AccountId: 011433970860
ContactId: 54e8aca9-4eba-4a60-9ae6-4f12479b6099
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 645229 ms
Total Talk Time (AGENT): 297893 ms
Total Talk Time (CUSTOMER): 288618 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/54e8aca9-4eba-4a60-9ae6-4f12479b6099_20250325T13:58_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Good morning dear how are you?
[AGENT][POSITIVE] I'm great, thanks for asking. How are you?
[CUSTOMER][POSITIVE] I'm very good. I need guidance if you can help me please.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] We both need guidance, but it depends on what you need help with.
[CUSTOMER][NEUTRAL] Well, I need guidance on because it shows that I am on collections because I haven't paid copays, but the hospital has it on file, but they don't know how to, I don't know I they they don't know how to request this from you, so my question to you is, can I just request you to pay me and I pay them and we get this out of the way?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's your policy number so I can see what's going on for you?
[CUSTOMER][POSITIVE] Thank you so much. It is somewhere 1435126.
[CUSTOMER][NEUTRAL] I've had gap insurance since [PII], [PII].
[AGENT][NEUTRAL] And what's your name?
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Can you verify your mailing address and your date of birth for me, [PII]?
[CUSTOMER][NEUTRAL] [PII]. What was the second question?
[AGENT][NEUTRAL] Your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and a callback number just in case the call is disconnected is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Thank you, and what's the email address that we have on file for you?
[CUSTOMER][NEUTRAL] Um, it's my name and last name, [PII].
[AGENT][NEUTRAL] Thank you. And what is the do you have that date of service so I can make sure that it's not here on in history?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes, I have a total of 4 of them.
[AGENT][NEUTRAL] And what's your first date of service?
[CUSTOMER][NEUTRAL] The first one.
[CUSTOMER][NEUTRAL] Let me start by the latest one is [PII].
[AGENT][NEUTRAL] [PII], um.
[AGENT][NEUTRAL] What is the amount that they're saying that it is?
[CUSTOMER][NEUTRAL] $80.
[AGENT][NEUTRAL] Do is it showing like a CPT code or the the total bill amount?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Actually
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] This one is mine.
[CUSTOMER][NEUTRAL] This one says remaining responsibility, but I'm wondering if that's.
[CUSTOMER][NEUTRAL] Yours or mine, because it's, there's one on the [PII] and then I made a payment on [PII] cause that one on [PII].
[CUSTOMER][NEUTRAL] Is my co-payment.
[CUSTOMER][NEUTRAL] I don't know if that makes any sense, so I did pay my copayment.
[AGENT][NEUTRAL] What is the
[AGENT][NEUTRAL] So what is the bill amount, the total bill amount for $531 like? I know that $80 is your, is your portion, mhm.
[CUSTOMER][NEUTRAL] Oh, the total bill amount was, um, the total bill amount is $405.02.
[AGENT][NEUTRAL] Thank you. OK, so it looks like the services that was received for that date of service, [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Those services are not covered under your policy, like office visits are not covered or the treatment received in the office is not covered under the policy. So that's why that, that's your balance. mhm.
[CUSTOMER][NEUTRAL] On that one.
[CUSTOMER][NEUTRAL] OK, so let me go to the next one.
[AGENT][NEUTRAL] Let me see what your benefits are covering. OK, so what's the next date of service?
[CUSTOMER][NEUTRAL] The next date of service is [PII].
[AGENT][NEUTRAL] Of [PII] or [PII].
[CUSTOMER][NEUTRAL] [PII]. All of these are [PII].
[AGENT][NEUTRAL] So [PII]. I'm not showing a claim on file for the date of service. What's your next date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What year? [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Not showing that claim on file either. And what's the next date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me make sure that
[AGENT][NEUTRAL] Mm. Not showing that one either.
[AGENT][NEUTRAL] So for these data services you ask, did you submit them. You can submit them, however, you'll need the explanation of benefits from your primary insurance company. You'll need the itemized bill with the.
[AGENT][NEUTRAL] I see the team codes listed for each data service that you're calling for?
[CUSTOMER][NEUTRAL] Alright, give me a second, let me find my pen so I can write that down.
[CUSTOMER][NEUTRAL] So then, uh, while I find my pen, oh here it is. Um, I need, I need to get an itemized bill.
[AGENT][NEUTRAL] Mhm. The itemized bill from the facility where you receive the services listing your ICD code, the reason that for the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so once I get that, I call you guys back or what do I do after that?
[AGENT][NEUTRAL] So once you receive, once you retrieve the EOB and the itemized bill list in the diagnosis code, you can fax it to us or you can, I'm not sure if you have an online account here with us at American Public Life.
[CUSTOMER][POSITIVE] I do. I actually do.
[AGENT][NEUTRAL] You can upload it there, you can file choose the option to file a claim and upload the information there and submit it or you can send it by mail, whichever option you choose.
[CUSTOMER][NEUTRAL] So are you guys gonna pay them directly? How does that work?
[AGENT][NEUTRAL] So it will go to you the payments will go to you because you submitted the claims. So I have a question for you. I see that none of those dates of services were available were listed in your history. Are you giving the facility your card like when you go to your appointments, do you give them your primary and the gap insurance card?
[CUSTOMER][NEUTRAL] Yes, I do, but here's the thing, I was just calling the doctor's office, and um, and I said, hey, this is going on, and he said, is that a supplement? I said yes it is. And he's like, oh OK, he's like, so what's your number? And I said, well, there's two numbers, there's an inpatient, like an in-hospital, and there's an outpatient one. And he's like, oh, which one do I use? I'm like, well, oh, either one will work?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Either one.
[AGENT][NEUTRAL] Right, because it's gonna pull up the same policy like either number, whichever number they use is still gonna pull up the same policy. Once we received the, the claim, the UB or the um 1500 form, we would know if it's inpatient or outpatient has coed.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK, well, I, I'm just gonna go ahead and do the, I'm just gonna go ahead and do the um.
[AGENT][NEUTRAL] But that didn't matter.
[AGENT][NEUTRAL] Let me let you know what your policy covers.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So that way when you if you do send the claims and then they're denied you won't be disappointed because they were denied. So your policy covers inpatient benefits 18 hours or more, you have $4000 per calendar year. Then your policy has outpatient benefits, meaning it's outpatient benefits of $2500 per calendar year. And this is not a guarantee of benefits, just a disclaimer of the policies coverage, but outpatient is considered as diagnostic testing, physical therapy.
[AGENT][NEUTRAL] Um, anything that's taking place at an outpatient setting like surgery center, ER visit, urgent care visit, that's considered as outpatient.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes, I'm aware because for example, I did uh.
[CUSTOMER][NEUTRAL] I've done a, a mammogram diagnostic like a biopsy that that covered it. Then I did another one to do a a CT scan. I had to go through, um, not long ago, an MRI I had to go through not long ago, so all that is fine. All that you guys have done, well, they have done their due diligence and you guys have paid them accordingly. The problem is that other people don't know how to do billing, or they just skip it and they just go to the next one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um and that's what's going on, and I show $1200 in collections.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEGATIVE] And that's crazy. That's really it's sad because they, if you have multiple insurances, you're supposed to submit a claim for to each insurance company that because.
[AGENT][NEUTRAL] I had to go, I went through that personally. Um, my daughter has a primary and a secondary insurance. She has a primary with myself and then she has one with her father.
[AGENT][NEGATIVE] But um they were only submitting it to me then it was coming back on my, on my insurance, but then it was coming back saying that I owe this, I owe it but if if she's had, if she has a secondary insurance, I'm not supposed to be on this full balance. I may owe a balance, but it's not supposed to be this full amount because you're not submitting it to the secondary insurance and then she says, well, um, we don't have to. I say, yes you do, that's illegal.
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][NEGATIVE] Some people just don't think. I'll tell you something really funny. I went to Publix the other day and I told the lady, can you please bring me a $100 bill? She's like, I don't have, you're gonna have to go to customer service. I said, hmm. I said, OK, well, I'm gonna pay you with, I'm gonna pay you with my Apple Pay, but first I want to pay you $20 cash. You can't do that, ma'am. I'm like, what?
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] She's like, you can't do that. I'm gonna have to take all your $100 and I said, no, you're not, you're only gonna charge me $80 you're gonna, I mean, $20 you're gonna give me back $80 and the rest you're gonna put it in Apple Pay. She's like, no, I can't do that. I'm like, call your manager.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] You can do separate transaction. It's gonna be cash and debit.
[CUSTOMER][NEGATIVE] So she called the manager and she got mad.
[CUSTOMER][NEUTRAL] She got so mad and she's like, you can't do them. He's like, yes, you can just put $20 cash and give her change. She should, she should have just broken my $100 and she would have been happy and she would have not gone through all the stress. But yeah, some people just don't want to go, they don't, I, I again, they just don't want to go the extra step. They don't know and it's just easier to swipe to the next file and move on.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] But um I'm gonna get an itemized bill and I'm gonna get it with an ICD code and I am going to upload it I'm gonna submit it and pay for it myself.
[AGENT][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] So I'm already in collections, so.
[AGENT][NEGATIVE] Right, no, no one wants to be in collection.
[CUSTOMER][POSITIVE] Yeah, I gotta get that off my back so but thank you so much for your guidance you've been super helpful.
[AGENT][POSITIVE] You're welcome, [PII]. It was a pleasure speaking with you. Thanks for calling APL and have a good day.
[CUSTOMER][POSITIVE] You too, love. Bye-bye.
[AGENT][POSITIVE] Thanks, bye.