AccountId: 011433970860
ContactId: 46443861-deae-46b1-856a-fea7d0f356eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1270219 ms
Total Talk Time (AGENT): 307201 ms
Total Talk Time (CUSTOMER): 237688 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/46443861-deae-46b1-856a-fea7d0f356eb_20250604T19:43_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, [PII], my name is uh [PII], and I'm calling on behalf of my husband. I've been authorized to talk to you people. Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So my question is I just had a settlement on a claim and they didn't pay the entire claim and I'm curious as to why.
[AGENT][NEUTRAL] What is the policy number please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, the number is 01897865.
[AGENT][NEUTRAL] OK, and verify your husband's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, his name is [PII].
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII].
[AGENT][NEUTRAL] OK thank you one moment and if we're disconnected, what is your callback number, Miss [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] May I place you on a brief hold please, Ms. [PII]?
[CUSTOMER][NEUTRAL] And what now?
[AGENT][NEUTRAL] May I place you on a brief hold?
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank
[AGENT][POSITIVE] Thank you so much for your patience, Ms. [PII], and also verify the mailing address, please.
[CUSTOMER][NEUTRAL] Um sure. [PII].
[AGENT][NEUTRAL] OK, thank you very much. One moment and you're calling to check to see why a claim did not pay in full. Do you have a claim number or a date of service I can check on that for you.
[CUSTOMER][NEUTRAL] Uh, the claim number is 36089003.
[AGENT][POSITIVE] 8903. OK, thank you very much. One moment.
[AGENT][NEUTRAL] I think that we just processed yesterday, OK.
[AGENT][NEUTRAL] And this was a lab.
[AGENT][NEUTRAL] Claim and it shows that procedure code. Yes, ma'am. It shows that procedure.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Two procedure codes it shows that the major medical pay that.
[AGENT][NEGATIVE] In full so there is no benefit to be paid on that and that was the procedure codes for 83036 that charge was $84.95.
[AGENT][NEUTRAL] And the other was procedure code 80061, and that charge was $169.43.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So the bill that was submitted.
[CUSTOMER][NEUTRAL] was submitted that we were charged with 3312, not 3119.
[AGENT][NEUTRAL] OK, um, you said it was to me it was 3312 and not 3119?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] I'm just trying to pull up the claim.
[AGENT][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] It might be in, um,
[CUSTOMER][NEUTRAL] Uh, well, since you guys redid your thing, I, I can't tell you where it is exactly, but it could be in that claim number 3603669.
[AGENT][NEUTRAL] 3603669. OK.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] We have the numbers, right? There are, I see those on the bill, but they weren't paid by major medical. They were, um, the bill was adjusted, so I'm not quite sure what you.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] 495.
[AGENT][NEUTRAL] OK. Under claim number 3603669.
[AGENT][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Uh, procedure code C1.
[AGENT][NEUTRAL] Second.
[AGENT][NEUTRAL] 83036, that charge was 84.95.
[AGENT][NEUTRAL] And for procedure code 0061 that.
[AGENT][NEUTRAL] Charge amount was 169. 43 which is what we have on.
[AGENT][NEUTRAL] Under claim number 3608903.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can you see the quest bill?
[AGENT][NEUTRAL] I'm still pulling it up right now.
[CUSTOMER][NEUTRAL] That I
[AGENT][NEUTRAL] I'm pulling it up under 36089003, so I'm almost there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What page page one moment.
[AGENT][NEUTRAL] Ms. [PII], I'm gonna place you on a brief hold, OK? on a brief hold.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so that's that one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 6 regions.
[AGENT][NEUTRAL] The office.
[AGENT][NEUTRAL] OK, just
[AGENT][NEUTRAL] It has to be the quest bill.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you.
[AGENT][POSITIVE] I have the request bill pulled up finally. Thank you.
[AGENT][NEUTRAL] OK, I have that pulled up and let's see here.
[AGENT][NEUTRAL] And for Miss [PII], are you there?
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. Now I have the crust bill pulled up and.
[AGENT][NEUTRAL] What was applied to deductible was $31.19 and that was for for procedure codes 83735 and.
[AGENT][NEUTRAL] One moment and 80,050.
[CUSTOMER][NEUTRAL] OK. In the past, this bill has been paid in full by you people?
[CUSTOMER][NEUTRAL] So I'm asking the question as to why the bill was not paid in full, because this is what I was charged and typically this is you, you cover these.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For procedure code 83036, the major medical paid the allowed amount.
[AGENT][NEUTRAL] Which was $8.25. And for procedure code 80061.
[AGENT][NEUTRAL] The major medical pay the loud amount of.
[AGENT][NEUTRAL] $9.67. So that's why we did not pay on those two procedure codes.
[CUSTOMER][NEUTRAL] If the major medical paid, why am I being charged?
[CUSTOMER][NEUTRAL] Because I got charged for that.
[AGENT][NEUTRAL] We of course only pay if they charge it to your deductible, your co-pay, or your co-insurance.
[AGENT][NEUTRAL] And they only apply deductible to those two procedure codes um forementioned 83735 and 80,050.
[CUSTOMER][NEGATIVE] That doesn't make sense.
[CUSTOMER][NEUTRAL] My original bill from Quest was $619. It was adjusted by my insurance by $570 and my insurance did pay $15.99 of this total bill, and the balance was 3312, and APL should have paid 3312.
[AGENT][NEGATIVE] The only amount that was applied to your deductible, I apologize, was $31.19. There was nothing applied to your co-pay.
[CUSTOMER][NEUTRAL] I don't know
[AGENT][NEUTRAL] Give me 1 2nd, can I
[AGENT][NEUTRAL] OK, give me one second please.
[AGENT][NEUTRAL] Let me just reach out to the adjuster process to claim. I'm gonna place you on a brief hold, OK, Miss [PII]. Thank you so much for your patience.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Me it
[AGENT][NEUTRAL] Ma'am?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm gonna reach out to the adjuster if you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm about to reach out to adjuster if you would just bear with me please OK thank you.
[CUSTOMER][NEUTRAL] That'll be fine.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I see that.
[AGENT][NEUTRAL] No, you should.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, Miss [PII], thank you so much for your patience I just.
[AGENT][NEUTRAL] Spoke with the adjuster.
[AGENT][NEUTRAL] She is going to reprocess the claim.
[AGENT][NEUTRAL] There should be an additional $1.93 payable, which will make it 3 $33.12 I just stated.
[CUSTOMER][NEUTRAL] OK, now my next question.
[CUSTOMER][NEUTRAL] Is who got paid because from your
[CUSTOMER][NEUTRAL] I can't tell from from uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] From my claim and on your site if you paid Quest or if you're paying my husband.
[AGENT][NEUTRAL] Um, paying your husband.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] That's all I needed to know. And, and, and, uh, can I just give you three things that I'm really upset about?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, this isn't this isn't the first time.
[CUSTOMER][NEGATIVE] I have this every time I make a claim, I have to make multiple claims.
[CUSTOMER][NEGATIVE] Because you guys don't get it right.
[CUSTOMER][NEUTRAL] And then, secondly,
[CUSTOMER][NEGATIVE] Your site before I could see how things were being processed. Your new site is not very friendly.
[CUSTOMER][NEGATIVE] It's very uninformative.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I see, OK.
[CUSTOMER][NEGATIVE] But it's very aggravating when I have to make more than one phone call for a $33 claim.
[CUSTOMER][NEGATIVE] And it takes more than 6 months to get it paid.
[AGENT][POSITIVE] OK, I apologize is.
[AGENT][NEUTRAL] Miss [PII].
[AGENT][NEUTRAL] I will stress your your concern with the OSC as far as the online service center um and again with the multiple claims I apologize for that and the length of time it takes to process. We try to have in process within a 7 to 10 business day window we try to and I apologize for that if it took longer.
[CUSTOMER][NEGATIVE] Alright, well I just hope I don't have to call again to get this fixed.
[AGENT][NEUTRAL] The adjuster will reprocess the claim, and that claim number is 36089003 for the additional $1.93.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] You're welcome, Miss [PII] thank you and have a great day, Miss [PII] and sorry about that.
[CUSTOMER][NEUTRAL] You too.