AccountId: 011433970860
ContactId: 795d63ab-4170-4948-95bb-012afda76088
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 758140 ms
Total Talk Time (AGENT): 319731 ms
Total Talk Time (CUSTOMER): 487086 ms
Interruptions: 13
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/795d63ab-4170-4948-95bb-012afda76088_20250519T16:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I just received a claim regarding American Public Life Insurance Company from [PII], and I have no idea what this is all about. Uh, it's called Provider Services South Florida ENT Association.
[CUSTOMER][NEUTRAL] And then the service description it says streaming physician office 31579, and I don't know who the physician is and I don't know what this is all about. Can you please help me out?
[AGENT][POSITIVE] Yes, Ms. [PII], I can help you.
[CUSTOMER][NEUTRAL] And it's a charge for $500 yes.
[AGENT][NEUTRAL] OK, I can help you, um, Ms. [PII] with your claim. What is your callback number, ma'am? Just in case our call gets disconnected.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, well, you, you, you, you can call [PII] and ask for my name and they transfer me uh from that number, that's the main number here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And then what is your policy number with American Public Life?
[CUSTOMER][NEUTRAL] Listen, I have like I said, we have this. I look and we have like uh it seems like uh we have this back, um, you know, and, uh.
[CUSTOMER][NEGATIVE] But from what I see, we have this policy back, uh, a few years back from 22 to 23, and it's a guy with a gap insurance from what I look into the internet and uh I really don't remember any bills that was sent to me at all. I don't know why they're sending me this bill now and what what is it for? It says streaming.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I really need that you uh look in there and and clarify for me what is this is all about because I don't know.
[AGENT][NEUTRAL] Right, OK. And do you see a policy number?
[CUSTOMER][NEUTRAL] Policy number, let me see. Yes, I have a policy that is 602016-258.
[AGENT][NEUTRAL] OK. All right. Let me look up.
[CUSTOMER][NEUTRAL] And there is a reference number also.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you need that?
[AGENT][NEUTRAL] Can you give that to me, please?
[CUSTOMER][NEUTRAL] It's 02
[CUSTOMER][NEUTRAL] Oh, OK. What do you mean?
[AGENT][NEUTRAL] You said reference number?
[CUSTOMER][NEUTRAL] Yeah, reference number is 02.
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] 16258
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the, the amount, the amount is $500.
[AGENT][NEUTRAL] OK. All right. Thank you, Ms. [PII]. Uh, and just for security reasons, I will need to verify your policy that you used to have with us, which is the policy number that you gave me, uh, the 02016258. Um, it was through Alaatha Community Action. It was the employer at the time.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Correct, that's, that's what I work, that's what I work for.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh, and can I please get your date of birth and your um address, phone number and email? Yes.
[CUSTOMER][NEUTRAL] Yeah, my dad, they.
[CUSTOMER][NEUTRAL] Well, uh, I'll, I'll give you my date of birth, which is [PII], and from there, uh my email here is uh [PII].
[AGENT][POSITIVE] Thank you, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then um what is your address and phone number that's on the policy, please?
[CUSTOMER][NEUTRAL] Well, this, this was sent this was sent to, yeah, my address, uh, my address is [PII], OK?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. Thank you. And then your phone number that's on the policy, please?
[CUSTOMER][NEUTRAL] Uh, phone number is just the one that I gave you. It's [PII]. That has to do with a part of Community Action Inc.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. I do show a different phone number.
[CUSTOMER][NEUTRAL] Yeah, well you may have probably my home phone number which I, you know, I don't.
[CUSTOMER][NEUTRAL] Really even use that anymore so don't.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, just anything you call me at this number and then we ran you call that's the main number and they transfer that to my office, OK?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right. Yes, ma'am. Thank you. OK. So, um,
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Do you see, you said you saw the claim number was 31579, is that correct?
[AGENT][NEUTRAL] Or do you see a claim number on that document that you received?
[CUSTOMER][NEUTRAL] OK, OK, there is a claim, no, there is a claim number here that is 3600.
[CUSTOMER][NEUTRAL] 781.
[AGENT][NEUTRAL] OK, alright, I do see this.
[CUSTOMER][NEUTRAL] And then and then it says something like date check date which I don't know what they're referring to, but check date I, you know, it's uh [PII], which I haven't received any checks so I don't know what they mean by check date.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get, let me get the claim pulled up real quick.
[AGENT][NEUTRAL] OK, so it does say that was for um South Florida ENT Associates and it was a uh
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Date of service, the date that you would have gone was uh [PII].
[CUSTOMER][POSITIVE] Correct, that's what it says.
[AGENT][NEUTRAL] Yes, and that the claim was denied because it was a non-covered service.
[CUSTOMER][NEUTRAL] Deny
[AGENT][NEGATIVE] Yeah, it was denied, um.
[CUSTOMER][NEUTRAL] OK, no non-cover service. I don't even know what the the treatment was all about. I, I mean cows. I mean, I don't know what it, what is this.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, uh, what I'm surprised is after, after, uh, uh, can I ask you a question? After all these years, why they did not notify me before and, uh, and I get this thing now. I mean, I, I have no idea why. I, I am so surprised, you know, I don't, I don't know.
[AGENT][NEUTRAL] And it was
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right, um,
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So what and there's two things I need to explain to you. The first one is, is this claim that they sent in the provider's office sent the claim to us for payment for services that were rendered on that day.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] We came back and told them that they need to send us the explanation of benefits from your primary insurance carrier for us to be able to look at the claim because I don't know if you remember, this was your secondary insurance and it was billed after your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] So they didn't send the explanation of benefits to us and we requested that um that any time that we send anything to the providers we also send to the insured so that they're in the loop and they know what's going on.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] never, I never, I never received such a notice because if I had then I will call you and see what was going on. I have no idea, but I, I, that's what it surprised me so much, you know, and another thing, what is this check date? Do you, that's when, because you claim.
[AGENT][NEUTRAL] Right, but
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The primary insurance if they did that it shows in your in your files there that you guys receive any kind of payment from the primary insurance?
[AGENT][NEUTRAL] No, no, ma'am, because the primary insurance, we haven't even got the explanation of benefits from the primary insurance. Um, now,
[CUSTOMER][NEGATIVE] And why didn't you insist or why didn't you told me? I mean, I, I, I don't even, I don't I have to go back to see what insurance I have at that time. I don't even remember, you know, I have to go back and and look in the files here with the administration and see what kind of primary insurance we had at that time because I really, you know.
[AGENT][NEGATIVE] That's what the letter is about. No, it's not for you.
[AGENT][NEUTRAL] But it's not
[AGENT][NEUTRAL] Right, but that
[AGENT][NEUTRAL] Yes, but that letter was not meant for you to send the explanation of benefits that letter was meant for the provider to send us the exclamation of benefits to us, not for you, but for the provider because the provider is the one that filed the claim, right, right, so.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEGATIVE] Oh, I see. That's why I never received it.
[CUSTOMER][NEGATIVE] I don't understand.
[AGENT][NEUTRAL] This is information for the providers so that they know what they need to send in to complete the claim.
[AGENT][NEUTRAL] And the letter that you got is to let you know that they have sent that.
[CUSTOMER][NEUTRAL] So let me ask you, let me ask you something, OK, let, yeah, yeah, I understand, but what I, what I'm asking is, um, when this happened, I mean, why do you guys waited so much to do this again when what does, uh, back in [PII].
[AGENT][NEUTRAL] We didn't do it. We didn't wait, we didn't wait the provider did. We didn't wait to do this the providers sent it to us.
[CUSTOMER][NEUTRAL] I mean, I don't understand. I really
[CUSTOMER][NEUTRAL] Huh?
[CUSTOMER][NEUTRAL] The provider did and you.
[CUSTOMER][NEUTRAL] I see. Uh, let me ask you something. Can you tell me what that South Florida and and uh ENT Association is located? Do you have that in your files?
[AGENT][NEUTRAL] And yes.
[AGENT][NEUTRAL] I do not. You'll have to Google that. Yeah, yeah, they sent.
[CUSTOMER][NEUTRAL] Or I have to look into it and see.
[CUSTOMER][NEUTRAL] Yeah, I have to Google that.
[AGENT][NEUTRAL] They sent us the claim on.
[CUSTOMER][NEUTRAL] Come in.
[AGENT][NEUTRAL] They sent us the claim on [PII] and we processed it on [PII], the very next day, so they're the ones that waited to send it in until May, yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You mean [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Or, 0, [PII] my goodness, that.
[AGENT][NEUTRAL] They just sent it in.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] This is incredible. Never, never, never saw something like this before. OK, uh, so, um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so, uh, and, and you say your name again is? I'm sorry?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sorry, OK, [PII], let me write it down so I know who I spoke to.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you may be able to contact the provider and ask them why they waited until [PII] to send in the claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][MIXED] This is so funny. I mean, it's, it's not funny, but, uh, you know, if I have a business and something like this happened to me, I don't wait 23 years to to claim again or something, you know. And do you know what that means, the check date, check date? Like it's a check being involved?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Now, and sometimes.
[AGENT][NEUTRAL] Now, that's
[AGENT][NEUTRAL] The check date is not us because we haven't done a check.
[CUSTOMER][NEUTRAL] You don't know. OK.
[CUSTOMER][NEUTRAL] No, it's not all. They probably got a check from the primary insurance. I don't know. They probably did. I, they, I'm sure they did. And, and then what happened is that the, the, you know, they did not pay the, the, they, they didn't get paid for the second one or whatever, you know.
[AGENT][NEUTRAL] And some
[AGENT][NEUTRAL] Maybe so, yeah.
[AGENT][NEUTRAL] And just uh
[CUSTOMER][NEGATIVE] But did they or they they did not build, they did not bill and now they realize that they haven't built. God knows what happened, and now they bill now.
[AGENT][NEUTRAL] Oh yeah, they probably did they probably did an audit and found that they didn't bill for this one and had to go back and do it, yes, that happens.
[CUSTOMER][POSITIVE] Hey, oh goodness, I don't, I don't wanna know what's gonna happen in the companies that are working like that. OK, alright, I appreciate what you're telling me and all I can do is start searching.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][MIXED] And trying to get these people a hold of these people and see why is it that I'm getting a bill now and why are they billing you guys and, you know, it's incredible. But I, I really appreciate your help, OK?
[AGENT][POSITIVE] OK. Well, you're very welcome, Miss [PII].
[CUSTOMER][NEUTRAL] Uh, and your clarification and
[CUSTOMER][POSITIVE] OK, have a have a nice day. Thank you very much for your help.
[AGENT][POSITIVE] You too. You have a blessed week and thanks for calling APL. Bye-bye, Ms. [PII].
[CUSTOMER][NEUTRAL] OK, and you, you, you too, of course, bye bye.
[AGENT][NEUTRAL] Mm. Bye-bye.