AccountId: 011433970860
ContactId: 6d1ce96e-f219-4364-ba87-617a9e66a7ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 711690 ms
Total Talk Time (AGENT): 245307 ms
Total Talk Time (CUSTOMER): 132146 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/6d1ce96e-f219-4364-ba87-617a9e66a7ec_20250519T19:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, I have some questions about a claim I had, um.
[CUSTOMER][NEUTRAL] In March.
[AGENT][NEUTRAL] Sure, I can help you with that. Um, can I get a good name or can I get your name and a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, it shows.
[CUSTOMER][NEUTRAL] Uh, yes, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the phone number is [PII].
[AGENT][NEUTRAL] OK. And what's your policy number?
[CUSTOMER][NEUTRAL] 02457138
[AGENT][NEUTRAL] Let me go ahead and pull that up and we'll see.
[AGENT][POSITIVE] I didn't mean to cut you off. I'm so sorry.
[CUSTOMER][NEUTRAL] No that's fine.
[AGENT][NEUTRAL] Can I get you to verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your mailing address and phone number?
[CUSTOMER][NEUTRAL] Uh, the [PII], and then, um.
[CUSTOMER][NEUTRAL] My phone number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the issue with the claim?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I was told that Gap Insurance would pay the majority of what's left, but it shows that I only paid $40 where I was stuck with the bill, uh, two different bills from uh physical therapy, and I was paying over $400.
[AGENT][NEUTRAL] OK. Let me look at that.
[CUSTOMER][NEUTRAL] I was wanting to question that.
[AGENT][NEUTRAL] Let me look at your policy.
[AGENT][NEUTRAL] Give me just a moment while I look that up. You said it was for physical therapy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, it looks like physical therapy would have been.
[AGENT][NEUTRAL] Under your outpatient.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me pull up the claim.
[AGENT][NEUTRAL] Give me just a moment while I, I try to look at, look at this for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have the date of service?
[CUSTOMER][NEUTRAL] Uh, I think it was [PII].
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEGATIVE] Think I'm not positive.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you know who the provider was?
[CUSTOMER][NEUTRAL] Provider, uh.
[AGENT][NEUTRAL] So like the the hospital name?
[CUSTOMER][NEUTRAL] Oh, it was with uh
[CUSTOMER][NEUTRAL] Aid integral therapy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I have one for InMed Health, but it's not showing that was the date.
[AGENT][NEUTRAL] Um, I'm showing the date, did you go?
[AGENT][NEUTRAL] On the [PII]?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It might have started in January, I think it might have, yeah.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] And then ended in March.
[AGENT][NEUTRAL] And let me see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] It might have been
[AGENT][NEUTRAL] Give me a second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull up that specific claim and see what happened.
[AGENT][NEUTRAL] You said it only paid $40 correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull it up and see why that's all it paid.
[CUSTOMER][NEUTRAL] Because I've, I went for like maybe, maybe 2, 2.5 months.
[CUSTOMER][NEUTRAL] Before they okayed it and said I didn't have to come back.
[AGENT][NEUTRAL] OK, yeah, because I'm showing only a data service from for one day, um.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Yeah, cause I'm not showing, I'm only showing for that one day.
[CUSTOMER][NEUTRAL] And do I need to file something with y'all again?
[AGENT][NEUTRAL] Uh, you might need to, let me go ahead and double check. Yeah, um, let me go ahead and double check and make sure we got everything.
[AGENT][NEUTRAL] Because they would have sent in the claim, it looks like.
[AGENT][NEUTRAL] Do you know who your major medical is?
[CUSTOMER][NEUTRAL] I was told that
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] I can look it up for him.
[CUSTOMER][NEUTRAL] Major medical I don't know what that means.
[AGENT][NEUTRAL] So the policy you gave me is a Medlink policy, which means it's a secondary gap policy, meaning that it has to, yeah, yeah, your main insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, my main insurance.
[CUSTOMER][NEUTRAL] Right yeah
[CUSTOMER][NEUTRAL] OK, yeah, give me one second.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It's with Cigna.
[AGENT][NEUTRAL] OK, give me just a second.
[AGENT][NEUTRAL] Because I'm only showing.
[AGENT][NEGATIVE] Them as having given it to us without showing that Cigna paid anything.
[AGENT][NEUTRAL] So let me double check and make sure I see everything.
[CUSTOMER][NEUTRAL] I was told somehow Emmett had somehow deleted my gap insurance off my account with them. I'm not sure that's how it happened.
[AGENT][NEGATIVE] Yeah, cause I'm not even showing that they sent in your Cigna, because what it is is your gap insurance pays after your major medical.
[CUSTOMER][NEUTRAL] That's why
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm not showing that they.
[AGENT][NEUTRAL] Since that
[CUSTOMER][NEUTRAL] Would I need to contact that doctor's office and uh refile with them?
[AGENT][NEUTRAL] Let me see. Well, let me go ahead and double check um.
[AGENT][NEUTRAL] Yeah, I would call them and make sure that they submitted your major medical or that Cigna, um, because I'm not seeing it on my end, um.
[AGENT][NEUTRAL] Where did it go? Here we go.
[AGENT][NEUTRAL] And because I'm looking at your explanation of benefits that they sent over or that we sent.
[AGENT][NEUTRAL] They have it as a facility fee.
[AGENT][NEUTRAL] Um, and it is showing that they only build for the one day.
[AGENT][NEUTRAL] So you went multiple times?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, they, they only billed for one day, yeah.
[CUSTOMER][NEUTRAL] And went for about 2 months.
[AGENT][NEUTRAL] I would, I would get with the provider.
[AGENT][NEUTRAL] That you saw because as I'm looking, I show that they only sent in a claim for uh [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so go with them and if you end up needing to file an appeals, um, you will need to wait 180 days um prior to the receipt.
[AGENT][NEUTRAL] Um, but I would go ahead and see if they can resubmit the claim, uh, since they did submit it first, see if they will submit it, uh, for the full time that you were there, um, because it looks like you do have a benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but if we're not seeing that Cigna paid part of it, Cigna would have to pay first, and then this insurance pays afterwards.
[AGENT][NEUTRAL] Towards, towards co-pay, co-deductible, and co-insurance. So it would need your major medical to pay first.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and I
[CUSTOMER][NEUTRAL] OK, and I call that doctor's office and have them reapply? I mean you refile it?
[AGENT][POSITIVE] Yes, I would
[AGENT][NEUTRAL] Right, they should be able to resubmit it uh themselves, if you want to go that route because they only, we show that they only submit it for one day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if you still need further assistance, go ahead and give us a call back, um, and then we can go through uh what your next steps could be if they're not gonna refile it or if they need more from you, if the medical provider needs more from you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] All right, well, thank you for calling APL and I hope you have a great day.