AccountId: 011433970860
ContactId: 599d258b-8ea0-4681-b331-05b1476b8e92
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 735179 ms
Total Talk Time (AGENT): 387293 ms
Total Talk Time (CUSTOMER): 242590 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/599d258b-8ea0-4681-b331-05b1476b8e92_20250122T14:54_UTC.wav
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[AGENT][NEUTRAL] Contacting HPO, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII].
[AGENT][NEUTRAL] Well, how can I help you?
[CUSTOMER][NEUTRAL] Yes, I'm calling regardless of my husband claims. Um, he did put me to authorize for his billing. His name is [PII].
[AGENT][NEUTRAL] Do you have the policy number for your husband?
[CUSTOMER][NEUTRAL] Yes, I do. I have the policy number is 01524156.
[AGENT][NEUTRAL] Thank you. If I could just verify his date of birth and a phone number, please?
[CUSTOMER][NEUTRAL] [PII] is phone number [PII].
[AGENT][POSITIVE] OK, thank you. I get here.
[AGENT][NEUTRAL] OK, yes, and you said that there were some claims that uh.
[AGENT][NEUTRAL] That you needed to look out for your husband. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes, there's some things that I'm concerned about uh about because there's one that is already in collection. First of all, I wanted to know how much is this, uh, deductible.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK. The policy actually, uh, pays, uh, it picks up the deductible co-payment or co-insurance for outpatient services up to $5000 or for inpatient services up to $5000. Now there's not a deductible with this policy. What we do is we actually pay.
[CUSTOMER][NEUTRAL] Oh, it pays up to 5000, yeah.
[AGENT][NEUTRAL] Yeah, this is, this is his, uh, this is his secondary gap, uh or gap insurance, so there is no deductible.
[CUSTOMER][NEUTRAL] OK, so, OK.
[CUSTOMER][NEUTRAL] Um, so I have one here, uh, let me see.
[CUSTOMER][NEUTRAL] Gus from twist.
[CUSTOMER][NEUTRAL] For the amount of $67.29 that already went through collection.
[CUSTOMER][NEUTRAL] Uh, do I give you a file number, pin number? Let me see.
[AGENT][NEUTRAL] So this is quite
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] This is Quest Diagnostics. OK. What is the data service for the?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That they service.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Looking at the paperwork here.
[CUSTOMER][NEUTRAL] Just tell me, uh, [PII].
[CUSTOMER][NEUTRAL] Of [PII]?
[AGENT][NEUTRAL] OK. The reason that I was asking is because um I don't show any, uh, I'm trying to see if there, if there are any uh um.
[AGENT][NEUTRAL] Lab labs that were submitted, um.
[AGENT][NEUTRAL] So let's just see here.
[AGENT][NEUTRAL] Request diagnostics.
[CUSTOMER][NEUTRAL] Yeah, because
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] It's submitted by [PII].
[CUSTOMER][NEUTRAL] So he goes to the doctor, they do the blood work.
[CUSTOMER][NEUTRAL] He pays $30 co-payment and then he sends the blood work lab to [PII].
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And then I see, yeah, so I see one for $67.
[CUSTOMER][NEUTRAL] And then I have another one.
[CUSTOMER][NEUTRAL] And we do give them the insurance. I don't know why we keep getting uh for $138.59.
[AGENT][NEUTRAL] OK. It looks like they haven't submitted it to us to be processed. Now that we do have um the, the last labs that I showed for your, for your husband were from uh [PII]. Uh, he does have coverage for, for treatment within a, within, you know, within independent labs, um, but we just haven't received that, that, uh, that bill yet so that we can pay it out. Um, but that's, uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Can I submit it, please?
[AGENT][NEUTRAL] Yes you can you can submit that online or you can fax that to us.
[AGENT][NEUTRAL] Or mail it. And what we're looking for is the explanation of benefits that shows the deductible, co-payment or co-insurance. We also need to know why he's having the labs. So if it's for a wellness check or if he had the labs done, um, for some other reason, uh, you can just write that on the explanation of benefits, that would be fine.
[AGENT][NEUTRAL] Um, and then you can submit that to us and then what we'll do in an instance like that is that we will go ahead and and make the payment to you rather than to the provider. But anytime that you have a bill like that and it doesn't look like the, the provider has submitted it to us, you can always send those in yourself.
[CUSTOMER][NEUTRAL] OK, so the reason why is because he's diabetic and he had to be um every 6 months they have to do is A1C.
[AGENT][NEUTRAL] Oh, OK, well, that's fine. You, you can just put that on the, on the on the uh fax or the or the um explanation of benefits when you submit that. So there's a couple of different ways that you can get that bill into us. Um, you, you can either uh mail it to us, you can fax it to us. We have an online service center that you can go on, uh, it is, it will be listed on his card, but the uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But the service center um web address is triple [PII]
[AGENT][NEUTRAL] Uh, secured, the word secured with a [PII] and then what you can do is you can submit that to us online, um, that explanation of benefits, the, uh, the, um, just letting us know that this is for us A1C and then um.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Can, uh, once we process that then we uh make the payment to you. But and anytime you have a bill like this that that it doesn't look like the uh provider has submitted it to us, you can always submit it yourself and then we just make, make the payment to you.
[AGENT][NEUTRAL] Now, our mailing it, would you like to mail it to us or fax it to us, or do you rather go online?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, just in case, can I have the fax number?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I have one.
[CUSTOMER][NEUTRAL] That we paid.
[CUSTOMER][NEUTRAL] From the provider that I'm pretty sure you know because I got the uh.
[CUSTOMER][NEUTRAL] The explanation of benefits. Um, he had a colonoscopy on June.
[CUSTOMER][NEUTRAL] On [PII] with the gastro doctor we paid the provider. It shows here paid provider $441.32.
[AGENT][NEUTRAL] Right. Now, we did get a bill for that from the um for, from the, uh, it looks like from the hospital, uh, and, and there were other things uh but we went ahead and paid those. um.
[AGENT][NEUTRAL] So it does look like we, we did.
[CUSTOMER][NEUTRAL] So you did pay?
[AGENT][NEUTRAL] Yes, it looks like there's several bills here. Let me go over them with you. Um, this is for, let's see this.
[AGENT][NEUTRAL] Give me just a moment please here.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] It's uh endoscopy and colonoscopy.
[AGENT][NEUTRAL] So, uh, yes.
[AGENT][NEUTRAL] Yes, OK, so the very 1st, 1st bill that I hear, I have this from [PII], um, we received a bill.
[AGENT][NEUTRAL] Uh, from, um, Gastrohealth, uh, we paid $441.32. Um, that, those were for the actual procedures themselves. Um, that was paid, uh, and then the other bill that we have, uh, we received something from the hospital itself. This is South Broward endoscopy. Um, they asked for, uh, $1680 which we paid.
[AGENT][NEUTRAL] Uh, that was back in, um, let's see when those bills came in. It looks like we received those claims.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] It's been a bit
[AGENT][NEUTRAL] been a bit of time. Let me just see.
[AGENT][NEUTRAL] 54.
[CUSTOMER][NEUTRAL] OK, so, sorry, go ahead.
[AGENT][NEUTRAL] Oh, excuse me, yeah.
[AGENT][NEUTRAL] No, I'm just trying to see if I can find the claims here.
[AGENT][NEUTRAL] It looks like we received it, yeah.
[CUSTOMER][NEUTRAL] Because they charging
[CUSTOMER][NEUTRAL] They charged me for the for the doctor, $440.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then they charge they ask you for the same payment. I just want to make sure that it, that because they did, they told me that I have to pay upfront 400 and.
[CUSTOMER][NEUTRAL] And I have, I have, they never sent me the receipt, of course, but I have it in my credit card.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Uh, and who was, what was the doctor's name?
[CUSTOMER][NEUTRAL] Uh, he was from gastrohealth. Um, I have to look for the doctor name.
[AGENT][NEUTRAL] Well, we, uh,
[CUSTOMER][NEUTRAL] So if I get that information, yeah, go ahead. Mhm.
[AGENT][NEUTRAL] Well, it looks like they've already sent it to us. Um, it looks like we received, uh, it was back in December, uh, for gastrohealth, for $441.32 as I mentioned before. Um, it looks like we received that, that claim, um.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] On the uh
[AGENT][NEUTRAL] Uh, [PII] we processed it on the [PII] and it was paid. So, um,
[AGENT][NEUTRAL] It's and they were, they did receive a check for $441.32. You may want to contact the provider and make sure that they, that they show that that was that that was credited to your account because we're showing that we paid it.
[CUSTOMER][NEUTRAL] And you pay it to the provider, to the doctor, or to
[AGENT][NEUTRAL] To the provider, to, to the doctor. Yes, because they send in a claim. Now, we don't have any idea that you, that you've already paid it. So if you've already paid this, you may want to talk to the provider because it's going to show as an overpayment. Um.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And who's the, who's, what's the name of the doctor you have there?
[AGENT][NEUTRAL] Well, it's not the name of the doctor, it's Gastrohealth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, hold on.
[CUSTOMER][NEUTRAL] I have it here.
[CUSTOMER][POSITIVE] Incredible. They're so easy to, to
[CUSTOMER][NEGATIVE] I know they charged me 400 and and then I asked for the bill and they told me that they couldn't send me the the receipt until later.
[CUSTOMER][NEUTRAL] Yeah, that office. This is what we pay I pay $429.
[AGENT][NEUTRAL] OK, you, you may want to check with them and see if that is still active because um we are showing.
[AGENT][NEUTRAL] They submitted the bills to us.
[CUSTOMER][NEUTRAL] OK, so I'll give them a call for that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there, is there anything else?
[CUSTOMER][NEGATIVE] And if maybe it's a different amount that they're charging, but they charged me $429.
[CUSTOMER][NEUTRAL] Upfront with the doctor. So if it's a a different bill then what should I do that? Do I submit it to APL?
[AGENT][NEUTRAL] Well, if, if they didn't, if it's a different bill or if they're saying that it's still due, you can certainly submit it to us, um, but, uh, as I mentioned before, it looks like we've paid it, so we would just need it, we just need, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll give them a call, OK?
[AGENT][NEUTRAL] Oh, OK. Is there anything else at all that I can help with, just let us know.
[CUSTOMER][POSITIVE] OK, thank you. Have a good day bye.
[AGENT][POSITIVE] OK, thanks for contacting AP have a good.