AccountId: 011433970860
ContactId: 6d7ee1e9-26df-428c-bda2-ca85ef887690
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343709 ms
Total Talk Time (AGENT): 115210 ms
Total Talk Time (CUSTOMER): 188535 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/6d7ee1e9-26df-428c-bda2-ca85ef887690_20250121T20:03_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Hey [PII], it's [PII], heck of a nice guy and APL agent extraordinaire. How are you today?
[AGENT][POSITIVE] Happy [PII]. Long time, [PII], long time.
[CUSTOMER][NEUTRAL] Happy [PII]. Yeah, yeah, I've been staying out of trouble except today feels like a double Monday. I have put out more fires than Smokey the Bear, which goes to show you how old I am.
[AGENT][NEUTRAL] Me too.
[CUSTOMER][NEUTRAL] It sucks to get old. Hey, um, here's my best callback number 954 for what it's worth 560-6000.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so here's the policy number and tell me when you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] It's 258-001-5.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] And that's going to be
[AGENT][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Yeah, hold on just for a second. I just wanna make sure I got the right girl now.
[CUSTOMER][NEUTRAL] Oh, I apologize, uh, it's gonna be 2,580,010.
[CUSTOMER][NEUTRAL] And that's for [PII], which I'll be assisting in and uh just tell me when you're ready for her date of birth.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] So she just emailed me, um, she says that she had uh and uh something that transpired an event, uh, you know, treatment date of [PII] of last year of [PII].
[AGENT][NEUTRAL] And how can I assist?
[CUSTOMER][NEUTRAL] Uh, and, uh, APL denied or or something's going on and, and I'm hoping it's because they just switched their benefits. Lately APL's been applying the new coverage when we when we update them to a new Medlink 9 or update their benefits and they usually go on the um they go on the new card rather than the old card that used to have coverage.
[AGENT][NEUTRAL] She's [PII].
[CUSTOMER][NEUTRAL] All I know is uh, yeah, that's what she's telling me yeah [PII] Monday.
[AGENT][NEUTRAL] [PII], OK. So let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] We received one claim. It was an office visit claim. Oh wait, no, it was a.
[CUSTOMER][NEUTRAL] On
[AGENT][NEUTRAL] Yeah, it was an outpatient office visit claim.
[AGENT][NEGATIVE] And so we paid the $199 but we denied the charge for 302 because that 9 that procedure code 99214 which is related to the physician's charges, isn't covered under the policy.
[CUSTOMER][NEUTRAL] So we paid the 1.
[CUSTOMER][NEUTRAL] Deny the
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK, so you paid $199 even on that one?
[AGENT][NEUTRAL] Yes, that was paid to the provider.
[CUSTOMER][NEUTRAL] OK, hold on.
[AGENT][NEUTRAL] That was her patient responsibility for the procedure code 31575.
[CUSTOMER][NEUTRAL] 31575.
[CUSTOMER][NEUTRAL] OK, and, uh, OK, and she owed the rest because it's just not covered right because.
[AGENT][NEUTRAL] Right, she owes the 302 because that is a part that was the bill for the physician's charges and that's not a covered benefit under.
[CUSTOMER][NEUTRAL] OK, at that time, yeah, because now they have that because the procedure was done in offices that's why.
[AGENT][NEUTRAL] Um, the policy.
[AGENT][NEUTRAL] Right, but yeah, yeah, it was done in office, but they paid.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, it was an office visit and you know with the office visits, the um physician, the co-pay associated with the physician's charges isn't covered.
[CUSTOMER][NEUTRAL] OK, well I thought it was just, uh, only for like you know $35 for PCP and $85. I didn't know they could charge any more than what your normal PCP is.
[CUSTOMER][NEUTRAL] Um, because she has, did she still have the Medli 9 plan back then?
[AGENT][NEUTRAL] Yeah, this is we processed it under the Medin 9.
[CUSTOMER][NEUTRAL] OK, alright, I'll tell her then. Alright, so, um, but the bill was like 500 bucks then?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] The total charge? OK.
[AGENT][NEUTRAL] 34, yeah, about 500, mhm.
[AGENT][NEUTRAL] Well, no, no, yeah, well, wait a minute, let me look at the claim.
[AGENT][NEUTRAL] Instead of let me look at the paper claim that they sent in.
[CUSTOMER][NEUTRAL] Yeah, because every time I call APL or any other company, it's kind of like that old um kids game, the telephone game, you know, where they whisper and 2020 kids later and I just by the time I remember what you told me, I forget when I call her.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I remember that game was called Phone, telephone or something.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, yeah, again, I'm showing my age.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Good times, good times, well, well before TikTok, yeah.
[AGENT][POSITIVE] Yeah, good times.
[AGENT][NEUTRAL] OK, let's see if I can pull up this.
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] OK, so, um, the billed amount for the office visit was $302. Her co-pay for that visit was $100 so that's what we didn't pay because that 99214 is not covered. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Got it now that makes more sense. OK, OK, alright, thanks a lot and uh that went to the provider. OK, I'll tell her thanks ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, OK, anything else?
[CUSTOMER][NEUTRAL] Alright, be good, no, that's it.
[AGENT][POSITIVE] Alright, thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Alright you take care.
[CUSTOMER][POSITIVE] Thanks bye.