AccountId: 011433970860
ContactId: 31e7b328-67a8-47a9-a9f9-cfc920cc2df6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 965669 ms
Total Talk Time (AGENT): 375576 ms
Total Talk Time (CUSTOMER): 308308 ms
Interruptions: 9
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/31e7b328-67a8-47a9-a9f9-cfc920cc2df6_20250327T13:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I was calling because of a claim that I saw with you guys and um the, the check was sent to the it, it, it looks like it says the provider. I just wanted to, to confirm that first.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can check and see. Um, and may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Um, my, my name and phone number?
[AGENT][NEUTRAL] Your name and a phone number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Oh OK, OK, [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the policy number if you have it?
[CUSTOMER][NEUTRAL] Um, I'm on the account. Let me see if I can find it.
[CUSTOMER][NEUTRAL] Policy number is 255-0888.
[AGENT][NEUTRAL] OK. And for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Um, date of birth is [PII]. Email address, um, I don't remember if I use my work or my personal. I'm gonna do my work [PII].
[AGENT][NEUTRAL] Personal.
[AGENT][NEUTRAL] Yes, thank you. And what's the mailing address to make sure we have it correctly?
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] OK, thank you. All right, um, let me look at this claim. It was sent out to the provider of service.
[CUSTOMER][NEUTRAL] OK, so the, OK, so here's the problem.
[AGENT][POSITIVE] Good.
[CUSTOMER][NEUTRAL] Here's the problem. I called the hospital and then I asked them, so what, what's because my account is, is currently a zero balance because I had already paid the, the bill, and um, I asked them, so what would happen when you guys because it looks like it's, it's a check, right? or or is it via ACH?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is a check.
[CUSTOMER][NEUTRAL] Check. OK, so I asked them what will happen when you guys get this check. I was told that the check would be sent back since the account is a zero balance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So once it if if they do send it back once it's received, they'll go ahead and apply that back to your account but right now since um we received the claim and it looks like the original claim came back from them, it did send out to the provider of service.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Wait, but the claim came from, I'm the one that submitted the claim because the first one was denied.
[AGENT][NEUTRAL] The first one was asking for additional. Let me go ahead and pull that information because the only way we pay a provider of service is if there's a sign on a benefit, and yes, the first document was sent from the facility with the signing of benefits, so it had to be sent out to them. Mhm.
[CUSTOMER][NEUTRAL] Right, and then
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You said with with what benefit with signed on, find something benefits?
[AGENT][NEUTRAL] Assignment of benefits. Assignment of benefits means that you sign a document saying that they can collect for you.
[CUSTOMER][NEGATIVE] Oh Lord, this is a pain.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh my God. OK. Mm.
[AGENT][NEUTRAL] Yeah, yeah, when you send that document, even we, yeah, we cannot do anything. It has to be sent to them because they're the one that, you know, submitted the, the first claim. If you would to submit the claim on the other hand and they will not send anything, you will do the submitting, then it will go to you, but yeah, that's how it usually works. Mhm.
[CUSTOMER][NEUTRAL] So in the
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] So if they send the check back, which I'm hoping, I don't even know if the correct information.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, you guys will then take it and because I, I just signed up for direct deposit, you guys will then just deposit it into my account?
[AGENT][NEUTRAL] No, it's just gonna be, mm mm, it's just gonna be applied back to the balance of the it's just gonna be applied back.
[CUSTOMER][NEUTRAL] If they send it back?
[AGENT][NEGATIVE] It's just gonna be returned.
[CUSTOMER][NEUTRAL] What do you mean?
[CUSTOMER][NEUTRAL] I'll fly back to where to you guys?
[AGENT][NEUTRAL] Yeah, it's just gonna be put back and you have that available again.
[AGENT][NEUTRAL] Unless you submit, yeah, unless you submit your.
[CUSTOMER][NEUTRAL] I, I search the deductible.
[CUSTOMER][NEUTRAL] Uh, I spent that deductible. I, like I paid these people $3900 and the deductible was, it's supposed to be paid back to me by my secondary insurance, but I paid upfront.
[CUSTOMER][NEGATIVE] So if, if they decide not to take this check, you're telling me I'm not gonna get this, this $3000 that's part of my insurance, even though I put in the, the claim?
[AGENT][NEUTRAL] OK, um, the
[AGENT][NEUTRAL] No, because the original claim came from them. The original claim came from um the HCA hospital.
[AGENT][NEUTRAL] So, um, that's why we have to send the payment direct to them. If you need a reimbursement.
[CUSTOMER][NEUTRAL] I'm, I'm confused.
[CUSTOMER][NEUTRAL] I, I understand why you have to send it to them.
[AGENT][NEUTRAL] Mhm, yeah. If you need a, a reimbursement, if you need a reimbursement, you will have to submit the whole claim. The whole claim means you need to get an itemized bill with the diagnosis codes and procedure codes. You need to get.
[CUSTOMER][NEUTRAL] Right, go ahead. Sorry.
[CUSTOMER][NEUTRAL] I did that, ma'am.
[AGENT][NEUTRAL] OK, um, yeah.
[CUSTOMER][NEUTRAL] Ma'am, I, I did that. I, I have the confirmation number in front of me.
[AGENT][NEUTRAL] You send it
[CUSTOMER][NEUTRAL] I, so, OK, so let me, let me start over.
[AGENT][NEUTRAL] Let me go.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I'm sorry. I, I, I, I feel like I keep interrupting you. You go in and I'll go. Go.
[AGENT][NEUTRAL] OK, the only thing I can do at this point because, um, I, I can only give you information that I see in front of me. I don't have any way of changing anything or just there, you know, so the only thing I can do is this have an examiner, a claim specialist call you back and explain to you what else can you do about this situation.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] But that's, yeah, that will be the only.
[CUSTOMER][NEUTRAL] But I want to understand the situation and I think I'm just missing some parts because I was trying to get clarification. So I, I was asking if what they are saying is because I paid the, I paid the bill. It was $3000 something dollars, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Understand.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I, if, if like this, so now my account with them shows a zero balance. If I like they claim when they get this this check for the $3000 which is a which is, which it should be covered by the insurance but I had already paid, so it really should be coming back to me directly, but I understand why it went to them, um, and they send it back to you, you, you said that, then I would never get the $3000 because they send it back to you, basically.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] If they just do a return and let us know that the return is because it's already paid, it's just gonna go back to your balance, to your calendar year maximum because it's just coming back basically. um, now.
[AGENT][NEUTRAL] You said you submitted the itemized bill and you submitted all the information after they submitted the claim again, but I don't make.
[CUSTOMER][NEUTRAL] Yes, yes, yes, I separated a whole separate claim, a whole separate claim.
[AGENT][NEUTRAL] Understand, Mr. I understand. Now I, I cannot make any decisions. I don't process claims. I'll have to get an examiner, a claim specialist to to advise you and see if it's possible for them to go ahead and send you that payment.
[CUSTOMER][NEUTRAL] Mhm. Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Because I'm just going by by rules.
[CUSTOMER][NEUTRAL] OK, cause maybe the the check can be canceled.
[AGENT][NEUTRAL] I'm just going by rules on how it's supposed to be and how it works. That's, that's all I'm giving you how it works. Now I cannot make a decision. The only ones that can make a decision is a claim specialist so they can decide if it's possible to send it to you.
[CUSTOMER][NEUTRAL] I understand, yes.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] If the information they have there is enough to send it to you or it's just gonna go back to the uh and you know they are the ones that makes decision we only have information OK so um I can go ahead and get and get a specialist, OK, go ahead.
[CUSTOMER][NEUTRAL] OK. I have one more question.
[CUSTOMER][NEUTRAL] Right, I, I, I definitely want the specialist, but I actually have one more question. Do you know, maybe the, the, the specialist might be, might be the the best one to answer that, but I'll, I'll ask you first. Do you know if, if when the money comes back, can I resubmit the claim for the same situation then in that case and and then hopefully then they'll know that it's a whole separate claim number and actually send me.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The the deductible, do you know or is that a question for the claim specialist that you mentioned?
[AGENT][NEUTRAL] That is what I've been telling you. OK, so, um, the claims department or the claims specialist is the one that makes decisions. So, uh, once, um, they can see if they have enough to just go ahead and send it to you once it's received or if they need something else from you um that will help send that out to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yeah, can you, can you have them call me please? Thank you.
[AGENT][NEUTRAL] OK. Yeah. OK. All right. Sure, no problem, and I'm sorry, I'm just trying to explain as best as I can. Yeah, we, we, we don't make decision on this line. I'm sorry. OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I'm fine.
[CUSTOMER][MIXED] It's a little, it's a little scary because it's like a lot of money and my insurance is supposed to cover it, so I thought this was taken care of, so this is very interesting. Um, but yeah, if you could, are, are they gonna, are you gonna give them my number and they're just gonna call me whenever, or?
[AGENT][NEUTRAL] Yeah, I
[AGENT][NEUTRAL] I am, yes.
[AGENT][NEUTRAL] Mhm, yes, mhm, yes, uh, the same number you provided to me in the beginning, which is the [PII] is gonna go into the request. It it it may be up to 24 business hours for you to get a call back, OK, because they need to go through all the paperwork. I am gonna explain to them exactly what you're trying to do. So when they call you, they have a little bit of information and see how they can help you, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] OK. Now if you don't mind holding for me just a minute, let me go ahead and send all this information over so they have it before I let you go, OK?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[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][POSITIVE] Thank you for holding and being patient for me Miss. OK, I went ahead and send that over so you should be expecting a call soon, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And, and they're gonna call, I guess within the hours that you guys are are are open, which is I think it's like [PII] to
[CUSTOMER][NEUTRAL] What time are you? What would the call happen exactly?
[AGENT][NEUTRAL] Um, again, it's [PII], the, the normal time is 24 hours, so, um, more than likely.
[CUSTOMER][NEUTRAL] They're not gonna call me at [PII], right? It's what I'm trying to ask.
[AGENT][NEUTRAL] Oh, no, no, no, no. [PII] central time is the latest that we can call because that's when the office closed.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] Yeah, so it's from [PII] yeah, [PII], OK?
[CUSTOMER][NEUTRAL] So I was just like to make sure.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today? You're welcome. You have a good day. OK. Bye-bye. Thank you.
[CUSTOMER][POSITIVE] All right. Thank you so much.
[CUSTOMER][NEUTRAL] No, that's it.
[CUSTOMER][NEUTRAL] You too bye bye.