AccountId: 011433970860
ContactId: 662976ab-abec-444d-af31-ba44e465b2d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1072180 ms
Total Talk Time (AGENT): 337209 ms
Total Talk Time (CUSTOMER): 617587 ms
Interruptions: 12
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/662976ab-abec-444d-af31-ba44e465b2d2_20250212T13:27_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi, good morning. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] I'm doing good. Um, I was wondering if I could or maybe you could help me. I spoke to [PII] last time and she was helping me and, um, not sure if I would be able to be transferred to her or um if you could just um assist. OK, awesome.
[AGENT][NEUTRAL] She's not in the office at this time.
[CUSTOMER][NEUTRAL] Uh, maybe you could help me. So, uh, when I called [PII] last week, actually, um, two weeks ago, um, I was explaining the situation that I had regarding, um, a claim. I had surgery.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, last year, and, um, the, um, anesthesia, uh, clinic, um, basically was, um, sending me a letter stating that the, the claim for $1500 hadn't been paid and so I contacted um my uh primary insurance and they stated that they paid a portion and then.
[CUSTOMER][NEUTRAL] Um, the rest was submitted to the secondary, which is APL. [PII] explained that the reason why APL hadn't paid it's because, um, the EOP hadn't been provided, so she instructed me to go ahead and upload the EOP, and that's the only thing that was needed basically the EOP from Aetna, um, showing that um what they paid and the remaining amount for APO to cover.
[CUSTOMER][NEUTRAL] So I went ahead and I did that and I got a text message saying that the claim had already been processed.
[CUSTOMER][NEUTRAL] And log into the system, um, but I'm not sure if I'm understanding the information correctly what I'm seeing online, uh, but it says amount paid 0, so I don't know if, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get your, let me get your name and policy number so I can look at the file.
[CUSTOMER][NEUTRAL] Yes, um, this [PII] and the policy number.
[CUSTOMER][NEUTRAL] If we give it to you.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Um, 01849205.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] ML 7
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 3. OK.
[AGENT][NEUTRAL] Let me get you verified and then we can proceed, OK?
[CUSTOMER][POSITIVE] Yeah, yeah, perfect, thank you.
[AGENT][NEUTRAL] If you can verify your date of birth, your mailing address, and your email.
[CUSTOMER][NEUTRAL] Yes, [PII], mailing address is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the email is uh uh [PII].
[AGENT][POSITIVE] OK, thank you for verifying.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let's see, what is your first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And what's the date of service of the claim that you sent in?
[CUSTOMER][NEUTRAL] Uh, this is for, um, [PII] last year. So, um, APL did send us, um, a check for the exact amount for the hospital bill. So this was a surgery at, at the hospital, so part of it, um, yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One of the bills was from the hospital and the anesthesia was uh usually billed um separate for the anesthesia services so the hospital uh bill was um submitted was paid already um by APL um I believe it was some some time like at the end of the year.
[CUSTOMER][NEGATIVE] Um, and the amount for the anesthesia, um, when I contacted the anesthesia services, um, they, after receiving the letter saying that they, you know, they couldn't get paid, that APO basically rejected the claim and
[CUSTOMER][NEUTRAL] And that they, uh, we had to provide another insurance. I called them and they said, actually, we already contacted um Aetna, which is your primary. They only paid a portion, so we sent the rest to APL and APL um hasn't paid, so contact APL. So that's when I ended up um speaking with [PII] and she explained that they needed.
[CUSTOMER][NEUTRAL] Um, APO needed the EOB showing that because they're not gonna just in case they don't wanna, they don't, they don't wanna pay it twice if Ena had paid, right? So showing that Ena uh was not responsible for paying those 1500 and then that APO will decide if if that check will be issued to us or if if it's gonna be sent to like Envision um anesthesia services directly.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I followed those instructions and I uploaded the, the EOP um on the [PII].
[CUSTOMER][NEUTRAL] Showing that um.
[CUSTOMER][NEUTRAL] The, the balance was the, the 1500.
[AGENT][NEUTRAL] And is it from anesthesia physician solution?
[CUSTOMER][NEUTRAL] Um, and the letter here.
[CUSTOMER][NEUTRAL] Yeah anesthesia physician solutions, yeah, mhm.
[CUSTOMER][NEUTRAL] So, so they're the ones owed that, that, that amount, so.
[CUSTOMER][NEGATIVE] Cannot say that it would either be sent um to them directly or to me for me to like send to them because um we already received the bill from them too um.
[AGENT][NEUTRAL] OK give me just a moment to look at your file, OK? Oh, give me one moment.
[CUSTOMER][POSITIVE] Thank you so much, yeah. Yeah.
[AGENT][NEUTRAL] OK, so did you receive a check around $3500?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, the check was, was exactly for the same amount from the hospital bill that was separate from the anesthesia.
[AGENT][NEUTRAL] Previously
[CUSTOMER][NEUTRAL] And I could tell you here, let me see.
[AGENT][NEUTRAL] Did you receive a check for about $3,504.23?
[CUSTOMER][POSITIVE] I believe so, yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And that was, again, yeah, the the exact amount for um.
[CUSTOMER][NEUTRAL] The, the hospital bills so it was sent to like directly to um cancer Hospital.
[AGENT][NEUTRAL] So I'm showing that there was a payment of $1,504.80 that was paid on the anesthesia physician solutions bill and that amount was included in that $3500 check.
[CUSTOMER][NEUTRAL] No, the $3500 check was directly for HCA Florida kind of hospitals.
[AGENT][NEUTRAL] It was for several, it was for several charges related to the surgery to include the anesthesiologist bill was included in the payment.
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] No, but the anesthesiologist is billing us separately though, like I have the, I'm looking at um the bill like in front of me right now, the bill from um.
[CUSTOMER][NEUTRAL] Actually, the, it was in the 35. The bill from the hospital was, the check was, I'm looking at the copy of the check. Now, the check was for $3,936.
[AGENT][NEUTRAL] OK, the check I'm looking at from American Public Life that we sent to you is 3,504.23.
[CUSTOMER][NEUTRAL] OK, for the check from STO.
[AGENT][NEUTRAL] That's the check that I'm talking about?
[CUSTOMER][NEUTRAL] No, I'm, I'm, no, the one that we received and I'm looking at it in front of me is the $3,936.62. And, and from that, that is, that is for the hospital bill that was exactly $3,786 and the rest is from my spouse's, like a credit that was from my spouse's um like the 5 $350 like office visit for my spouse. So, um.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It's, that is the only check that we've received, and I have the copy here, and it's for $3,936.62 that covered the hospital bill. We have not received any other check.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Yeah, and I, I have the I'm also looking at the explanation of benefits from um APO with the HP um.
[AGENT][NEUTRAL] What's the claim number? What's the claim number on the, the ELB that you're saying for the other check? What's the claim number of that one?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes. OK. Claim number here. It says 3481182.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the check date is.
[CUSTOMER][NEUTRAL] I see a check date [PII].
[CUSTOMER][NEUTRAL] Um, see what other information I see here.
[CUSTOMER][NEUTRAL] Yeah, that's, that's the, the date of the check, huh?
[AGENT][NEUTRAL] OK, so the check that I'm looking at for 350423, um, it was issued on [PII]. Uh, it was made payable to [PII] and mailed to [PII]. I do show it's still outstanding, so what I can do is verify.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, whether that check has cleared and if not,
[CUSTOMER][NEUTRAL] Why cause the husband been said.
[AGENT][NEUTRAL] Uh, since it's beyond
[AGENT][NEGATIVE] Since it's beyond 30 days from the date it was issued, we could request that this check be voided and then another one reissued. It was processed though. It just looks like you may not have received it or because it's from what I see it's still outstanding, but I'll have to get that verified for sure.
[CUSTOMER][NEUTRAL] Well, mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, something is going on here either like it wasn't received, it was lost in the mail because the only check that we received was that one that I.
[CUSTOMER][NEUTRAL] You know, that I, that I gave you the information and I'm also looking at, so I'm looking at the, the, the explanation of benefits from APO and it shows that that check for $3900 was going directly to the hospital to pay the exact amount from the hospital bill that was at 3786, 3,786 62 cents.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then the rest 150, the remaining 150 was for um office visits, um, so that's the only check.
[AGENT][NEUTRAL] Yeah, I'm not, I'm not disputing the payment that you received. I see that check.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, I, yeah, I understand what you're saying.
[AGENT][NEUTRAL] Yeah, and I do see that the anesthesiologist charge was not included in that check, but it was included in the one that I'm saying had not cleared. So what we will do is verify if the check, uh, that was for [PII] has cleared. If not, we can request that that check be check be voided and then we can get it reissued to the policyholder to the address that I just mentioned.
[CUSTOMER][NEUTRAL] Mm, right, OK, OK, and.
[CUSTOMER][POSITIVE] Right, OK, perfect.
[AGENT][NEUTRAL] So that's what we can do and, and the anesthesiologist charge is included in that 3500, I mean that 1500, I'm sorry. Let me get the total amount of that check again.
[CUSTOMER][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] The total check is 3,50423.
[AGENT][NEUTRAL] And the benefit for the anesthesiologist, uh, what we paid is 150,480, so that amount is included in the 3504.
[CUSTOMER][NEUTRAL] 1, 1000. I'm, I'm sorry, what exactly?
[AGENT][NEUTRAL] Is that what they
[AGENT][NEUTRAL] $1,504.80.
[CUSTOMER][NEUTRAL] OK, yes. Mhm. OK, yeah, yeah, yeah, and I'm I'm looking at at that check here too um online under my claims, but yeah, that, that was.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm, OK, how long will it take to
[AGENT][NEUTRAL] That's the one you've not received?
[CUSTOMER][NEGATIVE] That's the one that was not received, no. Um, and how long will it take to make sure that in the system that it didn't clear and
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, allow at least 24 to 48 hours for us to verify if it has cleared or not and then if it hasn't, then it'll go to uh the processing area and they can reprocess this claim and issue the benefit so you may wanna allow at least 5 to 7 days uh you may receive it by before then, but that's our standard time turnaround time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] 5 to 7 days. OK, perfect. Um.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] That's fine and then I think [PII] had also given me the option of doing like the, the direct deposit, um.
[CUSTOMER][NEGATIVE] Instead of submitting the check, now I'm a little scared since that one, like something happened with that one. I don't know what it was exactly, but um.
[AGENT][NEUTRAL] You're already set up on direct deposit, aren't you?
[CUSTOMER][POSITIVE] I could also do that too.
[CUSTOMER][NEUTRAL] Oh what? I'm sorry?
[AGENT][NEUTRAL] Are you already set up on direct deposit?
[CUSTOMER][NEUTRAL] Um, no, but that's something that I like I could consider to, so to avoid any further issues.
[AGENT][NEUTRAL] It looks like this is already set up on direct deposit we have. What is your checking account information?
[CUSTOMER][NEUTRAL] I, I don't have that with me right now, but um, I could, she sent me the link for um to go ahead and do it.
[CUSTOMER][NEUTRAL] So I could always like do that um online, so it's, you know, it, it's transferred that way instead of um.
[AGENT][NEUTRAL] Yeah, I'm showing that it's already I'm showing that it's already set up.
[CUSTOMER][NEUTRAL] Trying to check again. I don't know, I mean, like the other check.
[CUSTOMER][POSITIVE] Oh, OK, because I started doing it and I wasn't sure like if if I would completed it or not, but OK, perfect, that's fine.
[AGENT][NEUTRAL] OK, can you go ahead and verify your routing and checking just to make sure we have the correct information?
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] I don't have it with me now, but I, I have to go get it. Yeah, my husband has that information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] Um, but I know he was, he was working on it and I was just wasn't sure if um he had finished it or not, so, OK, yeah, so then it.
[AGENT][NEUTRAL] Yeah, it looks like it, it's set up.
[CUSTOMER][POSITIVE] Yeah, awesome. So in, in that case then the check would be, instead of receiving an actual like check, it would go directly.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] To the account.
[AGENT][POSITIVE] Yeah, instead of it being mailed, it'll be direct deposited. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][MIXED] Yeah, perfect, yeah, that was, that was weird because the other one was received just fine, but OK.
[AGENT][NEUTRAL] Yeah, it happens sometimes and so once I, once I get uh information as to whether the check has cleared or not, I'll call you either way if it cleared, I will call you and if it hasn't, I'll call you to give you the status and then let you know what the next step is.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great. Thank you so much.
[AGENT][NEUTRAL] And, and I, you're welcome, [PII], and I can reach you at [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is that a cell?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, I will give you a call back, OK?
[CUSTOMER][POSITIVE] Awesome thank you so much.
[AGENT][NEUTRAL] And let me give you the claim number as well that's associated with the payment that was made and you should be able to see online.
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] I, I think I probably see it here. Online I see it, it's 349-561-1.
[AGENT][NEUTRAL] Right, and so if you look at the explanation of benefits, um, it should show uh the last item is gonna be the charge from anesthesia physician Solutions and then it'll show you the amount that we're paying for that anesthesia charge on there.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, and the other one is for the doc the surgeon that conducted the surgery, yeah.
[AGENT][NEUTRAL] Mhm. Other service, other charges for related to that surgery.
[CUSTOMER][POSITIVE] Mhm mhm. Right. OK. Perfect. Thank you so much for confirming and um I'm looking forward to hearing from you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, you're welcome, [PII], and hopefully I can call you back today as to whether it did or did not clear.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Yeah, I mean like if it didn't clear, I don't know what that would be, but.
[AGENT][NEUTRAL] Yeah, it, it happens for whatever reason it could be the mail system we don't know, but at any rate, any rate, you know, we can uh stop the check if it has not cleared and then get a new one reissued.
[CUSTOMER][NEUTRAL] I'm sorry, if it cleared, yeah, it's, it's, yeah. Right. Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][POSITIVE] Yeah awesome perfect thank you so much.
[AGENT][NEUTRAL] OK. Anything else?
[CUSTOMER][POSITIVE] No, just that. Appreciate your time and your help.
[AGENT][POSITIVE] OK, [PII]. All righty. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, what.
[AGENT][NEUTRAL] Uh.