AccountId: 011433970860
ContactId: 56feb706-ba46-4272-ba0b-2e1a00092f69
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1403300 ms
Total Talk Time (AGENT): 471944 ms
Total Talk Time (CUSTOMER): 697980 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/56feb706-ba46-4272-ba0b-2e1a00092f69_20250512T20:25_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I have a question for you. Well, first, let me give you my um my um.
[CUSTOMER][NEUTRAL] My benefit certification number, you ready for that?
[AGENT][NEUTRAL] Um, yes, may I have your name first?
[CUSTOMER][NEUTRAL] Of course, [PII].
[AGENT][NEUTRAL] And [PII], what's a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that and your policy number?
[CUSTOMER][NEUTRAL] 01960211
[CUSTOMER][NEUTRAL] Mary
[CUSTOMER][NEUTRAL] M for Mary, L for Lisa, 88.
[AGENT][NEUTRAL] Thank you for that. And I have your policy here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Date of birth is [PII]. Mailing address is [PII]. And uh as far as the email, is that the [PII] or is it a [PII]? What do you have on file?
[AGENT][NEUTRAL] I see [PII].
[CUSTOMER][NEUTRAL] So that would be [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how may I assist you today?
[CUSTOMER][NEUTRAL] So my wife went to a doctor's office and they performed um.
[CUSTOMER][NEUTRAL] An ultrasound on her. It was a urinary uh visit urologist, and they performed an ultrasound and I see now that my insurance doesn't cover ultrasound at all. Do you guys cover uh ultrasounds in the doctor's office?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let's see, hold on one moment.
[AGENT][NEUTRAL] So under outpatient, um, yes, we do cover diagnostic testing. Um, you do have the office treatment rider, which covers the treatment done in the office as long as it's not cosmetic, um, up to $1000 per calendar day. However, since this is your secondary policy, if your primary does not apply, we cannot apply.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, the, the primary is saying that's uh part of.
[CUSTOMER][NEUTRAL] Let's see uh.
[CUSTOMER][NEUTRAL] As part of our deductible.
[AGENT][NEUTRAL] Primary thing is part of your deductible?
[CUSTOMER][NEUTRAL] So they, they
[CUSTOMER][NEUTRAL] Yeah, they took the charge of $1,118.19 and the insurance reduced it, um, down to $449.17.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Sorry, $445.38?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, so it's saying here in the explanation of code, um, code 835 for the multi-plan provider contract, charges have been discounted for the contracted rate or agreement amount not billable to the patient as stated in the comprehensive medical benefits in the applicable summary plan description.
[CUSTOMER][NEUTRAL] So what does that mean?
[AGENT][NEUTRAL] So you have two options. You can either um call your wife's doctor and let them know that you have the secondary policy and give them our, your policy number and our phone number for them to bill us or if you all want to file the claim on your own, um, you would just need the itemized bill from the doctors.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, now I'd rather the doctor's office, yeah, I asked my wife if she gave both the primary and secondary. She said I forgot to give the APL, so I'm gonna call the doctor's office back and give them um the APL information so that they can bill you guys.
[AGENT][NEUTRAL] OK, yeah, and then, yes, and then once they get, you can give them our phone number too just in case they want to call and verify benefits and then we'll tell them how to file the claim and everything and then once um they send it in, we'll go ahead and process it for you.
[CUSTOMER][NEUTRAL] So, OK, so I give them the same number as you have here on the back of the card, the one I called today, the [PII], is that right?
[AGENT][POSITIVE] Yes, sir. Mhm, that's correct.
[CUSTOMER][POSITIVE] OK, well thank you so much. I appreciate your assistance today.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I actually I do think I do think so, yes, one second, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Back on.
[CUSTOMER][NEUTRAL] Well we've been on the APL now since [PII] had it for a number number of years but um back on.
[CUSTOMER][NEUTRAL] If you can look this up, that would be great. Back on, um, this would be for my wife [PII]. Both I've got myself, my wife, and my son on the policy. I guess you can see all that. So my wife [PII], she went to an urgent care, uh, back on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Someone told us that they already build APL and I don't think so because you guys usually pay the copay for us, um, so.
[AGENT][POSITIVE] Oh, I can check for you.
[CUSTOMER][NEUTRAL] Yeah, so the data service was 0328-2024.
[CUSTOMER][NEUTRAL] You tell me and then I don't know what you need also.
[AGENT][NEUTRAL] And you said it's for your wife?
[CUSTOMER][NEUTRAL] Yeah, [PII], uh huh. Do you need the date of birth?
[AGENT][NEUTRAL] Um, the reason I'm asking, um, so there's no claim on file. They haven't, they haven't filed it with APL or maybe they filed it with your primar[PII]
[CUSTOMER][NEUTRAL] That's what I'm thinking because when I called them I'm like, did you send it to APL uh huh we build your secondary they paid. I'm like, huh, do you have anything on file?
[AGENT][NEUTRAL] Let me double check just to make sure. You said [PII].
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] That was the date the charges, uh, yeah, were, were applied.
[AGENT][NEUTRAL] Mhm. Yeah, we don't have a, wait, the date, so like the date of service?
[CUSTOMER][NEUTRAL] It says date of charges, but I'm pretty sure that was the date of service.
[CUSTOMER][NEUTRAL] There's a bill date of now [PII], but yeah, the date of service was [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. I just wanted to make sure, but no, sir, there's no um there's no claims on file for uh Ms. [PII].
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] For my wife.
[CUSTOMER][NEUTRAL] That's what I figured. I don't think they know, and, and they send me to collections and I'm like, I need all the information because you guys definitely didn't send it to APL. APL has been covering all kinds of stuff for us from ambulance to urgent care to X-rays. That's the point of the secondary insurance for us. Can I have you check another one please? if you don't mind? I have a I have a few of them that they sent me that they're all in collections now.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, these next few are gonna be me and then I also have on here for my son [PII], but let me give you the first one for me if you can please check.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Again, that's the urgent care.
[AGENT][NEUTRAL] No, it's [PII]. But this one is for you, you said, right? OK.
[CUSTOMER][NEUTRAL] Just for me, [PII].
[AGENT][NEUTRAL] OK, so I do, there are 2, is this, there are 2 claims here.
[AGENT][NEUTRAL] Um, let me see, but.
[CUSTOMER][NEUTRAL] Two claims?
[AGENT][NEUTRAL] Mhm. Let me see what hap. Oh, I see. So they submitted the claim, but they they didn't send in the primary explanation of benefits. So then they resend it and hold on, let me look at these two. They paid out on it. Hold on one moment.
[CUSTOMER][NEUTRAL] You guys paid out?
[AGENT][NEUTRAL] 25 we paid out on it, yes, um, 494. I'm just waiting for the claim to pop up here.
[AGENT][NEUTRAL] 494.
[AGENT][NEUTRAL] OK, so it was a, so it's, um, this is South Miami Hospital?
[CUSTOMER][NEUTRAL] Yep, it's, uh, yeah, it's the urgent care, it's part of Baptist Health South Florida, South Miami, that's right. Mhm.
[AGENT][NEGATIVE] So we paid $433.50. Wait, this went out to you all. Hold on, it didn't go to the provider.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] You guys mail it to me?
[AGENT][NEUTRAL] Wait a minute.
[AGENT][NEUTRAL] Mhm, let me double check. 446. How much was it? 43,350.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yep
[AGENT][NEUTRAL] Yes, sir. Uh, the check was mailed to you, um, back on [PII]. Um, it was a total of $433.50 on [PII]. The the check cleared. Um, looks like it was mailed to your home address.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] OK, well that's good information um so then I owe them the money.
[CUSTOMER][NEGATIVE] OK, so that's good. I owe them the money. They never billed me till this year. Can you believe it? This is back from [PII]. I probably didn't even know what you guys were paying for. I obviously deposited the check without knowing anything, and now they're sending me the bill over a year later.
[AGENT][NEUTRAL] What?
[CUSTOMER][POSITIVE] OK, so thank you for that. Can I give you another one, please?
[AGENT][POSITIVE] You're welcome, of course.
[CUSTOMER][NEUTRAL] This is for me also?
[CUSTOMER][NEUTRAL] So this one, the data service is [PII].
[CUSTOMER][NEUTRAL] Uh, just a couple days later, [PII], same place.
[CUSTOMER][NEUTRAL] [PII] South Miami Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Oh, you know what, can you hold on one second? I just wanna give [PII] wife so she can call that doctor and let them know that they need to bill you guys. Hold on one second, is that OK? Can you hold for a second for me?
[AGENT][NEUTRAL] Um, he got the pay. Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Me? Sure.
[CUSTOMER][POSITIVE] Oh thank you so much one minute please.
[AGENT][POSITIVE] You're welcome. OK.
[CUSTOMER][NEUTRAL] I spoke to it said hold on.
[CUSTOMER][NEUTRAL] OK, um, yeah, so I gave you service date of [PII]. Do you see anything for that one?
[AGENT][NEUTRAL] Yes, um, so we've received 1234 claims for that data service. Um, let me see.
[CUSTOMER][NEUTRAL] All for me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, some of them, they submitted and then like one didn't have the explanation of benefits, so it was res, so.
[AGENT][NEUTRAL] Uh, some of them were recent. Let me see this paid one though. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Wait, what?
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] But you said this is for [PII], the same one.
[CUSTOMER][NEUTRAL] Same one. I, it's the one that's like literally 3 minutes from our home, so we always go there if we, if our, if we can't get an appointment with the doctor.
[AGENT][NEUTRAL] OK, is that the same as Cre Care Clinics?
[AGENT][NEUTRAL] Uh, this is
[CUSTOMER][NEUTRAL] It should be because.
[AGENT][NEUTRAL] Because
[CUSTOMER][NEUTRAL] What are they calling it? I mean, up on my bill it says Baptist Health South Florida, South Miami Hospital.
[AGENT][NEUTRAL] Yeah, see, like the other claim says [PII], but this one says Cret Care Clinics and of the one of the claims that were received.
[CUSTOMER][NEUTRAL] Oh, so there
[CUSTOMER][NEUTRAL] OK, so they're they're basically sending it as as an urgent care, a critical care clinic?
[CUSTOMER][NEUTRAL] But they are part of the South Miami hospital. I don't know why they're sending that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this one, we did pay $100 to you for this one.
[CUSTOMER][NEUTRAL] Ah,
[AGENT][NEUTRAL] Can we get the um
[CUSTOMER][NEUTRAL] For the copay.
[AGENT][NEUTRAL] Check information. Hold on one second. Yes, sir. Let me see.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so this one was issued on [PII] and it cleared on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See they're just sending all the paperwork now a year later is that crazy?
[AGENT][NEUTRAL] That, that's very crazy. But you know what, a lot of, a lot of providers do that and then they, the only thing that like pushes them is if they get like audited or something and otherwise it's just sitting there.
[CUSTOMER][NEUTRAL] But that's
[CUSTOMER][NEUTRAL] Right, so now they got the collections after me, but that's fine. I'll, I know I owe the money, so I'll pay the collections. That's fine. OK, uh, here's another one, please. It's for me also. The data service is [PII], same place. I don't know how they billed it to you, but it's the Miami South Miami Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They're also saying I owe $100.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, uh, 8:21, yes.
[AGENT][NEUTRAL] Of 24, OK. Just want to make sure because for that one, I'm not showing anything on file.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So I don't think they, it looks like they didn't bill for that one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They didn't build a secondary.
[CUSTOMER][NEGATIVE] So they didn't bill you, so they need to bill you so, so let me ask you a question because I'm already in collections for this. What do I need to send you for you to give me the check so I can give it to the collection folks because the collection folks don't wanna hear about nothing. They just like pay us $100 or call a provider like we don't wanna hear all your stuff they don't care.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Well, to be honest, what you need to do is contact the provider and tell them that you all have put this in collection, but you didn't bill my secondary insurance because they're technically not supposed, collections isn't supposed to come anywhere until like all the insurance has been billed and and answered and you just didn't pay your bill. They didn't bill us, so they have not done, they didn't do what they needed to do to collect that. So, so I would start with them.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEGATIVE] And it's so, it's so weird because at the bottom of every sheet here, both sheets that show my primary, which was Aetna, and the secondary American Public Life, you see that? They even got it. They even have the 019-60211 ML8 right on here, and they don't even contact you guys. This is just laziness by the billing department, right? And instead they throw.
[AGENT][NEGATIVE] Yeah, they, you, you need to, they need, you need to contact them as soon as possible and they need to they need to contact the collections and stop the collections because they should not have started it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I will contact them this afternoon right after we get off the phone.
[AGENT][NEUTRAL] Because I don't want that to impact you negatively.
[CUSTOMER][NEGATIVE] Oh, exactly, it's not fair. It's just not right.
[AGENT][NEGATIVE] It's not.
[CUSTOMER][NEUTRAL] Hold on, I'm just taking some notes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you for that.
[CUSTOMER][NEUTRAL] The next one here, this is for my son, this is for [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I have 2 for him.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me know, let me know when you're when you're ready for the date.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] OK, this is also, I think we both went, we were both [PII], [PII].
[CUSTOMER][NEUTRAL] They're saying I owe them $100.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Same place South Miami Hospital.
[AGENT][NEUTRAL] 659.
[AGENT][NEUTRAL] OK, so this one,
[AGENT][NEUTRAL] Claim number 3431659.
[AGENT][NEGATIVE] It was denied, but it was denied requesting the explanation of benefits from primary insurance and we sent that to the provider and they have not sent it back in yet.
[AGENT][NEUTRAL] So as soon as we receive that explanation of benefits, we can continue processing this one for the decision. Is this one in collections also?
[CUSTOMER][NEGATIVE] Yeah, they're all in collection. They threw the whole bank gamut in collections.
[AGENT][NEGATIVE] Oh, no.
[CUSTOMER][NEUTRAL] Yeah, everything, so.
[CUSTOMER][NEGATIVE] So APL denied it because it was missing EOB.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] N A P L E O B.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And if they, if they like say that they weren't notified, let them know. Hold on, because I want you to have everything. Hold on one second. Let them know that the explanation, our explanation of benefits was mailed to them on [PII] requesting primary explanation of benefits and letting them know once we receive it, we'll continue processing.
[CUSTOMER][NEUTRAL] That was 3:15 last year, [PII], over a year ago. Is that right?
[AGENT][NEUTRAL] Mhm. Yes, sir.
[CUSTOMER][POSITIVE] Thank you so much. I appreciate that information. OK, here's another one for [PII], uh, this data service.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] This is [PII], [PII] for [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And APL number is on every single one of these. If I sent you a copy of this, you'd be like, what the heck? They got the information right in hand. They just don't, they don't bother. They just don't. It's like silly. What's the point of having two this anyway.
[AGENT][NEUTRAL] And if you're gonna send something to collection, you, you gotta make sure you did everything you could to get the balance and you just couldn't.
[CUSTOMER][NEUTRAL] You let me
[AGENT][NEGATIVE] Like, it, it has to be like some serious neglect.
[CUSTOMER][NEGATIVE] They just don't care, don't care.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] But for the [PII] for [PII], I'm not seeing a claim on file for that date of service.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEGATIVE] They didn't even send it to you, nothing.
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] They didn't send it to you. They're saying balance is $100 and typically that's the co-pay and yep, OK.
[CUSTOMER][NEUTRAL] OK, send to APL.
[CUSTOMER][NEUTRAL] Let me see, are there even more here? My goodness, uh, what's this one?
[CUSTOMER][NEUTRAL] This one is for.
[CUSTOMER][NEUTRAL] [PII], wait, did we do this one already? Now I'm now I'm mixed up.
[AGENT][NEUTRAL] What's the um date?
[CUSTOMER][NEUTRAL] Yeah, this is [PII] [PII]. I think we talked about this, but I didn't take any notes on it.
[AGENT][NEUTRAL] [PII] from Ms. [PII].
[CUSTOMER][NEUTRAL] So now I don't know if I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, hold on.
[AGENT][NEUTRAL] Oh, because there was, there was nothing on file for that one.
[CUSTOMER][NEUTRAL] Never sent it into you.
[AGENT][NEUTRAL] They didn't file. Mhm.
[CUSTOMER][NEUTRAL] OK, that's good, so I got these 123.
[CUSTOMER][NEUTRAL] 44 of them are going back to the hospital.
[CUSTOMER][POSITIVE] And then two of them, you thank you very much. You, you covered $533.50 for my for me.
[CUSTOMER][NEUTRAL] Um, so I'm gonna turn around and send them the money. I'm gonna pay them that they're owed it. You gave it to me, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] It's just because they only billed me a year later. Who's going to remember a year later? It's crazy.
[AGENT][NEUTRAL] Right, I don't even remember yesterday.
[CUSTOMER][NEUTRAL] Like, uh, like tomorrow, like tonight I'll say, I know I called someone this afternoon, who did I call?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Well, the good thing is, no, that's fine. The good thing is there is no timely filing limit. So they, you still have time, like there's no deadline or anything.
[CUSTOMER][NEUTRAL] Don't take that the wrong way.
[CUSTOMER][NEUTRAL] OK, alright, well thank you so much. um, if, if they, I, I don't know what to do if they give me a hard time. I mean they need to send it to my secondary it's on file. They just didn't send it like why?
[AGENT][NEUTRAL] Because your policy was active.
[CUSTOMER][NEGATIVE] Except one you, you guys denied it because they didn't provide the EOB. It's clear you send them a letter, give me the EOB so we can determine what we do on this, and they just didn't follow up.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well thank you so much I really appreciate your help. You guys are always fantastic thank you thank you thank you.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I can assist you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] Well, I think we've gone through enough here. I got, I got stuff to do to get this pushed back to different people, so thank you for the information. I really appreciate your patience going through all this stuff for the for the family here and you have a great rest of your day and hopefully I don't have to call you guys back at I do. I know I'll get great service as you always give it.
[AGENT][POSITIVE] Oh, you're very welcome.
[AGENT][POSITIVE] Well, thank you. I'm glad I could assist you and if you need anything, let us know.
[CUSTOMER][POSITIVE] Very much have a great day.
[AGENT][POSITIVE] Alright, thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye bye.