AccountId: 011433970860
ContactId: 6c2566ec-3d09-41f1-9da0-616ceab0397a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1132420 ms
Total Talk Time (AGENT): 346405 ms
Total Talk Time (CUSTOMER): 567488 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/6c2566ec-3d09-41f1-9da0-616ceab0397a_20250408T14:30_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hey this is [PII] I'm with Affordable employee benefits.
[AGENT][NEUTRAL] Hey [PII], how are you doing?
[CUSTOMER][NEUTRAL] I'm good. I was gonna check on some claims to make sure you'll have them and that they processed.
[AGENT][POSITIVE] It's a would be a pleasure to assist you. Yeah.
[CUSTOMER][NEUTRAL] Make sure y'all aren't
[CUSTOMER][NEUTRAL] Make sure y'all aren't missing information.
[AGENT][NEUTRAL] All right, uh, I can help you with that, [PII]. What is the callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] It's been a while since I've talked to you. This is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I know I hadn't called in in a while that's what I was just thinking about.
[AGENT][POSITIVE] Everything must be going smoothly. We like, hey, you haven't been, you haven't been affected by any of the storms lately, have you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Well, that's good, yeah.
[CUSTOMER][NEUTRAL] Um, yeah, we had a good many in our town, uh.
[CUSTOMER][NEUTRAL] My house wasn't here thankfully but a few houses a couple miles up the road, um.
[CUSTOMER][NEUTRAL] I don't think their houses are completely gone, but a lot of people have a lot of trees down on top of houses and stuff. Um, [PII], she lives in [PII], which is about 3 miles. I'm on top, but I mean we're so, you know, we have like little communities, I guess, but um, it's about 3.5 miles up the road but there's a house that got hit pretty hard there and then one of my friends that live in [PII], which is like near [PII], um, they have a huge yard and all like they have two vehicles that was completely destroyed.
[AGENT][NEUTRAL] Man
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] And then where the office is up the road I saw um a big oak tree fell on one of their vehicles and destroyed it.
[CUSTOMER][NEUTRAL] And a couple of girls I went to school with like they're a tree, it's mostly trees, but they all feel like on the
[CUSTOMER][NEUTRAL] Um, like on the porch and like tore that part off of it and uh we've had a friend that the roof took off but like I haven't seen.
[AGENT][NEGATIVE] It's been rough.
[CUSTOMER][NEUTRAL] As bad as like near [PII], like I mean it demolished all of that thankfully.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You know none of us is that bad, but it still, still hit our town pretty bad.
[AGENT][NEUTRAL] Yeah, I am so sorry. It has been rough. My um nephew is the park manager at Trey State Park, so he's up in that area too.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, so
[CUSTOMER][NEGATIVE] So it got bad at Trace Park I saw.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I saw a bunch of trees down there, but I hope it's over, but I doubt it because you know it goes the whole month of April.
[AGENT][NEUTRAL] I do too.
[AGENT][POSITIVE] We're gonna keep our fingers crossed cause, you know, I mean, it's kind of been, we've had it rough around [PII] and South, but not as bad as, you know, the Delta and [PII]. So we're gonna keep our fingers crossed that it's just, we just gonna
[CUSTOMER][NEUTRAL] And I didn't even realize, yeah, I didn't even realize like the Delta got weather like that until.
[AGENT][NEUTRAL] I didn't either.
[CUSTOMER][NEUTRAL] Recently
[AGENT][NEUTRAL] I didn't either. You know, the last tornado that came through [PII], my aunt and uncle were.
[AGENT][NEUTRAL] Um, trapped in their bathroom. Their house was basically gone, and they were trapped in there. They've moved to [PII], they're older, you know, so, and their family's here.
[CUSTOMER][NEUTRAL] Oh my.
[CUSTOMER][NEGATIVE] That's terrifying.
[AGENT][NEUTRAL] But they, they, they were trapped in the bathroom and they're like in their [PII], bless their hearts.
[CUSTOMER][NEGATIVE] That is scary.
[AGENT][NEUTRAL] I know. I tell you, I'd much rather have hurricanes, I think, than tornadoes cause you can, you know, tornadoes are just, oops, they're here.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] And they just take everything and make a huge mess out of it.
[AGENT][NEUTRAL] They sure do.
[AGENT][POSITIVE] But I am so thankful you're OK.
[CUSTOMER][NEGATIVE] I'm sorry that your folks is affected. That's scary like that's terrifying.
[AGENT][NEUTRAL] Well, yeah, yeah, I think they have a little PSTD from it, you know, when there's tornado warnings in the area.
[CUSTOMER][NEUTRAL] I'm sure.
[AGENT][NEUTRAL] But they've moved
[CUSTOMER][NEUTRAL] I was, um, in [PII] come through and wiped out half our town and I was a kid then like while I was in school and like it.
[AGENT][NEUTRAL] I here.
[CUSTOMER][NEGATIVE] It terrified me and like now any little thing like.
[CUSTOMER][NEUTRAL] He just
[AGENT][NEUTRAL] Thunder and lightning, you know, wind, strong wind, yeah.
[CUSTOMER][NEUTRAL] Once you get through it, like you're done, like you don't ever wanna do it again, terrifying.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Well, I'm thankful that you're OK. I've thought about y'all and hadn't talked to anybody, so.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Oh, how's that new?
[CUSTOMER][POSITIVE] Yeah, we have been doing good we ain't had to.
[AGENT][POSITIVE] Mm good.
[CUSTOMER][NEUTRAL] Um, OK, so what you need the policy number?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yeah, if you've got that.
[CUSTOMER][NEUTRAL] OK, 023-07669.
[CUSTOMER][NEUTRAL] And her name's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Some of these are look like they're older like she got a a Baptist be honest she's got a bunch of dates on it, but.
[CUSTOMER][NEUTRAL] [PII] it's got 671 here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify her date of birth?
[CUSTOMER][NEUTRAL] Um, that's what I was looking for. Can you give me your address?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We got OK, address is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a listed by dates of service?
[CUSTOMER][NEUTRAL] I do, um, the first I'm gonna start down here because I said that this one has processed, um, this one was.
[CUSTOMER][NEUTRAL] 2625.
[AGENT][NEUTRAL] What
[CUSTOMER][NEUTRAL] From Baptist it was 2350 was the charges.
[AGENT][NEUTRAL] Just making sure I get the right claim pulled up. You said 2000?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's a turtle.
[CUSTOMER][NEUTRAL] That's what it shows and then it after primary it left $246.04.
[AGENT][NEUTRAL] So I have one from Baptist Memorial Hospital GT.
[AGENT][NEUTRAL] For 2625, but the total charges were not 2000.
[CUSTOMER][NEUTRAL] I wonder because this is a bill I'm looking at and pull the air base from the primary.
[CUSTOMER][NEUTRAL] Um, does it like the insurance had left that 24604?
[AGENT][NEUTRAL] Let me get the claim docs pulled up.
[AGENT][NEUTRAL] Let's see what this is for.
[CUSTOMER][NEUTRAL] You might not have it yet. It says 20,350.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This one's 1830.
[CUSTOMER][NEUTRAL] 18,000.
[AGENT][NEUTRAL] 0 $1830.
[CUSTOMER][NEUTRAL] Oh OK um.
[CUSTOMER][NEUTRAL] Is it for the same date? 26?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] I wonder if there's a separate one let's see.
[CUSTOMER][NEUTRAL] What's the difference in that? I see you said 1826.
[AGENT][NEUTRAL] 1830
[CUSTOMER][NEUTRAL] 23
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 30 I'm telling you 1830 2 350. The difference is 520.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] The same thing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Around that day?
[CUSTOMER][NEUTRAL] Well I don't know what did that one process?
[AGENT][NEUTRAL] It did and we paid Baptist Memorial.
[CUSTOMER][NEUTRAL] So this one just says BMH golden triangle.
[AGENT][NEUTRAL] Well, that would make
[CUSTOMER][NEUTRAL] Is that what you said you said the GT?
[AGENT][NEUTRAL] This is Baptism Memorial Hospital GT.
[CUSTOMER][NEUTRAL] I wonder if the totals on the bills is like a range like a charge instead of the.
[CUSTOMER][NEUTRAL] Because I didn't pull the primary database which I probably should have.
[CUSTOMER][NEUTRAL] Started with I'm just gonna write this down and then go from there, OK, so 2625 data service.
[AGENT][NEUTRAL] Well, you know what? Well, no, no, I don't mm mm.
[CUSTOMER][NEUTRAL] APO has 1830.
[CUSTOMER][NEUTRAL] Bill says 2350. Well, um, did y'all pay on that one?
[AGENT][NEUTRAL] We did.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Did you leave a $50 copay?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] We paid 365 which.
[AGENT][NEUTRAL] Part of that went to the deductible.
[AGENT][NEUTRAL] To the policy deductible, so we were able to pay $3.65.
[AGENT][NEUTRAL] With the other $100 toward her deductible.
[CUSTOMER][NEUTRAL] 100 even.
[AGENT][NEUTRAL] Yeah, for the deductible.
[CUSTOMER][NEUTRAL] $100.
[AGENT][NEUTRAL] Mhm. And we paid 365.
[CUSTOMER][NEUTRAL] Alright, so that's all you said pay portion is 100.
[AGENT][NEUTRAL] So they had Blue Cross processed it and it was uh.
[AGENT][NEUTRAL] 103 65 was patient responsibility.
[AGENT][NEUTRAL] We paid 365 and applied the $100 to the deductible.
[CUSTOMER][NEUTRAL] OK, right here, OK.
[CUSTOMER][NEUTRAL] Alright, that is this one right here.
[CUSTOMER][NEUTRAL] 10365.
[CUSTOMER][NEUTRAL] So I got 15365 but.
[CUSTOMER][NEUTRAL] Y'all paid APL paid so they must have just the charges as like I don't know if that is if y'all received 1830 I'll make a note APL paid $3.65 and then $100 applied to.
[AGENT][NEUTRAL] Deductible.
[CUSTOMER][NEUTRAL] APL deductible, but you said you got 10365.
[AGENT][NEUTRAL] Right, and that's what Blue Cross supplied.
[CUSTOMER][NEUTRAL] They got insurance balance is 153.
[CUSTOMER][NEUTRAL] I'll have to pull that ELA and check it where the other feed to come from.
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] Hang on just a second.
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] And maybe was there another 150 maybe it applied to co-pay?
[AGENT][NEUTRAL] You have 153?
[CUSTOMER][NEUTRAL] Yeah, they, they're saying 153 65 was after Blue Cross. That's what [PII] says.
[AGENT][NEUTRAL] Because we.
[CUSTOMER][NEUTRAL] They had 10365 deductible and then 50.
[CUSTOMER][NEUTRAL] Was copay, but they decided that they have APL, so I don't, I didn't know if 50 was y'all's copay.
[AGENT][NEUTRAL] No, because we have um for that data service an office visit.
[AGENT][NEUTRAL] Billed for 153.
[CUSTOMER][NEUTRAL] I wonder if they combined them.
[CUSTOMER][NEUTRAL] 65.
[AGENT][NEUTRAL] Just 153, 153 total for the office visit.
[CUSTOMER][NEUTRAL] I wonder if they combined them.
[AGENT][NEUTRAL] But that's the cancer center.
[CUSTOMER][NEUTRAL] I'm gonna pull that in and and check it and make sure because that 365 matches in the 103 just the 50 part don't but I'll um.
[CUSTOMER][NEUTRAL] I'll pull that EIB and tickets so we go to it'd be fine and then just let me mark out the notes because that only makes sense. OK. The next one is showing was that on [PII] you showed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It was. Mhm.
[CUSTOMER][NEUTRAL] OK, that's what this one is.
[CUSTOMER][NEUTRAL] So this must get together.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, OK, this one is 12 5 24.
[AGENT][NEUTRAL] You have that. Is that the Baptist Cancer Center?
[CUSTOMER][NEUTRAL] Um, it, it's, it's also a golden triangle, but I mean they might have a cancer center in it, but the bill just has the.
[AGENT][NEUTRAL] What's the bill amount?
[CUSTOMER][NEUTRAL] Golden Triangle.
[CUSTOMER][NEUTRAL] It's got 2350 as well.
[AGENT][NEUTRAL] Does she go for treatment when she goes to, for a visit?
[CUSTOMER][NEUTRAL] See, I don't know what she's being treated for.
[AGENT][NEUTRAL] Because I've got the office visit claim for that data service, but I don't have a facility claim and on that other one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, it left $50 so that's why I'm wondering if that was your copay.
[AGENT][NEUTRAL] That other data service?
[AGENT][NEUTRAL] See, we don't, we don't determine, we pay toward the copay or deductible, but this one is not for that billed amount that you're saying.
[CUSTOMER][NEGATIVE] I'm wondering if they're not combining it and that's all I see because it just says payments $2300 and then it left uh $50 copay.
[AGENT][NEUTRAL] I have a claim for 153.
[CUSTOMER][NEUTRAL] On the 125.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And that's all you got? You don't have this big one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I wonder if it's uh not in a pool.
[CUSTOMER][NEUTRAL] 53 APL received.
[CUSTOMER][NEUTRAL] And did y'all pay on that one?
[AGENT][NEUTRAL] No, it's not covered as an office visit.
[CUSTOMER][NEGATIVE] And non covered too.
[CUSTOMER][NEUTRAL] The Cross Blue Shield left question mark thing if it's I think that's probably the 50.
[CUSTOMER][NEUTRAL] And then y'all didn't cover because no office visit and then same thing on 26.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 153 APL.
[CUSTOMER][NEUTRAL] Proceed and and see Blue Cross left.
[CUSTOMER][NEUTRAL] If it was 50 then that's gonna be where that other 50 came from that she was being billed, OK.
[CUSTOMER][NEUTRAL] So there's that one.
[CUSTOMER][NEGATIVE] And then this one is probably still not gonna match up. It is 1017 24.
[CUSTOMER][NEUTRAL] 1017 24.
[AGENT][NEGATIVE] What's that bad amount?
[CUSTOMER][NEUTRAL] 15
[CUSTOMER][NEUTRAL] Um, it's got on here 1,878.
[AGENT][NEGATIVE] Oh my gosh. No, it doesn't match.
[CUSTOMER][NEUTRAL] Is it a copay too or uh is it?
[AGENT][NEUTRAL] It's for a visit, yeah.
[CUSTOMER][NEUTRAL] Is it 153?
[AGENT][NEUTRAL] It is, but no, it's 3:56.
[CUSTOMER][NEUTRAL] This is [PII]
[AGENT][NEUTRAL] What in the world?
[CUSTOMER][NEGATIVE] I don't know. I was hoping I wouldn't have to go through Blue Cross and get all that first, and then I could just figure this out, but I don't like I'm gonna have to.
[CUSTOMER][NEUTRAL] Blue Cross Blue Shield line.
[AGENT][NEUTRAL] Sorry
[CUSTOMER][NEGATIVE] This is dumb, which I don't like how they do their billing either because if she had multiple stuff they probably have because all it says is balance forward it like it's not a.
[AGENT][NEUTRAL] I'm trying.
[CUSTOMER][NEUTRAL] Itemized on these older ones.
[CUSTOMER][NEUTRAL] OK, this one looks like it's an actual facility.
[AGENT][NEUTRAL] OK, what's that?
[CUSTOMER][NEUTRAL] This one is data service 126 24.
[CUSTOMER][NEUTRAL] But it says APO didn't pay because they maxed.
[AGENT][NEUTRAL] What was that total bill amount? Fingers crossed.
[CUSTOMER][NEUTRAL] Alright, this one says 29,30846.
[AGENT][NEUTRAL] Yes. Hallelujah. We can't one the matches, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's great
[AGENT][NEUTRAL] Finally.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that one, we did process we were able to pay 325 22, which maxed out the benefit for the year.
[CUSTOMER][NEUTRAL] Um, what's the benefit?
[CUSTOMER][NEUTRAL] Does it show you that?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 2800.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, they
[CUSTOMER][NEUTRAL] You know that's
[CUSTOMER][NEUTRAL] Right, thanks that's low compared to what their Blue Cross is, OK, um, alright, and one more and then.
[CUSTOMER][NEGATIVE] Let me get this one is back in well she ain't even built this so I don't know why.
[CUSTOMER][NEUTRAL] This is even this is 1027 23.
[CUSTOMER][NEUTRAL] We can see if you see it.
[AGENT][NEUTRAL] What is that bill amount?
[CUSTOMER][NEUTRAL] It's got 25,000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 80356.
[AGENT][POSITIVE] Another one matches, yay. OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Now that one we were not able to provide benefits because the outpatient benefit has already been met.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alright, alrighty next.
[CUSTOMER][NEGATIVE] Nothing for yeah.
[CUSTOMER][NEUTRAL] APL max this time.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK alright well let me.
[CUSTOMER][NEUTRAL] Do some checking on these others because I don't know.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Those are crazy.
[CUSTOMER][NEUTRAL] I just, I don't know.
[AGENT][POSITIVE] I, I'm like you. I'm like how in the world, uh.
[CUSTOMER][NEGATIVE] No, they're confused a little bit.
[CUSTOMER][NEUTRAL] So I'll see if I can pull the base and then try to figure it out backwards and then.
[CUSTOMER][NEGATIVE] Because I asked [PII] first and all they wrote back was APL left $50 on them three accounts which obviously you didn't because y'all don't cover offices and then it says.
[AGENT][NEUTRAL] Well, and see, and we don't determine what patient responsibility is, so I'm wondering if they're thinking it's Blue Cross.
[CUSTOMER][NEGATIVE] And they told me that [PII] that you said that was Mac they said that it's still in processing Blue Cross which don't seem right because that was 2 years ago.
[AGENT][NEUTRAL] And, and if we leave $50 I mean, if they say we left $50 to patient responsibility.
[CUSTOMER][NEUTRAL] Anyway
[CUSTOMER][NEUTRAL] That's what [PII] said, yeah.
[CUSTOMER][NEUTRAL] I mean,
[AGENT][POSITIVE] Good [PII].
[CUSTOMER][POSITIVE] I don't know. I'm gonna, I'm gonna, I'm gonna figure it out and I'll let her know. I'm gonna try my best, um, but thank you for your help.
[AGENT][NEUTRAL] I bet you do.
[AGENT][POSITIVE] It's been a pleasure to talk to you again, [PII]. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] That's all I got stay safe if y'all get stormed.
[AGENT][POSITIVE] Yeah, you too. Thanks for calling APL and I take care and have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Alright bye.
[CUSTOMER][NEUTRAL] You too bye.