI of the brain stem without, and without with and without dye that was.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] we made that payment of $30.13 Cleveland Kleac.
[AGENT][NEUTRAL] And prior to that.
[AGENT][NEUTRAL] There was an [PII].
[AGENT][NEUTRAL] Visit [PII] and [PII]. We didn't make a payment on that. That's also from Cleveland Clinic, Florida. Um, we were asking for a more detailed explanation of benefits from the primary.
[AGENT][NEUTRAL] And we're asking for that because the EOB that was submitted with the claim did not show any charges applied to the deductible co-pay or co-insurance and that looks like that was an ER visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you have anything before that?
[AGENT][NEUTRAL] I do. I'm going on that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so before that.
[CUSTOMER][NEUTRAL] And then this one in particular, the one for [PII] and [PII], was there an amount or that one was 0 as of today, right?
[AGENT][NEUTRAL] OK, the amount that was [PII].
[AGENT][NEUTRAL] It shows $6,352.40.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] [PII], it shows $11,164.50.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so next one up.
[AGENT][NEUTRAL] [PII], that was for Cleveland Clinic.
[AGENT][NEUTRAL] It is we made a payment of $29.08.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's Cleveland Clinic, Florida. We made a payment of
[AGENT][NEUTRAL] I'm sorry, maybe they're saying one is sorry give me one second.
[AGENT][NEUTRAL] It was the same one. OK, sorry about that. That's the same one we just discussed, so on to the next one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Apologize for that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] [PII]. That was for an office visit, Cleveland Clinic Foundation that was denied and that charge was $692.
[AGENT][NEGATIVE] It denied as office visits are not covered.
[AGENT][NEUTRAL] By the policy
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, next one.
[AGENT][NEUTRAL] [PII], Cleveland Clinic, Florida.
[AGENT][NEGATIVE] That charge was denied that was for $267.
[AGENT][NEGATIVE] It did not as a non-covered place of service.
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][POSITIVE] Oh, what was that? I'm sorry.
[AGENT][NEGATIVE] It not as a non-covered place of service.
[AGENT][NEUTRAL] And that was [PII].
[CUSTOMER][NEUTRAL] Non-covered place of service, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But is it Cleveland Clinic as well?
[AGENT][NEUTRAL] Yes, ma'am. Cleveland Clinic, Florida.
[AGENT][NEUTRAL] 3
[CUSTOMER][NEGATIVE] But if you cover some but not the others in the same place, that doesn't make sense.
[AGENT][NEUTRAL] It all depends on the place of service and how the claim was billed to us that's how it was processed.
[CUSTOMER][NEUTRAL] And does it say what it was for so I can look into that one.
[AGENT][NEUTRAL] Uh, give me one second, let me see what the
[AGENT][NEUTRAL] Pulling that up now just bear with me.
[AGENT][NEUTRAL] That is it shows.
[AGENT][NEUTRAL] subacute and chronic vaginitis.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For that is it 6273 and the one prior to that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was also in relation to um what I just stated and it's [PII] as well and that's Cleveland Clinic Foundation.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and [PII].
[CUSTOMER][NEUTRAL] Do you have an amount for that one or was it covered or didn't I?
[AGENT][NEGATIVE] I'm sorry, it was denied and that amount was $469.
[CUSTOMER][NEUTRAL] And the reason was it the same thing, the non-covered place of service?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Cleveland Clinic Florida and that was [PII] and that was a charge of
[AGENT][NEUTRAL] One, I'm sorry, I do the total charges we made a payment of $143.16 for this particular date of service. Let me see. Do you wanna know what that was for, or?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So that one was paid, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, that one was paid, um, let me see.
[AGENT][NEUTRAL] Iron deficiency anemia?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and prior to that one.
[CUSTOMER][NEUTRAL] And again, you said it was paid, right? It's hard to hear you. That's why I'm asking you again.
[AGENT][NEUTRAL] Yes, yes, it was paid $143.16.
[CUSTOMER][NEUTRAL] That one.
[CUSTOMER][NEUTRAL] OK. And then, um, OK, before that, I, I think I need to go back to November, yeah.
[AGENT][NEUTRAL] OK, and prior to that?
[AGENT][NEUTRAL] Go back to when I'm sorry.
[CUSTOMER][NEUTRAL] Oh, to November, December when I, I had an, um, other large charges, but I never found out whether they were covered or not.
[AGENT][NEUTRAL] OK, so you want me to check for November.
[AGENT][NEUTRAL] Is that correct? I'm sorry. I just wanna make sure. OK, alright, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for [PII].
[AGENT][NEUTRAL] Or December.
[AGENT][NEUTRAL] 2024.
[CUSTOMER][NEUTRAL] Do you have um
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] Do you have something in, let me think. So,
[CUSTOMER][NEUTRAL] I know I had an endoscopy in in February.
[CUSTOMER][NEUTRAL] So we skipped all of that. I don't think it was there and if it wasn't sent, I need to make sure that it gets sent, but that was I wanna say [PII].
[AGENT][NEUTRAL] I don't have anything. I'm sorry, you don't have anything on file for [PII], um.
[AGENT][NEUTRAL] Now I don't show anything on file that we have for [PII].
[CUSTOMER][NEUTRAL] OK. Um, anything else that has, uh-huh.
[AGENT][NEUTRAL] The last day we went over was [PII].
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEGATIVE] Correct, that you sent, you, you went through the February and then March and April, um, but nothing.
[CUSTOMER][NEUTRAL] Between February and [PII].
[CUSTOMER][NEUTRAL] Um, OK, and
[AGENT][NEUTRAL] You have something in January. Would you like me to go over that for you?
[CUSTOMER][NEUTRAL] Yes. So, [PII], you said the [PII] with 16, correct? Anything else?
[AGENT][POSITIVE] Correct, that is correct. OK. Yes, it is. One moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] as well. This was, you have several for uh [PII], OK.
[AGENT][NEUTRAL] So the next one is Cleveland Clinic Foundation. We made a payment of $19.79.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see what that was for.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It shows a pathology visit.
[AGENT][NEUTRAL] For that.
[CUSTOMER][NEUTRAL] Oh what is it? I'm sorry?
[AGENT][NEUTRAL] Pathology.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we made 1979 payment on that and then after that or before that.
[AGENT][NEUTRAL] There was a payment of.
[AGENT][NEUTRAL] $48.65 and this looks like that was for anesthesia.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that's anesthesia.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Another charge for anesthesia we've made a payment of $46.63.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And almost there one moment.
[AGENT][NEUTRAL] There was a payment of.
[AGENT][NEUTRAL] $241.77. This was also to Cleveland Clinic Foundation.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Give me one moment to see what that was for as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was the biopsy?
[AGENT][NEUTRAL] OK [PII].
[AGENT][NEUTRAL] I'm checking to see what else.
[AGENT][NEUTRAL] And that is it.
[CUSTOMER][NEUTRAL] And, and then that was, what was the amount?
[AGENT][NEGATIVE] And we don't have anything
[AGENT][NEUTRAL] Oh, the last payment. OK, I'm so sorry. Give me one second, let me make sure, one moment please.
[AGENT][NEUTRAL] That payment was $241.77.
[CUSTOMER][NEUTRAL] 77 cents. OK. So that looks like part of what I was asking the endoscopy and stuff. Um, OK. And then, um, do me a favor. What, um, what are the benefits? What, what's covered usually?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Your benefits are on a per day max. Um, please note verification of benefits provided does not guarantee.
[AGENT][NEUTRAL] Payment, um, we pay up to $500 per calendar day for covered services. What is not covered is would be that an office visit or any services or procedures inside an office, doctor's office, a clinic that's not covered, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Places of service would be um
[AGENT][NEUTRAL] Hospital outpatient facility would be an urgent care ER um diagnostic testing facility.
[AGENT][NEUTRAL] And also covered place services.
[CUSTOMER][NEUTRAL] Those who cover or you don't?
[AGENT][NEUTRAL] We cover those places of service and again.
[CUSTOMER][NEUTRAL] The ER the diagnostic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And lab you also have an independent lab writer which means if they have to send your um your lab off to like uh maybe quest or lab court that's also covered and everything of course has to be due to a sickness or an injury.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Have you, um, so for the labs, because I do have several, um, things that I've had to pay for Quest. So how do I submit those that I've had to pay out of pocket because my insurance haven't covered?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] To submit a claim, you would need the itemized bill.
[AGENT][NEUTRAL] That has the procedure code and diagnosis codes. That's very important and has to have the diagnosis codes, please.
[AGENT][NEUTRAL] You will also need your explanation of benefits from your primary insurance provider.
[AGENT][NEUTRAL] Along with a claim form that you're able to get you're able to get that from our website.
[AGENT][NEUTRAL] A midli claim form.
[CUSTOMER][NEUTRAL] OK, um, Male claim.
[AGENT][NEUTRAL] And yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] So you need those 3 things that I deal with the procedure.
[CUSTOMER][NEUTRAL] So the procedure code and diagnostic code.
[CUSTOMER][NEUTRAL] Procedure code, diagnostic code, and explanation of benefits from
[CUSTOMER][NEUTRAL] My provider.
[CUSTOMER][NEUTRAL] So, for example, in the
[AGENT][NEUTRAL] From your primary insurance provider.
[CUSTOMER][NEUTRAL] From the insurance provider, sir, Cigna. OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So the procedure code, the diagnostic code, I get it from my, the ordering doctor, I would think.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Then the invoice itself it's from Quest, right? Whatever they billed me.
[CUSTOMER][NEUTRAL] And then Cigna, why they didn't covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Correct, we will need that, yes, all of those things.
[CUSTOMER][NEUTRAL] OK. And then you cover, so the amount, that wasn't clear. So you said $500 per calendar, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Or calendar days.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Calendar day.
[CUSTOMER][NEUTRAL] OK, so, so what's the max on anything because again I've, I've received bills from for like I don't know, I think it's like up to $10,000 so I wanna make sure that I'm sending the correct one.
[AGENT][NEUTRAL] OK, um, we will pay only up to $500 each day for covered services. So each day we pay a max of $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Each day that the procedure, lab, visit, whatever, right? Because I've had several, I don't know, I've had probably 60 since October last year. So that's not a problem. They all have different days. OK, per day max. OK.
[AGENT][NEUTRAL] Yes, so it's a per day max, so it's a per day max.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All right. Got it. Um, all right. And then, do me a favor because I know that my insurance ends [PII], this one, APL.
[CUSTOMER][POSITIVE] But we, by the time I get all this information, it's probably a month from now. That's not a problem. I can still submit them, right?
[AGENT][POSITIVE] You can still cement, that is correct.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] OK, and then for everything that we went through, what's the correct way that I can pull it and get a statement of what you've received, what you've paid and everything? Is that through the portal?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then for the claims, is it done through the portal? Do I upload the information or do I have to mail it? What's the process? I've never done one.
[AGENT][NEUTRAL] OK, you can upload the information on to the portal.
[AGENT][NEUTRAL] Or if you like you can mail it in or fax it in to us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or fax, OK.
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][POSITIVE] OK, that's what I needed. Thank you so much.
[AGENT][POSITIVE] You're welcome. You're very welcome. Thank you so much for calling APL. You have a great day.
[CUSTOMER][POSITIVE] Thanks. Bye bye.