AccountId: 011433970860
ContactId: 3d069db7-c6ef-4763-b685-5e226f0ec23a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1187939 ms
Total Talk Time (AGENT): 389355 ms
Total Talk Time (CUSTOMER): 520455 ms
Interruptions: 7
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/3d069db7-c6ef-4763-b685-5e226f0ec23a_20250527T12:02_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Yes ma'am, good morning. I hope you had a good Memorial Day. Uh, my name is [PII] here in [PII]. Uh, I'm sorry.
[AGENT][POSITIVE] I hope you did too.
[AGENT][NEUTRAL] I said I hope you did too, as far as the holiday.
[CUSTOMER][NEUTRAL] Yeah, I, I, it was, it was alright. It was nice not to have to work. Um, I have a bill from last year. It looks it's not a bill. It's just a statement of benefits, um, from last year. I got 3 bills or, um, I'm gonna check with you, verify the status of them, if I may, and where we are. So what I'm gonna be financially responsible for, please.
[AGENT][NEUTRAL] OK, so you're the insured and you're wanting to check on 3 claims for yourself, is that correct? Yes, I can help you.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah, there, well, there's 3,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, there's explanation of benefits and I just wondered what the status is is I, you know, uh, one was denied and that's fine. It said, um, not a covered expense, so I just wanna make sure what that pertains to and there's, um, two other ones, um, last year's the.
[AGENT][NEUTRAL] OK. And uh, what was your last name?
[CUSTOMER][NEUTRAL] Right. Last name [PII]
[AGENT][POSITIVE] OK, thank you and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII] and while I'm at it, I um uh please leave the details if you, if in the event you need to um call back at any time um I'm only up to about [PII]. I work overnight, so I work at from [PII], [PII] next morning, so I'm going to bed soon. So, um, in the event that you'll ever have to call me, just leave a detailed voicemail and I'll get back to you, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure. Yes, be happy to do that. And [PII], what is a good, I'm sorry, what is your policy number?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Policy number, let me see, that would that be on the card itself?
[AGENT][NEUTRAL] It'll be on the card. It would also be on your explanation of benefits from APL.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Whichever is easier for you.
[CUSTOMER][NEUTRAL] OK, I, I see the top, ma'am policy number 021 7.
[CUSTOMER][NEUTRAL] 492 7
[AGENT][POSITIVE] OK, thank you, give me a couple.
[CUSTOMER][NEUTRAL] That's 0217.
[AGENT][NEUTRAL] Uh-huh. 497.
[AGENT][NEUTRAL] OK, and this is for
[CUSTOMER][NEUTRAL] 02174927
[AGENT][NEUTRAL] OK then thank you and [PII] I will have to verify several pieces of information with you first for security and then also any information provided will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] That's, that's fine.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then also your home mailing address, please.
[CUSTOMER][NEUTRAL] [PII]. That's one followed by [PII].
[AGENT][NEUTRAL] Thank you. The phone number on file for you is the same as the one that you gave me, so that is your best contact number that we should have, correct?
[CUSTOMER][NEUTRAL] Right, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. And lastly your email address, please?
[CUSTOMER][NEUTRAL] would be [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying all of your information. And this is on your dental policy that you're calling about, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right, one of them is, one of them is.
[AGENT][NEUTRAL] OK. And [PII], what is the date of service that you're calling about?
[CUSTOMER][NEUTRAL] Well, the first one that I, the biggest one that I wanna, um, clear with clear with you is, um, dated [PII] of last year, that's [PII]. I, I figured by now I would have gotten some any um word from them themselves office doctor office themselves looking for their money, but I just wanna make sure that I can put this one to bed.
[AGENT][NEUTRAL] OK. So you said it was [PII] or [PII]?
[CUSTOMER][NEUTRAL] Um, it's.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, now on your dental policy, [PII], we do not have a data service of [PII]. We do not have a claim.
[AGENT][NEUTRAL] On file for you for that date.
[CUSTOMER][NEUTRAL] OK, alright, I'm looking at, I apologize, I'm looking at the check date, try this date instead. [PII], same month, same year, [PII], please.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Thank you for your help.
[AGENT][NEUTRAL] OK, so that should be you're welcome. So that should be claim number 3449206.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so I do show that we paid the provider a benefit of $227 on that claim.
[CUSTOMER][NEUTRAL] OK, one second, let me write that down.
[AGENT][NEUTRAL] And it, it should show that also, [PII], on your explanation of benefits.
[CUSTOMER][NEUTRAL] One second please.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm sorry, one moment please.
[CUSTOMER][NEUTRAL] I apologize for what, ma'am?
[AGENT][NEUTRAL] I said that it should show that also on your explanation of benefits, what the amount were on which codes.
[CUSTOMER][NEUTRAL] Not, not on the, I don't keep the best record, um, I should do better than I am, um, this one was dated, um, it was a check dated [PII], and it said on the back remarks we are waiting information to confirm eligibility for benefits in that card, um, upon receipt of information, we'll continue processing your claim. That's the that's one that I find.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right, so then there should have been another one that was sent out. It was went through processing when we were able to pay it once we received that information. Um, it was processed on 53. So let's see, um, that, uh, give me just one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To see what date that was. I'm sorry.
[AGENT][NEUTRAL] So [PII] this year was on.
[AGENT][NEUTRAL] OK, so that went through like a processing on.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]. 0, correct. Yes. Uh-huh. So just a second. I'm waiting on the screen here.
[CUSTOMER][NEUTRAL] This one would have been for last year.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] So that was a Friday. So the check would not have gone out of the explanation of benefits until [PII], but you should have received another one. But yes, so we were able to pay that benefit.
[AGENT][NEUTRAL] To the provider in the amount of $227.
[AGENT][NEUTRAL] Now because you are signed up.
[CUSTOMER][NEUTRAL] 227 even.
[AGENT][NEUTRAL] Yes, sir. Uh-huh.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] And then in the port.
[CUSTOMER][NEUTRAL] So was it the bill lowered then because.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Go ahead with your question.
[CUSTOMER][NEUTRAL] But the bills that I had are the total patient responsibility.
[CUSTOMER][NEUTRAL] Was showing 1,329. Were you were you able to work with them and lower that? Is that what typically done or am I on the hook for the difference of that?
[AGENT][NEUTRAL] No, sir, that was, your bill was 1329. That was the claim that was received and the amount of the benefit that we were able to pay was what I just gave to you.
[AGENT][NEUTRAL] And we do not determine patient responsibility.
[CUSTOMER][NEGATIVE] OK, so you didn't work you don't work the bill down at all.
[AGENT][NEUTRAL] Correct, we do not. So that would be up to the provider.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So I need to get him with American, um, not with American public life, but I need to get with Coach Dental and see Iow them.
[AGENT][POSITIVE] Correct, yes, sir. Uh-huh.
[CUSTOMER][NEUTRAL] OK, uh, I'm surprised they haven't come by haven't send me any additional, um, uh.
[CUSTOMER][NEGATIVE] You know, I would figure in the mail they would have sent me no more more notices than they have of whatever they have done, uh, looking for their money. Alright, so that's not good news. Um, the other one was, um, there are two other bills. There's one, now we're.
[AGENT][NEUTRAL] Is this also on your dental policy?
[CUSTOMER][NEUTRAL] Excuse me?
[CUSTOMER][NEUTRAL] Yeah, the dental policy. This, no, this one's for skin pathology associates. It is a non-covered procedure.
[AGENT][NEUTRAL] OK, so it'll be a
[AGENT][NEUTRAL] OK, so this, OK, so are we done with your dental policy? Because I have to pull one policy up at a time in order to look at your claims. They're all under different policies. So were there any other dental questions?
[CUSTOMER][NEUTRAL] Let me check on that because the only other one that I've got is just on the phone they sent me an email, um, bill they did not send me any papers so let me take a look at that real quick and see who that's from, please. One second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am, that, that'd be and there's two other bills. They're both medical, lunch from a resurgeon orthopedics.
[AGENT][NEUTRAL] OK, so let me
[AGENT][NEUTRAL] OK, so give me a moment to get out of this policy and to locate your other policy information.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so on your medical, what is the the first day of service?
[CUSTOMER][NEUTRAL] Data service, uh, let me take a look, um, back, um, it was, uh, [PII] of this year.
[CUSTOMER][NEUTRAL] And it's a different policy number of course because medical so it would be a different policy number but it's 02.
[AGENT][POSITIVE] That is correct. Mhm.
[CUSTOMER][NEUTRAL] 0217
[AGENT][NEUTRAL] I have it. 492 3.
[CUSTOMER][NEUTRAL] Oh, you do 4923. Yes ma'am.
[AGENT][NEUTRAL] Yes, sir. OK.
[AGENT][NEUTRAL] And what was the bill amount?
[CUSTOMER][NEUTRAL] And I'm looking at claim number 3.
[AGENT][NEUTRAL] OK, you can.
[CUSTOMER][NEGATIVE] Uh, that, that doesn't say anything on it just says, um, the explanation of benefits doesn't show any, um, um, paid amount doesn't show anything of what was actually my responsibility either. It says, um, it's the claim number 360.
[CUSTOMER][NEGATIVE] 2668 for skin pathology associates and it just didn't show anything paid.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It said not covered procedures, so I don't know what that's necessarily pertaining to.
[CUSTOMER][NEUTRAL] And what the amount that would be.
[AGENT][NEUTRAL] OK, so this was for data service 13-2025 and this is for Skin Pathology Associates is the, who the claim.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] And it just says um patient account number provider service was developed skin pathology associates skin service service descriptions and non-covered procedure and then it says uh procure PROC 88306. I get I'm sure that means something to you and then one remark um for marker one which said it's uh payable under this not wait benefits payable under the certificate are limited.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Uh-huh. So those outlined in the schedule of benefits. This is not a covered loss under the plan. Therefore, no amount is payable.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So it looks like maybe did you have an
[CUSTOMER][NEUTRAL] And I don't know what that's for.
[AGENT][NEUTRAL] Office visit and some type of um.
[AGENT][NEUTRAL] pathology done for that data service?
[CUSTOMER][NEUTRAL] Yeah, I mean, but yeah, but you know how what that amount would be to pertaining to this one? Would it be so I know that what the expense would be.
[AGENT][NEUTRAL] OK, so that.
[AGENT][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] I'm gonna have to pull this information a little differently, [PII], so bear with me just a moment please.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I, I have a bill from Skin pathology associates for the same date, so I think it must be the same thing for $100.
[AGENT][POSITIVE] It's still loading. Yes, that is correct. That was the total bill amount.
[CUSTOMER][NEUTRAL] 100 even.
[CUSTOMER][POSITIVE] Thanks
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, so that's what I owe them.
[CUSTOMER][NEUTRAL] So I owe about $1100 on the first one for the dental and then $100 for this one and then the last one I have for you, ma'am, let me, um, again I gotta look at my phone bear with me it's an old phone hand me down from my sister, so one second, let, let me look in the email it's right here.
[AGENT][NEUTRAL] Yeah, you're
[AGENT][NEUTRAL] You're, you're fine. Yes, you're fine.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I can tell you that as the loading is from resurgence orthopedics.
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] In the amount due at [PII] and did you get a bill from that on that from resurgence, uh, let me find the date for you. It was this year.
[AGENT][NEUTRAL] And you're, you're getting the data service [PII], is that right?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Excuse me?
[AGENT][NEUTRAL] Are you looking for the data service?
[CUSTOMER][POSITIVE] Yes ma'am, yes, I'm sorry, putting down the phone so I could.
[AGENT][NEUTRAL] For this one, OK.
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Alright ma'am, I'll call back on that way because I only keep you waiting uh I have to find it, um, it's gonna take a little bit more effort, OK.
[AGENT][POSITIVE] Well, you're OK.
[AGENT][POSITIVE] Are you sure? I, I mean, I'm, I don't mind waiting for you to look for it.
[CUSTOMER][NEUTRAL] please.
[AGENT][NEUTRAL] What did you say the name of the provider was, [PII]?
[CUSTOMER][POSITIVE] I appreciate.
[CUSTOMER][NEUTRAL] I'm sorry, ma'am?
[AGENT][NEUTRAL] What did you say the name of the other?
[AGENT][NEUTRAL] The group that you received a bill from was for?
[CUSTOMER][NEUTRAL] Yeah, this one, the last bill that I've got a question about is resurgence, um, orthopedics. It was this year, um, I don't know specific date. It was in early spring and it was, um, the amounts were 350. Uh, the cat's, my cat bishop is jumping up on my table where I've got all the paperwork and so he's getting getting in the way and I only keep on the phone.
[AGENT][NEUTRAL] 00 no.
[CUSTOMER][MIXED] I love them to death, but I'm trying to find it and I'll have to call back, but right now, um, the 227 is all that's gonna be paid on the $1300 so that leaves at $1100 with the dentist, and then I've got the other one, the $100 that matches up, so, uh, 11, about $1200 right now. OK, not a great morning, but it's nothing that you've done, and I appreciate your time and help. Thank you.
[AGENT][NEUTRAL] Uh, you
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] That's
[AGENT][POSITIVE] Well, you're certainly welcome, but I truly do not mind giving, I mean, if you need to look for the other bill, I don't mind waiting, I promise.
[CUSTOMER][NEUTRAL] That I know that's OK. um, I, I'll look for it and then um uh I, I don't even have a computer. I just got a cell phone, so I'm trying to, um, I mean trying to listen to what you're saying, but I then I try and look for the phone and uh the email so.
[AGENT][NEUTRAL] Do you
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I've got limited stuff that I'm working with, so I'll just call back when that's easier for both of us.
[AGENT][NEUTRAL] Well it's
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Well, do you happen to, would it have been maybe for that same date for the January?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Third day disservice.
[CUSTOMER][NEUTRAL] It would have been um I think it would have been like um in March March because I took some time off um but.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] It might have been in January so again I don't.
[CUSTOMER][NEUTRAL] I don't remember um, I'll take a look and call you back or call y'all back when I find out more information, OK?
[AGENT][NEUTRAL] OK, then. Well, if that, is there anything else that I could help you this morning with?
[CUSTOMER][POSITIVE] No, um, I'm just sick to my stomach about the $1100 bill, but, um, uh, I'll be able to set up again, uh, with that much money. I figured that they would have been hounding me about it, um, more than they have, so, um, I'll call coas and then handle it from there. Thank you for your time, ma'am. I appreciate your help.
[AGENT][NEUTRAL] Uh.
[AGENT][POSITIVE] Well, you're certainly welcome, [PII]. So if that's all I can help you with this morning, thank you for calling APL and I hope you have a nice restful day.
[CUSTOMER][POSITIVE] Thank you ma'am you too take care bye.
[AGENT][POSITIVE] Yes, sir. Thank you. Bye bye.