AccountId: 011433970860
ContactId: 2c9458d0-38d0-421d-a939-46d36ecd9803
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 595630 ms
Total Talk Time (AGENT): 149752 ms
Total Talk Time (CUSTOMER): 211103 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/2c9458d0-38d0-421d-a939-46d36ecd9803_20250509T14:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I have a question regarding, uh, bills that may have been, uh, passed to you. I.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yeah, it is.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I, I guess outpatient would be 0233.
[CUSTOMER][NEUTRAL] 7500
[CUSTOMER][NEUTRAL] M as in Max. L as in Larry, and the number 8.
[AGENT][NEUTRAL] Uh, can I get your name and your date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And then can you verify your address and your email address, please?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] And email?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you so much. And now are these claims for yourself or?
[CUSTOMER][NEUTRAL] No, yeah, so.
[CUSTOMER][NEUTRAL] It's for a physical therapy. I wanna make sure that um if it's possible to deny any payments because I already, I didn't realize that it was uh out of network for my original, um, the primary insurance, and I don't want to be billed a crazy amount, so I worked something out with them, so I'm just gonna pay out of pocket.
[AGENT][NEUTRAL] OK, um, let's see, uh, what dates of service?
[CUSTOMER][NEUTRAL] It should be
[CUSTOMER][NEUTRAL] It should be under 4 F O R C E.
[AGENT][NEUTRAL] Was it in like March or April or?
[CUSTOMER][NEUTRAL] Um, uh, April and May.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I don't show we've received anything yet. Um, did they indicate they were gonna send it in or?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, they said they already sent like 3 of them in.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] It be for Ortho.
[CUSTOMER][NEUTRAL] Uh, the date of
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] Is it for [PII]?
[AGENT][NEUTRAL] Would that be the
[CUSTOMER][NEUTRAL] It possibly is possibly.
[AGENT][NEUTRAL] Um, I have something for them, that was for, um, looks like March though, so it's just an office visit.
[AGENT][NEUTRAL] So I don't, I don't
[CUSTOMER][NEUTRAL] Uh, no, that's an office, no, no, that's, no, that's not it.
[AGENT][NEUTRAL] OK, yeah, I don't have any claims on file yet.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Is there any way you can put it like a reject claim on those items on those uh if you do receive anything like that?
[AGENT][NEUTRAL] Well, does your
[AGENT][NEUTRAL] Well, your primary insurance, are they denying the claim?
[CUSTOMER][NEUTRAL] Yeah, because there it's out of pocket, it's out of uh out of network so there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So yeah.
[AGENT][NEUTRAL] So if they deny the claims, we won't process them anyway, if they're denied by your primary.
[CUSTOMER][NEUTRAL] OK, oh, I see.
[AGENT][NEUTRAL] Yeah, so they have to be considered for us to process them. So but if they're denied and not covered, then we won't be able to process them anyway.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Alright, um, just in case, would you be able to put some sort of note or something like that?
[CUSTOMER][NEUTRAL] So um.
[AGENT][NEUTRAL] Well, there's, there's not a way for us to, I mean, we, if we receive a claim, we don't have a way but to process it according to the policy.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh yeah, I would just make sure that they don't submit to us just in case if your primary does for some reason apply it towards the out of network deductible.
[AGENT][NEUTRAL] Um, then we would process the claim. Is it, is it out of a facility that you're going to?
[CUSTOMER][NEUTRAL] Yeah I mean I see it like for example I see it in my uh I see it on my uh.
[CUSTOMER][NEGATIVE] On my bills per per se, but it's not like actual bills on uh on my primary but they're like outrageous bills so it just means that they were just in the negotiated bill almost but they're still it's still outrageous.
[CUSTOMER][NEUTRAL] Bills.
[AGENT][NEUTRAL] OK, but yeah, I would just indicate, you know, just not to send them to us, um, but like I said, if they are denied by your primary we don't process them so.
[CUSTOMER][NEUTRAL] Like, oh, so what do you mean by denied because I, for example, I see it on Aetna but it just says uh.
[CUSTOMER][NEUTRAL] Out of network and like a crazy bill so so it's like something like.
[CUSTOMER][NEUTRAL] Yeah, yeah, I'll explain, um.
[AGENT][NEUTRAL] To say it applied towards a deductible or?
[CUSTOMER][NEUTRAL] Not really. Let me just see if I could sign in really quickly. Give me one second.
[CUSTOMER][NEUTRAL] Let me see if I can sign in.
[CUSTOMER][NEUTRAL] Just bear with me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I go under claims and explanation of benefit statement.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Does it show anything applied towards a deductible or?
[AGENT][NEUTRAL] Or does it just say not covered?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'll tell you I know.
[CUSTOMER][NEUTRAL] Trying to find it. Give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I went to claims.
[CUSTOMER][NEUTRAL] Yeah, that, uh, explanation of benefits payments just claimed and it says.
[CUSTOMER][NEUTRAL] Processed amount billed.
[CUSTOMER][NEUTRAL] Which is like $488 plans share $0 and then your share $488.
[AGENT][NEUTRAL] Does it say it applied to a deductible, or?
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] Like, can you see your explanation of benefits?
[CUSTOMER][NEUTRAL] Yeah, always says uh.
[CUSTOMER][NEUTRAL] No, it doesn't say anything. It just says process your share $488 and it says always confirm the amount you owe with your provider.
[CUSTOMER][NEUTRAL] Then $112 went towards deductible.
[AGENT][NEUTRAL] OK, so 112 went towards deductibles. So it looks like they've considered the claim. They're just putting it towards your deductibles. So again, you just need to tell your PT place, just do not bill us, don't send claims to us. If you have some negotiated.
[CUSTOMER][NEUTRAL] Yeah, they, they
[CUSTOMER][NEUTRAL] Yeah, yeah, they, they, they're they're aware of this now. I didn't know about this before. I didn't think it was gonna be this uh an issue. I just like, you know, you go to PT, you give your uh.
[CUSTOMER][NEUTRAL] Your, uh, insurance and that's it. I didn't really think it was gonna be.
[CUSTOMER][NEUTRAL] All this so um.
[CUSTOMER][NEGATIVE] You, you're sure you didn't receive anything from.
[CUSTOMER][NEUTRAL] The PT or Aetna.
[AGENT][NEUTRAL] No, we've not, no, we haven't received any physical therapy claims, no.
[CUSTOMER][NEUTRAL] Regarding this?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess, uh, so if it says your shared the amount you the amount I owe to the provider, right?
[AGENT][NEUTRAL] Um, you have to check with them on what you would owe.
[AGENT][NEUTRAL] Um, we can't determine patient responsibility, but, but yeah, I don't have any PT claims at all on file, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK alright thank you.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.