AccountId: 011433970860
ContactId: 307d75ca-a5f7-4af2-9edc-3137054c69a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1314380 ms
Total Talk Time (AGENT): 513505 ms
Total Talk Time (CUSTOMER): 349569 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/307d75ca-a5f7-4af2-9edc-3137054c69a3_20250211T16:49_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. I have a reference number.
[AGENT][NEUTRAL] OK, let me get your name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what number is it?
[AGENT][NEUTRAL] That you have?
[CUSTOMER][NEUTRAL] It's it's the reference number SOL.
[CUSTOMER][NEUTRAL] 01282025
[AGENT][NEUTRAL] And what number is that?
[CUSTOMER][NEUTRAL] That is the reference number that I got from uh.
[CUSTOMER][NEUTRAL] Uh, a bill that I got.
[AGENT][NEUTRAL] Yeah, so that could be for the provider's office. How can I help you today?
[CUSTOMER][NEUTRAL] I have got a bill from uh Texas Digestive disease consultant when I went and had my, when I, when I had my colonoscopy done and I.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] The APL did not pick up none of the bill and I was just trying to figure out why they didn't pick up none of the bill.
[AGENT][NEUTRAL] OK, do you have your APL policy number?
[CUSTOMER][NEUTRAL] Uh, no, uh, is it, it might be on my card.
[AGENT][NEUTRAL] It should be on your card. Do you have your card?
[CUSTOMER][POSITIVE] Yes ma'am I do. Let me dig it out real quick.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] It's gonna be uh an outpatient inpatient policy cert number.
[AGENT][NEUTRAL] I kind of mid
[CUSTOMER][NEUTRAL] Hold on, I'm, I'm looking at it
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's the
[CUSTOMER][NEUTRAL] Insurance coverage and the individual policy.
[AGENT][NEUTRAL] It may start with a 0.
[CUSTOMER][NEUTRAL] policy and clerk number, the er number.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] 02030165
[AGENT][NEUTRAL] OK, what's a good phone number, [PII] in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, give me one second to pull up your file.
[AGENT][NEUTRAL] And what's your date of birth and mailing address?
[CUSTOMER][NEUTRAL] Date of birth [PII]. Mailing address [PII].
[AGENT][NEUTRAL] Thank you [PII] and what's your email address on file?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what day did you have the colonoscopy?
[CUSTOMER][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] It says [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the bill that you're receiving, is it from the hospital or is it from?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's from Texas Digestive Disease Consultants.
[AGENT][NEUTRAL] OK, so that's from the person who, who did the doctor that did it. Give me one second.
[AGENT][NEUTRAL] And is there a charge amount on there?
[CUSTOMER][NEUTRAL] $677.34.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, would that be the same as gastrointestinal associates?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so I do.
[CUSTOMER][NEUTRAL] That's who done it
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I see a claim for [PII].
[AGENT][NEUTRAL] Looks like the total charge was $3,105. Does that sound about right? Or was the amount larger?
[CUSTOMER][NEGATIVE] I do not know. I, I, I don't have that bill. I, I, I don't, that's the only, it's the only bill I got right here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what does it say you owe on the bill?
[CUSTOMER][NEUTRAL] $677.34.
[AGENT][NEUTRAL] OK, so we paid $680.
[AGENT][NEUTRAL] To gastrointestinal associates.
[AGENT][NEUTRAL] And let's see, give me a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Did you have an EGDGD done as well?
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] When you had the colonoscopy. Uh-huh.
[CUSTOMER][NEUTRAL] The upper
[CUSTOMER][NEUTRAL] Uh, I did, but I, I don't, they wasn't done at the same time.
[AGENT][NEUTRAL] OK, this one shows it shows date of service of the [PII] as well. They usually do the, the EGD when they do a colonoscopy.
[AGENT][NEUTRAL] Let's see. Give me a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] EGD that's, that is what what is what is that EGD?
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's like an upper GI.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Checking your esophagus, your stomach, and things like that.
[CUSTOMER][NEUTRAL] Yeah, they went, they, they had to go in there and stretch my esophagus back out.
[AGENT][NEUTRAL] Yeah, that's what it, that's what that is.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK, that's what I, I thought it was. I just wanted to make sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so for this date of service I see a uh a hos a facility charge from GI Associates Endoscopy Center.
[AGENT][NEUTRAL] That's for the facility charge and then the one that I went over just a few minutes ago, um, it is for.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] It's from Gastrointestinal Associates.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So which, which of these two, which is it?
[AGENT][NEUTRAL] Is it the one from Gastrointestinal Associates that you're receiving the bill for?
[CUSTOMER][NEGATIVE] I, I, I do not know to be, I, I don't, don't say nothing on here about that. All, all, all this, all this bill says this is, uh.
[CUSTOMER][NEUTRAL] The Texas Digestive Disease Consultant, that's all it, that's all it says.
[CUSTOMER][NEUTRAL] They don't say where it's from or this that and the other, but that's all it says.
[AGENT][NEUTRAL] OK, well, I'm showing that we made a payment on both of these claims, uh, for date of service [PII].
[AGENT][NEUTRAL] And what are they saying that you owe?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] It's showing right here that the Blue Cross in [PII] deducted deductible $40443.37. And then Blue Cross of [PII] adjusted, I guess they paid $390.60.
[CUSTOMER][NEUTRAL] Then it says charge by 0.
[CUSTOMER][NEUTRAL] And uh that was for the tissue biopsy.
[CUSTOMER][NEUTRAL] And for the.
[CUSTOMER][NEUTRAL] I don't know how to pronounce this word.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] It's I I M U N N O H I S T O C H.
[CUSTOMER][NEUTRAL] E M I S T R Y.
[AGENT][NEUTRAL] OK. So, I, did you say that that's from, does it say Texas digestive disease?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so I also see another bill from that location.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] This total charge is $1,551 on the ELB that you have, does it show the total charge?
[CUSTOMER][NEUTRAL] Uh, total balance.
[CUSTOMER][NEUTRAL] Uh, let me pull my cal.
[AGENT][NEUTRAL] Not the balance but the total charge that they billed.
[AGENT][NEUTRAL] Before any deductions.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Do you see a $11551 fee or charge?
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] No, no, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I do show a claim from Texas Digestive Disease totaling $1,551 and then of course you said you have the EOB that shows that you're responsible for 44337, but there was no payment made on this one. Let me see why. Give me a moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so this is uh considered like an independent, this is lab charges that we received from Texas uh digestive disease. um.
[AGENT][NEUTRAL] And which is considered an independent laboratory.
[AGENT][NEUTRAL] An independent lab is not covered under this policy.
[AGENT][NEUTRAL] So there was no payment made on this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So, so from what I gathered, I owe this $667.
[AGENT][NEUTRAL] Is that the amount that's in your deductible column?
[CUSTOMER][NEUTRAL] No, ma'am. That's just the amount, the amount.
[CUSTOMER][NEUTRAL] I've added all the the numbers up is that is in the that that is in the fee column without a minus beside it.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It was $2,227.73.
[CUSTOMER][NEUTRAL] So American Blue Cross, I guess they pay.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I guess they pay $390 and then they paid.
[CUSTOMER][NEUTRAL] Another $300 and then they paid another $182.
[CUSTOMER][NEUTRAL] For they
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, so it doesn't look like anything it doesn't look like uh Blue Cross paid anything it was applied towards your calendar, your deductible.
[AGENT][NEUTRAL] So the 443.37.
[AGENT][NEUTRAL] The 100 $100. 36 cents.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And then [PII].
[AGENT][NEUTRAL] All of those amounts were applied towards your calendar year deductible.
[CUSTOMER][NEUTRAL] Yeah, that's what I'm trying to figure out is.
[CUSTOMER][NEUTRAL] Did they, did they try, did they not, uh, my deductible starts every year, correct?
[AGENT][NEUTRAL] Well, is your, your major medical, is it from January December?
[AGENT][NEUTRAL] Your
[CUSTOMER][NEUTRAL] Yes my
[AGENT][NEUTRAL] OK, so yeah, that's per calendar year.
[CUSTOMER][NEUTRAL] OK, then that's, that's what I'm trying to figure out is it I've had this done and.
[CUSTOMER][NEUTRAL] 9:30 or 24.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So that yeah that, yeah, so I'm just trying to figure out is why they had why did they process this last year when my deductible had been met.
[CUSTOMER][NEGATIVE] And they just now processing it this year when my me and my deductible has not been met, therefore I owe this bill.
[AGENT][NEUTRAL] Well, since it's a [PII] charge, we process it under your [PII] benefits. Now, um, and I would say that, um, Blue Cross will do the same. So since it's for [PII], it'll be calculated under your [PII] benefits and not [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you may not have reached, do you know what your, your primary insurance deductible is per year?
[CUSTOMER][NEUTRAL] It's like 2500 bucks or something like that.
[AGENT][NEUTRAL] OK, so maybe you had not met your deductible amount yet when this claim was processed by Blue Cross.
[CUSTOMER][NEUTRAL] Yeah, that's what I, that's what I'm trying to figure out is.
[AGENT][NEUTRAL] Yeah, so you
[CUSTOMER][NEUTRAL] Uh, I, I don't understand.
[AGENT][NEUTRAL] Yeah, you may wanna reach out to.
[CUSTOMER][NEUTRAL] Yeah, I met my deductible last year. Blue Cross.
[AGENT][NEUTRAL] You, you, you said you did?
[CUSTOMER][NEUTRAL] I met my deductible last year.
[CUSTOMER][NEUTRAL] But I have not met my deductible.
[AGENT][NEUTRAL] But do you know if it was met with this particular claim?
[CUSTOMER][NEUTRAL] This this colon.
[AGENT][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] This upper this upper GI and the colonoscopy?
[CUSTOMER][NEUTRAL] That's only 2 times I went to last year was 2 times.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so you may wanna reach out to Blue Cross.
[AGENT][NEUTRAL] Um, and ask them if the amounts applied towards your deductible on this claim, that's what it looks like to me. You hadn't satisfied your deductible when this claim was processed by Blue Cross.
[AGENT][NEUTRAL] So that's why they applied it towards your deductible.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Now have independent lab, if it was covered under your APL policy, we would have absorbed some of that some of that amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But independent lab is not covered under the APL policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm trying, I'm just trying to did that policy change?
[AGENT][NEUTRAL] No, I'm showing that you've had the, let me check something.
[CUSTOMER][NEUTRAL] The the reason I'm asking is because.
[AGENT][NEUTRAL] You know, I'm showing that you've had the same policy since [PII], so nothing has changed.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Because see that this would be.
[CUSTOMER][NEUTRAL] This is the 2nd time I've had this done.
[AGENT][NEUTRAL] Uh-huh. Since, since you've had the policy?
[CUSTOMER][NEUTRAL] The the upper GI.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And I've, I, as I say, I I was calling because I've never had to pay no more than a $100 bill.
[AGENT][NEUTRAL] When did, do you remember when you had the other one done?
[CUSTOMER][NEUTRAL] No, ma'am, I do not
[AGENT][NEUTRAL] Let me see. Let me look at your history.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, I do show a colonoscopy for [PII], um, and this would be the, this would be from gastrointestinal. So this is the uh surgeon that performed it. So, this charge was paid as well as the one that you had in September. The facility and the surgeon's charge was covered.
[AGENT][NEUTRAL] But the, but the lab charges they sent those off to be to be read or you know, to read the lab results and so then we and so then we received a claim, a claim from an independent laboratory and claims from an independent lab under your policy is not covered so that one wasn't wasn't paid, which is the one we're talking about now from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, because independent lab is not covered, but the other charges related to it was paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The hospital bill and then the surgeon's charge was covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] What do I need to do to add that policy to add that to my policy?
[AGENT][NEUTRAL] Well, because this is a group policy, you know, you have it through your employer group that would be a question for them. I believe they may choose the policies for the employees.
[AGENT][NEUTRAL] And so you know that may be something that as an employee you can suggest but it's up to your employer as to what benefits they have under your policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, yeah, I'm having another surgery done tomorrow.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Right, so.
[AGENT][NEUTRAL] If it's, you know, the facility charge, you know, if it's outpatient hospital, the facility charge, the surgeon's charge, the anesthesiologist charge, um, those, those, those services, uh, can be considered under your policy.
[CUSTOMER][NEUTRAL] Yeah, it's gonna be an outpatient. It's a uh it's gonna be a hemorrhoid surgery.
[AGENT][NEUTRAL] OK, OK, so, so that would, that can be considered under your um outpatient benefit and just so you know, your outpatient and your inpatient benefit is combined. It's a combined maximum of $5000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so I don't show that we processed any claims for you for [PII]. Have you had any other services this year?
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Looks like there's 2 claims pending for you.
[CUSTOMER][NEUTRAL] Other than
[AGENT][NEUTRAL] To be processed.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I've had, uh, I had to go when everybody was getting real bad sick here in [PII]. I went and had a, uh, COVID and a flu test done twice. The doctor twice.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] For this year. That's the only, that's the only other time I've been to the doctor. And, uh, the other day I went, I had an appointment last week for this hemorrhoid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And it was Doctor at the Baptist Medical in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But, but other than that, I haven't, I haven't been to the doctor except for the, the two, the two flus and, uh, Doctor [PII]'s visit for this hemorrhoid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right. So, um,
[AGENT][NEUTRAL] There are 2 claims that are pending to be processed. It looks like it's the office visits that that you had.
[AGENT][NEUTRAL] Um, and so the office visit, it looked like they did some treatment while you were there in the office, these items will not be covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It covers outpatient and inpatient. Outpatient is, is emergency room, urgent care, surgery in a hospital.
[AGENT][NEUTRAL] Um, those are the items that's covered under the policy that you have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So you should be good for the surgery.
[CUSTOMER][POSITIVE] Alrighty
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty thank you ma'am.
[AGENT][NEUTRAL] Oh, you're welcome, [PII]. Did you have any other questions?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] OK, well thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Uh, bye-bye.
[AGENT][NEUTRAL] [PII], I think I still have you connected.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, uh, no worries, thank you for calling APL.
[CUSTOMER][POSITIVE] I'm sorry, thank you.