AccountId: 011433970860
ContactId: 45e41fd2-bd93-4c0e-ad92-79a817319cb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366250 ms
Total Talk Time (AGENT): 173224 ms
Total Talk Time (CUSTOMER): 139801 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/45e41fd2-bd93-4c0e-ad92-79a817319cb1_20250305T17:23_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, good morning, or I guess good afternoon depending on where you're at. Um, so I got all these like, um, explanation of benefits or whatever and stuff in the mail, and I was wondering um if I get a check or anything because um.
[CUSTOMER][NEUTRAL] Um, I got a bunch of these things and it says um.
[CUSTOMER][NEUTRAL] You know, like
[CUSTOMER][NEGATIVE] I thought I get reimbursed for for all the stuff that I've been paying for.
[AGENT][NEUTRAL] OK, um, let me take a.
[CUSTOMER][NEUTRAL] For, um, yeah.
[AGENT][NEUTRAL] Let me take a look at your policy, um, and I can definitely help you with the claims and the status. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, uh, [PII] and phone number [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Let's see, what is it?
[CUSTOMER][NEUTRAL] OK. 01372327.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify, um, well, you already gave me your name, your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Co
[CUSTOMER][NEUTRAL] [PII] and then it's [PII].
[CUSTOMER][NEUTRAL] And uh what was the last one?
[AGENT][NEUTRAL] Email.
[CUSTOMER][NEUTRAL] You know, um,
[CUSTOMER][NEUTRAL] I, I have so many emails. Uh, is it [PII] or is it [PII]? OK, so I don't know. OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alrighty, thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. And so, um, we have received claims from [PII]. Um, all of the claims were paid on though. Did you want to like, you wanted me to give you like the claim number and what was paid?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No, no, so what does, what does that claim mean? Does it because last year it sent me a check.
[AGENT][NEUTRAL] So these all went to the provider.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so all these are going to the right, OK, because I, I thought I'd get reimbursed for paying 80 bucks.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If there is a patient, um, if there is a part like something that you pay because this is just showing like outstanding balances.
[AGENT][NEUTRAL] After primary has applied.
[AGENT][NEUTRAL] So if there is something.
[CUSTOMER][NEUTRAL] OK, so the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If there is something that is um owed to you or something that you want to file for, you can, um, the provider just sent this in for.
[AGENT][NEUTRAL] Like the remaining balances after they sent it to primary.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Right, that, that's hard because I, I saw like last year I don't know, they just, I got the check, so I don't know why I'm going to them now.
[AGENT][NEUTRAL] Uh, let me see. Well, so some of the claims you have submitted like
[AGENT][NEUTRAL] Well, there's a few between the years. The ones that you submit are for what you're um like for what you paid. So you were
[AGENT][NEUTRAL] That's why the payment went back to you, but they're submitting the, the payments for what's still owed to them. So if you have like a co-pay or something that you want to file for, you can.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] OK, I, I, I would just be confused on this whole thing, but.
[AGENT][NEUTRAL] You say you're still confused?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, cause last year, because the insurance only, like, for physical therapy, right? Like I, I had an $80 co-pay. And then I guess I got that back later.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] That's what I thought.
[CUSTOMER][NEUTRAL] And this was like last last year, beginning of the year.
[AGENT][NEUTRAL] Right, this is true. And so the difference between last year and this year is last year, these claims were filed by you, so they went, it was filed by you, so it was paid to you because it was a reimbursement for what you've already paid. For this year, the difference is this is being filed from the provider for outstanding balances that still owed to them. So you can still file your portion like you did last year. They're just trying to get the remaining balance that's owed to them.
[CUSTOMER][NEUTRAL] Well, so what is the remaining balance because
[CUSTOMER][NEUTRAL] Like, um, I mean, it's $80 right? So.
[CUSTOMER][NEUTRAL] Uh, how is that different than last year? Like it, it's still physical therapy, you know, like.
[AGENT][NEUTRAL] So I
[CUSTOMER][NEGATIVE] That's what they charged me.
[AGENT][NEUTRAL] Yes, so we're talking about two different things. So the physical therapy fee that you paid, you can still file for like you did last year and and still be reimbursed or they'll let you know the decision. You can still file. The difference between what you did last year and what your provider is filing this year is they're not filing for what you paid, they're filing for what they owed to them. You can file your claim for what you paid to be reimbursed.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Great. OK. Yeah, I'll just have to get with them and turn it off.
[AGENT][POSITIVE] Alrighty. Well, was there anything else I can help you with today? You're welcome.
[CUSTOMER][POSITIVE] Cool, thank you. I'll be understand.
[CUSTOMER][POSITIVE] No, no, I think you got it. I help me understand. I'm, I'm running on 2 hours of sleep, so my brain's a little off today.
[AGENT][MIXED] You're totally fine. That's what we're here for, and insurance is confusing anyway.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] I appreciate it. You have a great day.
[AGENT][POSITIVE] All right, you're welcome. Well, thanks for calling APL. I hope you get some rest.
[CUSTOMER][POSITIVE] Thank you. All right, bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.