AccountId: 011433970860
ContactId: 3b05d2fc-8b5d-4032-a439-9360df48ad09
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 459869 ms
Total Talk Time (AGENT): 138254 ms
Total Talk Time (CUSTOMER): 168034 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/3b05d2fc-8b5d-4032-a439-9360df48ad09_20250414T19:17_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I received a couple um invoices from my providers, um, stating that, um, the claims weren't paid um by you guys. I know I had an issue with my, um, coverage, but they went ahead and they figured everything out and my coverage was, um, reinstated. I just wanna go over these claims with you to see if you can help me out.
[AGENT][NEUTRAL] OK, may I have your policy number?
[CUSTOMER][NEUTRAL] Sure, it is Jesus Christ. Now give me one second. 01.
[CUSTOMER][NEUTRAL] 89
[CUSTOMER][NEUTRAL] 5252 and now I, I don't know I guess 8 for outpatient.
[AGENT][NEUTRAL] And may I have your date of birth please?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, did you hear me?
[AGENT][NEUTRAL] Yes, I can hear you now. May I have your date of birth?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I do need to verify the mailing address on file and email address please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure, it's [PII], and it should be just [PII].
[AGENT][NEUTRAL] Thank you and may I have a callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and may I have a date of service that you're calling in regards to?
[CUSTOMER][NEUTRAL] OK, the first day of service is [PII].
[CUSTOMER][NEUTRAL] From Baptist Hill South Florida Homestead Hospital.
[AGENT][NEUTRAL] OK, so I did pull that claim up for the facility and it does show that we processed that claim.
[AGENT][NEUTRAL] On [PII] and it shows that your maximum for outpatient had been met at that time.
[CUSTOMER][NEUTRAL] Hm, what is my maximum outpatient benefit because I was under the impression that it would cover what I was responsible for with my insurance.
[AGENT][NEUTRAL] Yes, if it shows that um you do have a max that you.
[AGENT][POSITIVE] That was chosen, so let me pull that benefit up for you.
[AGENT][NEUTRAL] For your outpatient verification of coverage does not guarantee the payment of the claim. It shows that you have a benefit amount of $2500 that we will pay towards the primary insurance deductible, co-insurance, or co-pay.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and I already met those $2500 because I don't think I did.
[AGENT][NEUTRAL] Yes, it shows that we've already paid out a total of $2500 for 2024.
[CUSTOMER][NEUTRAL] Um, OK, um, that's interesting. Alright, so then that's because I was already, I already met my maximum, OK, and then.
[CUSTOMER][NEUTRAL] Data service 11 7 2024.
[AGENT][NEUTRAL] Is that for the facility bill as well?
[CUSTOMER][NEUTRAL] It's for, um, yeah, this was for a sleep study, yes.
[AGENT][NEUTRAL] So for this one we did make a payment in the amount of 152 47. Once we made that payment, that was the maximum amount that will be paid out for 2024.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, I have two more, um, another one is for 1224 2024, so we have.
[CUSTOMER][NEUTRAL] So I mean if I got admitted they shouldn't be charging me the co-payment. OK, I'm gonna have to figure it out but.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So it would be 1224 2024.
[AGENT][NEUTRAL] For the date of service of 12-24-24, no claim is on file.
[AGENT][NEUTRAL] Oh, you said 12:20. I apologize, 12:20.
[CUSTOMER][NEUTRAL] OK, then try 12
[CUSTOMER][NEUTRAL] from [PII] to [PII], I was hospitalized.
[CUSTOMER][NEUTRAL] So that would I guess be inpatient?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the one that you just asked me to check on was the it was was it [PII] or [PII] 24?
[CUSTOMER][NEUTRAL] No, it was [PII] because I was admitted from [PII] to [PII], but I received an invoice for inpatient deductible for 1224-24.
[AGENT][NEUTRAL] OK, so for the 1224 of 24, no claim is on file.
[CUSTOMER][NEUTRAL] OK, no problem, then I'll have them send it to you and you don't have anything either for [PII] correct?
[AGENT][NEUTRAL] No claim for 1223 either.
[CUSTOMER][NEUTRAL] Awesome, OK, so how would I be able to get like, uh, I guess like maybe an itemized or a statement of all the claims that were submitted to you guys that you guys paid out towards my outpatient responsibility?
[AGENT][NEUTRAL] Yes, you have access to that on the secured portal. Do you have that website?
[CUSTOMER][NEUTRAL] Um, no, I do not. Can you please give it to me?
[AGENT][NEUTRAL] OK, it, it should also be listed on the card just in case it is secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I'm probably
[CUSTOMER][POSITIVE] [PII]. OK, fantastic. Alright, OK, thank you so much for your help.
[AGENT][NEUTRAL] You're welcome and once you access it, you can check statuses of any claims as well.
[CUSTOMER][POSITIVE] Oh, that's great. And then if I need them to get reprocess, I can do it through there too, or no?
[AGENT][NEUTRAL] You have to submit that claim back in for us to review and then if we reviewed it once the examiner, then the examiner will go in and um process it as need be, if it's eligible.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Understood. OK, thank you so much have a good one.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.