AccountId: 011433970860
ContactId: 3a10b096-94a9-48f9-ba13-8b89ffd770d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406359 ms
Total Talk Time (AGENT): 187767 ms
Total Talk Time (CUSTOMER): 187925 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/2025/04/04/3a10b096-94a9-48f9-ba13-8b89ffd770d1_20250404T13:20_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, how are you? This is [PII].
[AGENT][POSITIVE] I'm good. How about you today?
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEGATIVE] I'm doing great. I, like, the reason why I'm calling is, uh, I submitted a claim, um, a couple of times, uh, twice already and it has been denied. I see that the reason that it has been denied is, uh, supposedly cause I went to a clinic or a doctor, which is actually not true. Um, I went to the, to the hospital, uh Pascon Palmer Hospital, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] The thing is, uh, I see that it has been denied twice. You guys are asking me for more information, and there's no more information that I can provide. I, I contacted the hospital, they gave me the information that I sent to you guys. I contacted the, the, my insurance. I mean, I don't know what to do in here.
[AGENT][NEUTRAL] OK, go ahead and give me your policy number.
[AGENT][NEUTRAL] Let me get you pulled up.
[CUSTOMER][NEUTRAL] OK, policy number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, it's 02301155.
[AGENT][NEUTRAL] Alrighty, now, thank you for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Alrighty, thank you for all that information. I'll go ahead and verify your date of birth and your address for me please sir.
[CUSTOMER][NEUTRAL] It's [PII]. Um, my address, uh, I don't know which one is on the file. My current address is [PII], uh, no [PII]. OK.
[AGENT][NEUTRAL] Yeah, that's what that's what we have. OK, thank you for all that information. OK, so you're, you're calling about a hospital bill that you submitted that we're still asking information. OK, let me do a little research so hang on just a moment for me, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK thank you I appreciate it.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, let's see. I see a hospital bill.
[AGENT][NEUTRAL] For 34. Would that be it? Let me look it up. Let's see.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's a it's it's the one for 01 thing I guess, um, uh, because I guess they got uh the, the starting of the procedure cause I uploaded all the records that it led to the surgery that I had all the doctor visits that I went and
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I was just trying to give extra proof so you guys can see that this has been a procedure that I went to the doctor multiple times. They checked my eyes, they diagnosed me with keratoonos, and then, uh, and then I got a surgery about, uh, 4 weeks ago, about a month ago.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, OK, well I can tell you what we are needing, uh, on that hospital bill. Yeah, it looks like it's not real clear on the EOB from your primary insurance carrier that you were submitting that what is applied towards your deductible copay and co-insurance. So what I would advise in order because really what we need, call your primary insurance company and tell them you need them to send you.
[AGENT][NEUTRAL] A copy of the provider's EOB.
[CUSTOMER][NEUTRAL] OK, that's, that's the only thing that you guys need.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That is it for the hospital bill, yes, sir. It's just not clarified where what is coming out, deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] Yeah, so that's basically what we need and you can resubmit that on the OSC website along with the that claim form so we'll know which which one it belongs with.
[CUSTOMER][NEUTRAL] OK, so it
[CUSTOMER][NEUTRAL] Um, so what you guys need is the hospital EOB. That's what you said?
[AGENT][NEUTRAL] Correct. From your, from your primary insurance company, we need the providers EOB.
[CUSTOMER][NEUTRAL] Oh, provider, OK.
[AGENT][NEUTRAL] Right, OK. That, that will detail out exactly what, what we need.
[CUSTOMER][NEUTRAL] I be.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, um, also I see that in there is, uh, the thing is I see on the last one I see a bunch of notes, um, the first one said that the insurance, uh, it covered, uh, the full payment, which is not true. I, I, I paid 1500, um, and that it was covered by a doctor office or clinic, which is not true either.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What should I do about that?
[AGENT][NEUTRAL] Uh, well, if uh I do see one on I mean uh [PII], yeah, because if the, if the doctor's office files with a place of treatment 11, it's not covered here. So it's how your provider's filing it. So if you think that that that's incorrect, you would have to call that provider's office and um ask him about it because we can't change the way they file that claim.
[AGENT][NEGATIVE] That has to be, yeah, cause you don't have any office visit benefits here at all. Nothing done in an office setting at a doctor's office, only outpatient at a hospital or outpatient surgical facility.
[AGENT][NEGATIVE] Yeah, so that is why that's being denied. Yeah.
[CUSTOMER][NEUTRAL] But, yeah, that's what I'm saying. OK, so if my procedure was done in a hospital facility, it should be covered by your insurance, right?
[AGENT][NEUTRAL] But they have to bill it that way.
[AGENT][NEUTRAL] Yes, because we have to base it on yeah how they're billing it, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I would just check with that provider. Yes, sir. Mhm. Yup. And is that all that I can help answer for you? Yes, sir. Is that all I can help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK, I'll call.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yeah, all right. Well, thank you for calling APO Mr. [PII]. You have a good day.
[CUSTOMER][POSITIVE] Yes, that'll be all. Thank you.
[CUSTOMER][NEUTRAL] OK, bye.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you, sir. Bye-bye.