AccountId: 011433970860
ContactId: 422717b8-bc33-46a2-a981-c356bad6f612
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 632570 ms
Total Talk Time (AGENT): 204841 ms
Total Talk Time (CUSTOMER): 347153 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/422717b8-bc33-46a2-a981-c356bad6f612_20250331T21:28_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII], I wanted to check some, uh, some, uh, doctor bills that we have and see how they fit within the gap, uh, insurance that we have, um, and this is for my wife.
[CUSTOMER][NEUTRAL] Please, her name is [PII].
[AGENT][NEUTRAL] OK, do you have a callback number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, that's, uh, can I give you her birth date or something like that? Would that be OK? I don't have the card right in front of me.
[AGENT][NEUTRAL] Whose name is the policy in?
[CUSTOMER][NEUTRAL] The policy would be under [PII]
[AGENT][NEUTRAL] Do you have her social social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Hold on one moment, please.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] OK. Is she there with you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, she is.
[AGENT][NEUTRAL] OK, I just have to have her permission to speak to you.
[CUSTOMER][NEUTRAL] I'm talking to APL, the gas people that.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, ma'am. I just have to have your permission to speak with him.
[AGENT][NEUTRAL] On your policy. OK, thank you.
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, a question in that direction, can, can I be added in a sense for the next time somebody wants to talk to me?
[AGENT][NEUTRAL] Yes, you can send in, uh.
[AGENT][NEUTRAL] Form stating, you know, that we can put on file that we can talk to you each time.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, is that form on the website? I went and looked, I went to the website and got some of the, uh, claim forms. Is it on the website?
[AGENT][NEUTRAL] It should be, it's the, um, it's called a HIPAA release, HIPPA.
[CUSTOMER][NEUTRAL] Hi, OK, uh-huh.
[AGENT][NEUTRAL] Yes, that's it.
[CUSTOMER][NEUTRAL] It's really
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] All right I appreciate it, yes, my question has to do.
[AGENT][NEUTRAL] And you can just fill it out.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK, yes, thank you, uh-huh, my question has to do with last uh year, um, she had some office visits that were follow ups from some surgery.
[CUSTOMER][NEUTRAL] And these follow ups were like $900 each.
[CUSTOMER][NEUTRAL] Are, are, do we have any sort of coverage or does that, I mean, do we have any sort of does that, does that fall under an office visit?
[AGENT][NEUTRAL] OK, I'll look that up for you. Um, can I verify some information and then I'll look that up for you. Do you know her date of birth?
[CUSTOMER][NEUTRAL] Or is there some way that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Her date of birth is the lit up is [PII].
[AGENT][NEUTRAL] And can I verify the address and her email address?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] and her email is [PII] or it may be may be is it a Bell's ISD one?
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] For her, I guess, it would be [PII].
[AGENT][NEUTRAL] And your name was [PII]?
[CUSTOMER][NEUTRAL] And I'm [PII]. Yes ma'am.
[AGENT][POSITIVE] OK. Thank you, Mr. [PII].
[AGENT][NEUTRAL] And you just had questions about her claim I can help you with that. um, do you know what data service it was?
[CUSTOMER][NEUTRAL] Yes, yeah.
[CUSTOMER][NEUTRAL] Well, here's the thing, it was last summer, but we didn't do anything with you guys because she was, she had met all her uh uh deductibles and co-insurance, so we didn't need any gap coverage on it.
[CUSTOMER][NEUTRAL] But then the follow-ups, since we're school teachers, you know, our year starts in September.
[CUSTOMER][NEUTRAL] So in September, October, November, she had 3 doctor follow-ups, each of them about $900 a piece.
[AGENT][NEUTRAL] Was this like for [PII]?
[CUSTOMER][NEUTRAL] And I was
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK. Yeah, I'm showing she hadn't filed anything with us since 23, so yes, she could file those office visits are covered under this policy.
[CUSTOMER][NEUTRAL] But those, those would only be covered as office visits. That's my question. There, there's no way to to tie it into the uh.
[CUSTOMER][NEUTRAL] What's the word I'm looking for?
[AGENT][NEUTRAL] Now, it depends on.
[CUSTOMER][NEUTRAL] That's not, that's.
[AGENT][NEUTRAL] How it's it just depends on how it's coded. I really couldn't tell you until I seen the actual procedure codes.
[AGENT][NEUTRAL] How they file it.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, so depending on the code, it might make a difference as to how it's looked at it might be considered and and uh covered outpatient service is that what you're saying?
[AGENT][NEUTRAL] Right, it depends on how, what code they file. If they file an office visit, it'd be under office visit. If they file, if she had some kind of service done in that in that office, then it would be it fall under the.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] Well, it was done in the office, so, so the best thing for me to do is to get one of those because my trying to be sure I understand how all this works. I'm trying not to do, I'm trying not to spin my wheels over here, nor send you guys a bunch of stuff that doesn't make any sense uh make any difference anyway so that's why I'm trying to kind of understand this. If one of those was if our bill for one of those was like $200 to $300 I could send that one to you and then depending on how you accept it.
[CUSTOMER][NEUTRAL] Uh, if that, if you accept that as part of that 500, then I could send you a second one, right? It just and see how you respond to them.
[AGENT][NEUTRAL] Right, yeah, it just depends on what the procedure code is.
[CUSTOMER][NEUTRAL] Right, but what I'm saying is from, from my end rather than sending a whole bunch of stuff and you take it at $25 a piece, I could kind of test the waters as it were and see how you, how you, uh, handle it based on the codes that you get.
[AGENT][NEUTRAL] Right, you can file one of them and then see how we pay it and file the rest. It's just however you wanna do it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, alright, and if I, I mean, I'm sure I'm gonna make mistake.
[AGENT][NEUTRAL] Because she only gets.
[AGENT][NEUTRAL] She only gets like 4 office visits per calendar year, so if we pay it under office visit then you'll know to file 3 more.
[CUSTOMER][NEUTRAL] Yes, go ahead.
[CUSTOMER][NEUTRAL] OK, I guess, OK. Right.
[AGENT][NEUTRAL] Instead of filing all of them.
[CUSTOMER][NEUTRAL] I guess my question might go this might also go this way then if I send it to you guys.
[CUSTOMER][NEUTRAL] Will you
[CUSTOMER][NEUTRAL] Automatically try to read the codes and see if it qualifies for the out of office stuff I mean out of uh sorry I'm one of the outpatient stuff or will it, if it has the doctor's name on it and it's not a hospital name, will it be coded as office visit?
[AGENT][NEUTRAL] It's, yes, it will. It depends on the information that we're getting in. We need a bill that has procedure codes.
[AGENT][NEUTRAL] The diagnosis code.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] The charges
[AGENT][NEUTRAL] And your explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] OK, OK, I'm on, I'm on double, so.
[AGENT][NEUTRAL] And if we, if we don't get all that, we'll ask for it.
[CUSTOMER][NEUTRAL] OK, OK, OK, thank you. Alright, so you need procedure codes.
[AGENT][NEUTRAL] Diagnosis code.
[CUSTOMER][NEUTRAL] Diagnosed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Charges
[CUSTOMER][NEUTRAL] And can a person, can a, can a person like me.
[CUSTOMER][NEUTRAL] At least recognize if all those codes are in there.
[AGENT][NEUTRAL] Probably not. I'm not gonna lie to you.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] I asked the question, so I am not insulted by the answer. That's why I asked. OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Alright, well I'm going to do one of them and I'm just gonna do my best to send you what I've got and we'll just go from there and and and it's nice to know that.
[CUSTOMER][NEUTRAL] If there's more that could be done or whatever that you would ask me and tell me something's missing or try to get some clarification from me is that what you're saying?
[AGENT][NEUTRAL] Yes, sir. Uh, if we need anything, you'll get an explanation of benefits in the mail telling you what we need, what else we need.
[CUSTOMER][NEUTRAL] OK, OK, alright, OK, alright, that's encouraging. Now the EOB, for example, that could be from my, that would be from my health insurance, correct? from Blue Cross Blue Shield. OK, alright, and then the procedure codes and the diagnostic gnostic codes that needs to come from the actual doctor's office.
[AGENT][NEUTRAL] Right. Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, and make sure you tell them now that you need a diagnosis code and the procedure code. The diagnosis code is the code.
[AGENT][NEUTRAL] It's the reason why you went to their office and the procedure code is what they did in the office or if it was an office visit.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK OK.
[CUSTOMER][NEUTRAL] I'm gonna try something
[CUSTOMER][POSITIVE] We're able to get information through the portal. I'm going to try that first and see if that has the information you need before I start calling them up and ask them to mail me a bunch of stuff. Does that sound like a a good move to you?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] OK, OK, thank you for your time I appreciate it. Like I said, I just, I didn't wanna, you guys have to, you know, spend so much time trying to help me understand what needs to happen through the mail and that's why I wanted to call and see if I could at least narrow things down a little bit. So thank you very much for your time, OK?
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, well, uh, you don't know what you don't know, so working from that direction, that's all I know to ask.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] And I'll trust you guys to let me know what else I don't know and we'll take care of it. So.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][POSITIVE] Thank you. Thank you, Mr. [PII], for calling APL. You have a good afternoon.
[CUSTOMER][POSITIVE] Alright thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.