AccountId: 011433970860
ContactId: 45cf0cb0-e8ac-4504-882b-5e1e27f6a943
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 995109 ms
Total Talk Time (AGENT): 414869 ms
Total Talk Time (CUSTOMER): 425073 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/45cf0cb0-e8ac-4504-882b-5e1e27f6a943_20250519T18:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hello, ma'am.
[CUSTOMER][NEUTRAL] Um, I have some questions about, um,
[CUSTOMER][NEUTRAL] Services I received from a clinic which they say that uh Lifetas never
[CUSTOMER][NEUTRAL] Received or responded to?
[AGENT][NEUTRAL] OK, I'm sorry, so a clinic, um, they, uh, did they sent claim information to us and never got a response, is that right?
[CUSTOMER][NEUTRAL] Um, I believe so.
[AGENT][NEUTRAL] OK, we can take a look and see if those claims were received. um, what was your name?
[CUSTOMER][NEUTRAL] Uh my first name is [PII], [PII] Last name is [PII]
[AGENT][NEUTRAL] OK, and then before we go any further, um, [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Let me pull it out.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I think it says 02.
[CUSTOMER][NEUTRAL] 472134
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Alright, um, [PII] just gonna verify some information really quick. Uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] I guess maybe it's [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you. Looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying all of that. OK, so the policy that you gave me, [PII], I'm showing that it did terminate, uh, [PII]. Give me one moment, um, I'm not showing that you have any active policies with us at this time.
[CUSTOMER][POSITIVE] Yes, ma'am. That's correct. Um, it's 4.
[CUSTOMER][NEUTRAL] For an appointment that happened last year, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Sure, OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] In August, uh, I think it was.
[AGENT][NEUTRAL] I see one here.
[CUSTOMER][NEUTRAL] But uh so I made a payment.
[AGENT][NEUTRAL] Mhm. Go ahead, I'm sorry. No, no, no, you're fine.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I was gonna say I made a payment um to make the appointment for.
[CUSTOMER][NEUTRAL] I think it was 165, and they said they didn't receive that, so I'm not sure. I have to send them proof that I made that, which I'm doing, but also for the charges for that appointment, it looks like I was double charged they put down similar appointment type twice, two different, two similar codes and similar cost.
[AGENT][POSITIVE] Oh goodness.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For one appointment and um.
[CUSTOMER][NEGATIVE] Yeah, so they're saying, so I have to figure out why they didn't receive.
[CUSTOMER][NEUTRAL] The 165 for me which I have proof I'm gonna send to them but for the two charges of 3, we can see this 3.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] OK, so yeah, it was.
[CUSTOMER][NEUTRAL] One charge of CPT code 99240T. MD telehealth new patient and then another for $315 and another one for 90838T tech MD.
[CUSTOMER][NEUTRAL] Um, telehealth ID.
[CUSTOMER][NEUTRAL] Site treat it with.
[CUSTOMER][NEUTRAL] It's supposed to be with medication or something, and that was for 300 and
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, we briefly discussed uh some medication stuff. He asked me if I had any medication. I said no, but I don't know if this is uh accurate that they should be charging me $615 or if you guys ever received any of this, and this was on the [PII], wait, let me see the exact date. I'm sorry, the, it was [PII].
[AGENT][NEUTRAL] No, no, no, that's fine.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I sure appreciate all of that information that certainly helps, um, so I will say I have absolutely nothing from that date of service, nor do I have any of those, uh, specific procedure codes that you mentioned. I only have uh 3 claims on file for you, [PII] that was from the first one we received was.
[AGENT][NEUTRAL] That was [PII].
[AGENT][NEUTRAL] And that was for the amount of looks like it was just $200.02 and that was um.
[AGENT][NEUTRAL] Let's see, give me just a moment, let me take a look at these notes.
[AGENT][NEUTRAL] Uh, looks like it was for a surgery, um, so for this policy, this was, uh, a limited indemnity medical plan. So it is a very different than, of course, major medical in the way that it works. Um, so for this particular policy, um, your outpatient benefits only allow um outpatient surgery in an outpatient hospital or a physician's office. So based on the information we received, we were unable to pay that benefit as it was not a covered facility.
[AGENT][NEUTRAL] Let me check these others.
[CUSTOMER][NEUTRAL] Uh, what
[CUSTOMER][NEUTRAL] What was the surgery?
[AGENT][NEUTRAL] Um, I'm not sure what it was exactly. I do see it's the provider neighborhood improvement.
[AGENT][NEUTRAL] Providers.
[AGENT][NEUTRAL] Oh it looks like they sent in the same.
[CUSTOMER][NEUTRAL] Oh, I have to dig in
[AGENT][NEUTRAL] OK, so two of these claims are identical, um, so it looks like they just sent in that claim twice and again that was um [PII] and then I have another claim.
[AGENT][NEUTRAL] From the same provider that was for.
[AGENT][NEUTRAL] [PII] of this year and of course that one denied as you know, your coverage had terminated but anything these are the only claims we have on file for you so what I would do, so you're not stuck in the middle well I'm sorry, you did, did you say you already paid these claims, [PII]?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEGATIVE] These bills.
[CUSTOMER][NEUTRAL] So the first, the first one I did pay except paid 160, but it doesn't fit in the life stands account 165, but I'm, I'm in the process of collecting the stuff from my bank and mailing. I have to mail it to them, which I'm doing so it can go towards.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Go towards one of these. The other, the other one, the, I, I think the [PII], um, I wasn't expecting, um, Listance to cover anything. I had been back and forth on the phone with Life, I'm sorry, not Lifes, but APL with you guys about getting a certain appointment and they said that, you know, it's not covered in my plan and I said, OK, well I guess I'll just have to.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] To it out of pocket. And then when I started the appointment with the provider, she said, oh, I said, thanks for seeing us and so hard you appointment. They keep, um, you know, she said, oh why is that? I said, they, you know, they keep saying they don't recognize my insurance or, um, you know, it's not the proper coverage. And then she stopped the appointment, saying, OK, well, we also have very strict, uh, insurance requirements here as well. And so she stopped the appointment. We talked for a few minutes, uh, you know, after that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Not long, and then um I then I got a.
[CUSTOMER][NEGATIVE] Almost $400 bill in the mail saying that she had done some type of diagnostic evaluation on me and I've been on the phone back and forth with them back and forth with them. I don't know how many times, but, uh, yeah, I was like this is not accurate, um, this is not true and uh can you please look into it? Yeah, so I'm dealing with a lot of, uh, you know, that that showed up.
[AGENT][NEUTRAL] Oh gosh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I think that's the April when you're talking about was actually from last year where um nothing had showed up and then
[CUSTOMER][NEUTRAL] It showed up like later in the year and then I started inquiring about exactly what the charges were for, and then they started to kind of like piecing things together and claiming things that didn't happen, so.
[AGENT][NEUTRAL] Mm yeah that's a lot. Gosh, I'm so sorry you have to deal with all that. Well, I will say as far as this policy is concerned, um, this, it was active between [PII] up until [PII] or excuse me, [PII], so anything between that time while this policy was active can still be claimed.
[CUSTOMER][NEUTRAL] It's a lot.
[AGENT][NEUTRAL] So if you would rather it's completely up to you you can call that provider and have them reach out to us explain that you spoke with us we never received that information um that they're referring to and that they can try resending it to us or if you would like you can simply just file the claim information yourself.
[CUSTOMER][NEUTRAL] I think I'll just do it myself. I can send I can send it to you guys through like a online portal or email or something.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, so with the portal you probably won't have access to it anymore since you're, you don't have an access policy with us at this time, um, so you are, and we wouldn't be able to take it by email, so I have a mailing address and then if you have access to a fax machine you can fax the information to us.
[CUSTOMER][NEUTRAL] I don't have a fax, but I can do the mailing address.
[AGENT][NEUTRAL] Sure, let me know when you're ready. I'll give you that mailing address and then I'll also uh let you know exactly the information that we need for claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you ready for the address?
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, so that is um it's [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII], [PII].
[AGENT][NEUTRAL] And that zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and just to confirm, the [PII] was [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the zip code [PII]?
[AGENT][POSITIVE] Yes sir, that's correct.
[CUSTOMER][NEUTRAL] And what's the actual name uh of the location or is it just the [PII]?
[AGENT][NEUTRAL] It's just the [PII] that's our, uh, specifically for claims that address is for claims or claim information, um, and of course it would just be, you know, APL.
[CUSTOMER][NEUTRAL] Just put APL before above that.
[AGENT][POSITIVE] Yeah, yeah, that is perfectly fine.
[CUSTOMER][NEUTRAL] OK tracking and what's the list of things other than the bill that you guys need?
[AGENT][NEUTRAL] Right, OK, so first, of course we would need the correct claim form. Uh, you can find copies of that claim form on our website. Uh, it's just [PII], the public website, uh, under the claim forms, and you would do the hospital indemnity claim form.
[AGENT][NEUTRAL] And then we would need the itemized statement.
[AGENT][NEUTRAL] That shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that's typically in the bill, right?
[AGENT][NEUTRAL] It really depends. I don't like saying that simply because all providers kind of operate differently. Some might give that to you just on their own others you might have to ask for that specific information to be shown so I was just like stating that just to be safe um you can send what you have uh the problem is, of course.
[AGENT][NEUTRAL] It could take a bit to get to us. Processing time once it's been received can take about 7 to 10 business days. So if it turns out we need additional information, you would unfortunately just have to wait that much longer, um, otherwise you could try calling them and asking for that specific information and hopefully they'll be nice and just send it to you like and you know you wouldn't have to worry about it. It sounds like they're being a little difficult.
[CUSTOMER][NEUTRAL] Oh, they're being very difficult, but I already have the bill which has the CPT codes for the, the charges. I, I have that part. I just have to get the.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What claim form for public.
[AGENT][NEUTRAL] The claim form. Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, the one that you mentioned.
[AGENT][NEUTRAL] Yes, uh, and that website it's just a [PII] and you'll see right up at the top right I think it'll say claims and forms and you would of course just scroll to the one that says hospital indemnity.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And um as I was saying before, it looks like they're.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You you seems like they're double charging me for this.
[CUSTOMER][NEUTRAL] Um, cause it looks like, I mean, it seems like it's a similar thing, even though we might have mentioned medication briefly. I don't know if that's a whole another um appointment cost, you know, within that, you know, 50 minute time period that I spoke to him. I don't know if it's right, so if they could.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Also look into that and see if it's a double charge for the insurance as well as for the patient.
[AGENT][POSITIVE] Yeah, I would definitely get to the bottom of that.
[CUSTOMER][NEUTRAL] Yeah and the other one I had to write up a whole like multi-page statement of.
[CUSTOMER][NEUTRAL] You know that this didn't happen, which I'm still, you know, waiting to hear back from them, but I started with.
[AGENT][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] Yeah, it's kind of crazy that um the one of the reasons.
[AGENT][NEGATIVE] That's awful.
[CUSTOMER][NEGATIVE] It's absolutely awful, but I think that it happens quite often, um, and one of the reasons I know is because I asked her for like, hey, can I get a, a summary of what took place, and she didn't have it. And then months and months later she provided one but it was very, very brief, very few details in there, and then it didn't, it didn't match.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] The code they were charging you for what she claimed to have done so it's yeah kind of kind of crazy.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh what a mess. I'm so sorry you have to deal with that. Uh, medical stuff on its own is a lot to deal with and then you tack this stuff on top and, oh, I'm so sorry. Well, definitely I know that was I information overload. Um, did you have any questions for me at the moment, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, not at this time. I think I got it down to the best of my building. What did you say your name was, ma'am?
[AGENT][NEUTRAL] Sure. [PII]
[CUSTOMER][POSITIVE] OK, yeah, let me work on this stuff and I'll try and start sending you guys, uh, what I can. I'll definitely call back if I have questions.
[AGENT][POSITIVE] Absolutely, absolutely. All right, well, I sure hope it gets better for you and I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too thanks you too.
[AGENT][POSITIVE] All right, thank you. Bye bye.
[CUSTOMER][NEUTRAL] Goodbye.