AccountId: 011433970860
ContactId: 3f7468ff-3a03-4406-82fc-18b7f9a8c5f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1012489 ms
Total Talk Time (AGENT): 509430 ms
Total Talk Time (CUSTOMER): 286893 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/3f7468ff-3a03-4406-82fc-18b7f9a8c5f0_20250122T19:11_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. My name is [PII], and I, um, I have a question about a claim that, um, about a claim.
[AGENT][NEUTRAL] OK, yes, we can look that up. What is your policy number?
[CUSTOMER][NEUTRAL] It is 251.
[CUSTOMER][NEUTRAL] 8201.
[AGENT][NEUTRAL] Thank you. If I could verify your date of birth, please, and your phone number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My phone number is [PII].
[AGENT][POSITIVE] I do appreciate that. Thank you. And what is the date of service that we're looking for, please?
[CUSTOMER][NEUTRAL] Uh, it was [PII].
[AGENT][NEUTRAL] And this is for you or?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. I'm just.
[AGENT][NEUTRAL] Let me just pull this up and we can.
[CUSTOMER][NEUTRAL] And I'm not really quite sure. I'm not really quite sure how all this works, so please, uh, bear with me.
[AGENT][NEUTRAL] No, that's quite all right. Um, we'll, we'll just go over it and, and, uh, OK, so it looks like we received a claim from I-35 ASC Limited and uh I'm gonna look at this and find out who this is exactly because it's
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, that's the one that I'm talking about in particular.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] It looks like it was 4.
[AGENT][NEUTRAL] A hospital bill.
[CUSTOMER][NEUTRAL] Outpatient surgery. Yes. Yes.
[AGENT][POSITIVE] Yes, right, that's correct, yes.
[AGENT][NEUTRAL] Now, you said that you had a question about it.
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] How, how does it work? Because my understanding is I had to pay out of pocket.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I was
[CUSTOMER][NEGATIVE] Informed that I should be getting reimbursed for whatever I paid for out of pocket, and I'm not really quite sure how that works.
[AGENT][NEUTRAL] OK. Um, well, let me, let me tell you how, how, how we got it. And then, yes, normally that, that's normally that's the way that it works. So, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We don't show that, that you actually paid anything on this because we, we would never know that unless, unless, uh, you know, we have documentation for that. So what has happened is this. The hospital, um, I-35 ASC, um, uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, what they did was they turned in a facility bill for the hospital, for the use of the hospital.
[AGENT][NEUTRAL] And they turned that in along with your explanation of benefits from Health E. Now, on that, the um the explanation of benefits, you know, you have a, you have an ineligible amount, the amount that your, your uh your hospital, your, your insurance considers eligible for this amount, and what they did was they uh put $1,103.74 towards what, what you would normally owe, what your normal out of pocket would be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is what we pay with the hospital. OK, so you've paid, you've already paid that towards the hospital, is that what you're saying?
[CUSTOMER][NEUTRAL] Right, and that's what I paid.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Well, what has happened, um, uh,
[AGENT][NEUTRAL] We contacted the when we got this, we did contact the provider to let them know that we received their fax, um, and, uh, and also we had uh on their fax there um there was some, there was some there was some information that wasn't eligible legible I should say, and so we had to get that, but we were letting them know that we were paying them.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And that is what we did. It's because they, they did not let us know that you had already paid the bill uh yourself. Now that's going to show as an overpayment on um your account.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEGATIVE] So, unfortunately,
[CUSTOMER][NEUTRAL] On their part or y'all's part?
[AGENT][NEUTRAL] Um, well, on, well, actually, on, on their part, if, if you've already paid this amount of money.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And they're and what they did was they sent it to us as though it had never been paid as though we were supposed to pay it and so we've paid it so if it, it looks like it's been overpaid to the hospital.
[AGENT][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] So you guys overpay them the 1,103?
[AGENT][NEUTRAL] Well, we don't know, we don't know that we've overpaid them. Let me put it this way, um, [PII], what is, what has happened is, um, uh, what has happened is, is that, um, they billed it twice. So it looks like they billed you, and they also billed us if you indeed have have paid this and you have, and I'm sure that you have your credit card proof that you paid this.
[CUSTOMER][NEUTRAL] 000.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What it looks like is that they have overcharged it. Now, um, we don't, because we received the facility bill and we've already paid them, we're not going to, we can't ask them for a refund. Um, what you would need to do is you would need to get a hold of the, of the hospital, their, their, um, billing department and let them know that you've paid this and I'm going to give you the information.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You won't
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, um, I'm kinda confused because I did call them they did say they received payment, then they went ahead and billed.
[CUSTOMER][NEUTRAL] My secondary, which is you guys.
[CUSTOMER][NEUTRAL] For that [PII]. Does that make sense?
[AGENT][NEUTRAL] So they, so
[AGENT][NEUTRAL] They're say, well, not.
[CUSTOMER][NEUTRAL] They, they
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] They initially got paid on the [PII].
[CUSTOMER][NEUTRAL] It's what she said.
[CUSTOMER][NEUTRAL] The amount that
[CUSTOMER][NEUTRAL] They billed for. So when they got that port, see, I paid this 1,103 before I had the surgery. I had to pay it prior.
[CUSTOMER][NEUTRAL] Before they did anything with me.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So then she said the lady from over there in the business office said that you guys had already paid whatever they submitted.
[CUSTOMER][NEUTRAL] From the surgery back from [PII].
[CUSTOMER][NEUTRAL] So now they were gonna send in.
[CUSTOMER][NEUTRAL] To my secondary, which is APL.
[CUSTOMER][NEUTRAL] The amount that I paid the 1,103.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] So you guys pay them that too?
[AGENT][NEUTRAL] Yes, um, we, we did pay them $1,103.74. What it sounds like that they're going to do is return our check to us. Now, what would end up happening.
[AGENT][NEUTRAL] It it's
[AGENT][NEGATIVE] Normally, that is not the way that it works.
[AGENT][NEUTRAL] Um, because if they return our check to us, the only thing that I can do.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The only thing that I can do is put these, these benefits back into your into your into your um your bank of, of, of uh benefits. I can only put this amount back. I can't, I can't actually give you the, the $1,103.74 because what we do is we pay that is benefits and it looks like that you've already paid it.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, what normally ends up happening in a case like this is that they will return the money to you because they billed you twice. They, they billed you twice in the form of, of asking you for money before they would do anything, you know, before the surgery and then turning around and billing your insurance.
[CUSTOMER][NEUTRAL] Right. And
[CUSTOMER][NEUTRAL] Right, and the lady did tell me that. She said, as soon as we settle with, with your secondary, we'll reimburse you.
[AGENT][POSITIVE] OK, they'll reimburse you. Yes, that's the way that it should work.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yes, that's
[CUSTOMER][NEUTRAL] OK, so when do they, when do they get that money so that I can get reimbursed? You know, $1000 is $1000.
[AGENT][NEUTRAL] Yes, it is. Um, so let me just check and see. Now, uh, the check went out on the, uh, it was processed on the [PII]. Wait a minute, let's see. It was processed. Let me just check and see here really quickly. I can tell you what has happened.
[CUSTOMER][NEUTRAL] How many times did you guys pay him?
[AGENT][NEUTRAL] Uh, just once. It's just that one time, um, which was enough. I didn't realize, you know, we didn't know that you'd already paid them, so let's see.
[AGENT][NEUTRAL] OK, so the check went out on the [PII], the check was processed on the [PII]. It actually went out.
[AGENT][NEUTRAL] On [PII]. It's in it's uh on its way to the hospital now.
[AGENT][NEUTRAL] So it is in transit, it is in the mail.
[CUSTOMER][NEUTRAL] OK, and how much is that for?
[AGENT][NEGATIVE] That was, that was the $1,103.74. So once they received that, there's no way that they could have received it yet. I can't imagine. Maybe they have. Um, I'm not showing the capacity.
[CUSTOMER][NEUTRAL] You know, she, I just talked her a little while ago.
[AGENT][NEUTRAL] OK, good. OK, so, um, once they receive that it should be normally that uh we are told by the post office that people will receive the checks uh within 6 to 7 business days, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it should, it's on its way to them. So I don't know when they'll get it, but it should be soon.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So what was the
[CUSTOMER][NEUTRAL] You said y'all
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] Never mind. I'm, you know what I'm thinking that you paid, you, you guys paid the bill for the hospital stay, for the hospital, but you all did not.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] Well, what, the, the hospital building.
[CUSTOMER][NEUTRAL] My insurance, my insurance pay for that health ease, correct?
[AGENT][NEUTRAL] No, no, what they did was they put that money towards your deductible. Um, let me, let me go back to your, to your EOB. So we have your explanation of benefits from health ease and uh the, the explanation of payment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And what it shows is, is the amount of the, uh, first of all, there's the charge, the bill charge, which is $1900 that's how much your, your uh uh operation cost, and then they put towards your.
[CUSTOMER][POSITIVE] OK. Can you, can you hold one second so, can you hold one second so I can open up mine so I can understand what you're telling me? If you don't mind. I'm so sorry.
[AGENT][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Yes, of course, of course.
[AGENT][NEUTRAL] No, not at all. Please, no, please go ahead. That's fine. Well, that way you'll, you'll be able to see what I'm looking at.
[CUSTOMER][NEUTRAL] It's just
[CUSTOMER][NEGATIVE] It gets so confusing.
[CUSTOMER][NEGATIVE] OK, give me just one second, let me find it in here because I just got it and it is so confusing for, for me to understand what's happening here and I just don't wanna get screwed over.
[AGENT][NEUTRAL] I understand that. That's a lot of money.
[CUSTOMER][NEUTRAL] And without understanding, without somebody explaining what really happened, then maybe, you know, I, I'll be able to understand it just a little bit better.
[AGENT][POSITIVE] Well, that's quite all right. That's what we're here for. So please go ahead and pull it up and just uh just take your time and just let me know when you're, when you're ready, when you're looking at it and then we can go over it together.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Now you're, you're looking at your, your explanation of business that's from Health E, is that correct?
[CUSTOMER][NEUTRAL] OK, I'm putting.
[CUSTOMER][NEUTRAL] Yes, yes, I just got um my paperwork from them.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, good. OK.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] If it's gonna let me open it here.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I know that my computer's been very slow. It's, I think it's it's still on the holiday time.
[CUSTOMER][NEUTRAL] I think it's frozen. What, what town are you in?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, I'm in [PII].
[CUSTOMER][NEUTRAL] Oh, OK. See y'all are cold over there.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Well, I'm in, I'm in [PII]. We just barely got our cold this week.
[AGENT][NEUTRAL] Yeah, I'm waiting for April or May.
[CUSTOMER][NEGATIVE] Well, this thing is taking a little long. I don't know.
[AGENT][NEUTRAL] Um, you know what, uh, let's, let's see. Let me see here what, uh, we'll see if this doesn't work. Um.
[CUSTOMER][NEUTRAL] I don't know how much time you have.
[AGENT][NEUTRAL] OK. Do you mind, uh, verify, excuse me, verifying your email address for me, please, ma'am?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can I get, I'll give you my work email because I'm at my computer right now. Can I do that?
[AGENT][NEUTRAL] Uh, yes, sure. What is that?
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] Yeah, it said that my loading failed so they're probably having issues right now. OK, my work email is [PII], which is my last name.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so what we're gonna do, let's see if this will work.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna see if I can't.
[AGENT][NEUTRAL] For this one page to you at least.
[CUSTOMER][NEUTRAL] Yeah, it looks like
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] That's gonna have to happen because they're um they're having issues loading right now.
[AGENT][NEUTRAL] Yeah, that's
[CUSTOMER][NEGATIVE] So you just hate when that happens.
[AGENT][NEUTRAL] Oh yeah, that's it's always something. OK, let's see. OK, so what we're gonna do is we're gonna try and send you.
[AGENT][NEUTRAL] That one page and see if it's gonna work here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I can get this.
[AGENT][NEUTRAL] Just waiting for things to stop spinning and we can.
[CUSTOMER][NEUTRAL] Oh, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the current time. All right. Let's, uh, no, I don't wanna do that.
[AGENT][POSITIVE] OK. All right. OK. So we uh we're gonna do it together. So [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], yeah, [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. Is that?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see if this doesn't work.
[AGENT][NEUTRAL] And I'm going to uh put this as the EOB details.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is coming to you.
[AGENT][NEUTRAL] And that should
[AGENT][NEUTRAL] Be coming just any minute. So just let me know uh whether uh and I had to send it encrypted because it's your insurance information. So just let me know when you've gotten it.
[AGENT][NEUTRAL] Is it, is it pulling up at all for you, or?
[AGENT][NEUTRAL] [PII], is it, are you seeing it?
[AGENT][NEUTRAL] Just let me know when, whenever you do see it, OK?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.