AccountId: 011433970860
ContactId: 5214c966-3883-4841-a2d6-b2ad1edd871c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 677840 ms
Total Talk Time (AGENT): 515601 ms
Total Talk Time (CUSTOMER): 65870 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/5214c966-3883-4841-a2d6-b2ad1edd871c_20250410T18:48_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, good afternoon. My name is [PII], um.
[CUSTOMER][NEUTRAL] I received a letter saying that um.
[CUSTOMER][NEUTRAL] They, they don't know or we wanna know what happened or help me to find out what happened to a check that was supposed to been sent to me.
[AGENT][POSITIVE] Yes, um, I can certainly.
[CUSTOMER][NEUTRAL] It was 927 24.
[AGENT][NEUTRAL] And what is your policy number? I can certainly look that up.
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] 02259902
[AGENT][NEUTRAL] Thank you. If I could just verify your date of birth, sir, and a phone number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you very much and this.
[AGENT][NEUTRAL] We have here
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] It looks like.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] Back in September.
[AGENT][NEUTRAL] The claim was submitted.
[AGENT][NEGATIVE] And $50 was supposed to have been sent to you and it looks like it was, and let me just see where that, that's uh usually you receive those uh those letters because um you submitted a claim to us and uh the check isn't, isn't uh cashed within a certain period of time. Um, and so it's not good anymore, so we need to reissue it and that's, that's generally what has happened and that's what it looks like that's what has happened here, uh.
[AGENT][POSITIVE] So what I can do is I can, yes, sir?
[CUSTOMER][NEUTRAL] Why would the plan be for just $50?
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Usually $1100 1200 dollars, something like that.
[AGENT][NEUTRAL] Well, let's look at your, let's look at the claim itself. Uh.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I, I apologize my computer is just a little lagging here.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] That's all right.
[AGENT][NEUTRAL] So let's see what we've got.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] And I'm just going through the claim paperwork here to see where we.
[AGENT][NEGATIVE] Should be done.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] You can tell
[AGENT][NEUTRAL] So what it looks like uh was submitted or uh was uh your um
[AGENT][NEUTRAL] Your uh explanation of benefits.
[AGENT][NEUTRAL] From, uh,
[AGENT][NEUTRAL] OK, so we have a um
[AGENT][NEUTRAL] We have a facility bill for [PII].
[AGENT][NEUTRAL] And it looks.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] It, yes, it says [PII].
[AGENT][NEUTRAL] On, on this.
[CUSTOMER][NEUTRAL] OK, it's
[CUSTOMER][NEUTRAL] So what it say check date [PII].
[AGENT][NEUTRAL] Oh, no, no, what I'm talking, um, no, I'm sorry. Um, what I'm talking about is, uh, I'm looking at your AvMed um explanation of benefits that you submitted to us, and it looks like, uh, you want that you had uh some sort of um medical service done on [PII] according to your AvMed EOB.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] So, OK, so they charged for that service, they charged $197.89 and AvMed put towards your co-pay is $50.
[AGENT][NEUTRAL] So that's uh that was that. OK, so the next thing, let's see what we have here. So that's what the $50 is for. Uh, the next thing that we have is a uh a service now, again, this is, we're all looking at the, uh, I'm looking at the AvMed explanation of benefits, which is what we use to process. So the very next charge is for [PII]. This is also for Genesis Care, um.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, right. I, I recognize that.
[AGENT][NEGATIVE] They charged 700. OK, so they charged $741.42 and AMed um denied the claim. They said the uh authorization or referral is not on file, um, and so they, they did not pay anything on that.
[AGENT][NEGATIVE] That's the, that's the first thing that they, they did not pay. So on your AvMed EOB that was submitted to us, it shows that for the [PII] services, um, there was also something on [PII]. Uh this whole bill totaled $1,312.53. AvMed denied the entire claim.
[AGENT][NEUTRAL] Now, because we are your secondary insurance, um, we need that deductible co-payment or co-insurance in order to, to make a, to pay a claim. So if your major medical, in this case, your, your primary insurance, AvMed doesn't, doesn't put anything towards your deductible, co-payment or co-insurance, there's, there's nothing for us to, to pay. Um, so that, that is on that one.
[AGENT][NEUTRAL] Um, now the next date of service that we have here.
[AGENT][NEUTRAL] Is [PII] [PII].
[AGENT][NEUTRAL] April and [PII]. Again, this is for Genesis Care, um, a total bill of $11,146.65 again, going by your explanation of benefits from your primary insurance. Now what they have done is that they said that this is after medical review, they denied this claim. So this is for the dates of service [PII].
[AGENT][NEUTRAL] Um, the next thing that we have, let's see.
[AGENT][NEUTRAL] We have, uh, [PII].
[AGENT][NEUTRAL] Through the [PII], again, this is Genesis Care, um, a bill totaling $5,671.68 and AvMed, um, what they did was they, uh, they will negotiate with the, with the provider, uh, for a lesser fee so that they'll pay a lesser amount and in this case it was $996.64 that they, they negotiated that 5.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh $5600 bill down to $996.64. They paid that. So again, there's no deductible, co-payment or co-insurance for us to pay. Um, the next thing is the Genesis Care uh bill for [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] that bill was $2,162. Again, AvMed negotiated the bill down to $396.61 and and that and they paid that. Now again, this is all paperwork that you submitted, so you should have all these documents. Um, the next thing that we have is [PII], um.
[AGENT][NEUTRAL] Again, Genesis Care was the provider. Um, for [PII], there was a bill for $2,162 and again AdMed um negotiated the bill down to $396.61 which they paid in full. Again, no deductible, co-payment or co-insurance. None of this went towards your deductible, co-payment or co-insurance, which is what we do.
[AGENT][NEUTRAL] Um, now the next thing I have is, uh, several dates of service, uh, [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, [PII] and [PII], um, for Genesis Care, uh, a bill totaling, um.
[AGENT][NEUTRAL] $5,345.18 and uh AvMed um negotiated the bill down to 90, yeah, $65.63 and so they paid that.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And these are all
[CUSTOMER][NEUTRAL] I remember that.
[AGENT][NEUTRAL] Yeah, there, those are all facility bills. So so far the only thing that is that we have to pay is that $50.
[AGENT][NEUTRAL] Um, the last, uh,
[AGENT][NEUTRAL] Bills that I've got, um, [PII], um, again, Genesis Care, uh, that's $5,345.18. Um, AvMed negotiated the price down to $965.63 which they paid in full, um, again with no deductible, co-payment, or co-insurance.
[AGENT][NEUTRAL] And then it looks like the final claim is [PII]. A bill of $3,509.68. AMed negotiated the bill down to $603.
[AGENT][NEGATIVE] Excuse me, $6000 forgive me, 603 cents, 603 cents, which they paid in full. So, the check that we sent to you was the only, uh, there was only $50 that was applied to that first.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, facility bill.
[AGENT][NEUTRAL] On [PII], and that is why the check that we sent to you.
[AGENT][NEUTRAL] It was only $50.
[AGENT][NEUTRAL] Now, the reason that you
[CUSTOMER][NEUTRAL] I don't remember.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] I don't remember seeing that check.
[AGENT][NEUTRAL] OK, no, that's great. That's what and that's why it wasn't cashed and that's why you were sent that letter. So, what, uh, what I need to do is, um, I need to verify your address so that what we're going to do is we're going to go ahead and submit uh that check. We're going to cancel it. Um, it, it wouldn't, it from uh September, it wouldn't be any good anymore anyway. Um, so we just need to reissue it, and that is why you received that letter.
[AGENT][NEUTRAL] Um, do you mind verifying your, um, address and your zip code for me, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. OK, so that's what we've got. Um, so what I'm going to do.
[AGENT][NEUTRAL] I'm going to go ahead and and have this reissued and uh we will void out the, the um original check that we sent to you back in September and they will issue another one to this address.
[AGENT][NEUTRAL] And you should be receiving that. It usually, uh, we'll, uh, we have to send it through the mail and it usually takes about 6 to 8 business days. Uh, but that is where this uh check will be, will be going now. Is there anything else at all that I may help with?
[CUSTOMER][POSITIVE] Appreciate it.
[CUSTOMER][POSITIVE] No, that's it. I appreciate your help.
[AGENT][POSITIVE] OK, thanks for contacting us have a