AccountId: 011433970860
ContactId: 79e568b7-6d97-4de4-93dc-475f17fa7769
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 716559 ms
Total Talk Time (AGENT): 352817 ms
Total Talk Time (CUSTOMER): 319147 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/79e568b7-6d97-4de4-93dc-475f17fa7769_20250122T21:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is Lindon customer services. How are you?
[AGENT][POSITIVE] I'm doing well. I'm good thank you. How are you?
[CUSTOMER][NEUTRAL] I'm good. I have, uh, [PII] on the phone and she's received a letter about a claim, and she's wanting to see what that claim was about.
[AGENT][NEUTRAL] Certainly, do you have her policy number?
[CUSTOMER][NEUTRAL] Uh-huh, it's 254-540-2.
[CUSTOMER][NEUTRAL] And I verified all her information.
[AGENT][NEUTRAL] OK, and is that her callback number the [PII]?
[CUSTOMER][NEUTRAL] [PII], yeah, 5.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] All right, great, thank you [PII].
[CUSTOMER][NEUTRAL] OK, thank you, and here she is.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hello. Hi, [PII]. My name's [PII]. I'm in the claims department. [PII] transferred you over. You have some questions in regards to a claim?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] I, I did receive a letter saying that you guys have received our policy and you, I don't know.
[CUSTOMER][NEUTRAL] Review it, and if you have any additional questions you will contact me. I'm trying to figure out what claim are we talking about because I haven't used the insurance some time in November, I think, I don't remember if I use in December, but.
[CUSTOMER][NEUTRAL] Um, we are almost at the at the end of January. I mean, what's the reason of this claim?
[AGENT][NEUTRAL] Let me take a look and see.
[AGENT][NEUTRAL] So it looks like it was uh a duplicate. Are you speaking of the last claims that were pro um do you have a claim number? Did you get, you got the explanation of benefits from us?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, because I do see there were some claims that were recently processed on [PII], and they look like they were submitted from the provider's office, but they were for services that were for October.
[AGENT][NEGATIVE] And it looks like we denied them as duplicate because we had received them uh previously.
[CUSTOMER][NEUTRAL] OK, so are you saying that the doctor's office make a mistake?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And that's what you said.
[AGENT][NEUTRAL] I don't know that they made a mistake they just maybe they're trying to so um it looks like, like I said that they submitted these claims um previously and so they resubmitted them again um and they're looking for um payment for the services, however, it doesn't uh let me see.
[AGENT][NEUTRAL] It appears that we did receive them uh last year as well so that when we received them this year they were duplicate claims so it was a duplicate claim that we had received before.
[AGENT][NEUTRAL] So we process them as duplicate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, so when you received them the first time, did, did you pay them? Did they get paid?
[AGENT][NEUTRAL] Um, I do see that some of the services got paid, um, yeah, I do see that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I would have to look at them by date. Now the the let me take a look here at what was paid.
[AGENT][NEUTRAL] Would you like me to go through those dates of service with you?
[CUSTOMER][NEUTRAL] Yeah, please, I mean, I, I'm trying to figure out what's going on here because I, I know.
[CUSTOMER][NEGATIVE] I, I do have a, a bill that I received from I know but that it's kinda, it's driving me crazy right now that I have to go.
[CUSTOMER][POSITIVE] Get the financial assistance right now to pay that, because we're talking about a lot, a lot of money.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] And the E and Enova is at the laboratory?
[AGENT][NEUTRAL] Or is that the doctor's office or both?
[CUSTOMER][NEUTRAL] It should be, yeah.
[CUSTOMER][NEUTRAL] Both, yeah, both.
[AGENT][NEUTRAL] OK, because it does look like we paid some of those claims that were eligible, say for the physician visits, um, there were some of those claims that were uh eligible for the physician visit. However, this policy doesn't cover the laboratory fees, the um laboratory fees didn't, did not get paid for those dates of service. They look like they were in October.
[AGENT][NEUTRAL] Um, and this is when all this, uh,
[AGENT][NEUTRAL] Most of the billing from the [PII] is from October, it looks like.
[CUSTOMER][NEUTRAL] Yeah, I know.
[AGENT][NEUTRAL] Is that the is that the one you're receiving the bill from?
[CUSTOMER][NEUTRAL] Yeah, yeah, cause, um, yeah. I mean, I already went to talk to I know, I went to the office, we had to sit down and talk, I talked to them for a long time because I was trying to figure out what I was gonna do. I, I did explain to them, I said, listen, the insurance that I had, it was, it was the ability, it was very limited. It did not take everything.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It's, uh, this is, this is not like a full coverage, this is kind of like a partial, you know, I had to explain that to them with those words and tell them what was going on, you know. So like I said, that's what they suggest me to apply for financial assistance to see if financial assistance might be able to help me with that, you know. So I did, I did apply because I said, OK, then yeah, we need to take care of this ASAP because I don't wanna be, I, I don't wanna go crazy.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And, you know, and also, and also I don't have a job. I'm trying to find a job, so it's been a little bit like, I'm going in circles right now. I'm going, I'm going crazy right now. I don't know what to do. So it's, it's not your, it's, I know, it's not, it's not your guys' fault, you know, and, and, and, you know, it's, it's just, it's just that, unfortunately because of my
[AGENT][NEUTRAL] OK. Well, I'm sorry to, yeah.
[CUSTOMER][NEUTRAL] My illness, I do need insurance at all times. I cannot be without insurance, you know, so, uh, it's, uh, and, and, you know, I'm just hoping that this financial assistance work because, because if it does, you know, I might not be able to pay, not even a penny. If it does, I'm gonna be like, OK, so I can concentrate on finding a job. So that's not my main concern, you know, I need to find something, it's been really tough, you know.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Uh, it's been really hard last this past year has been crazy. I've been going for one job working.
[CUSTOMER][NEGATIVE] Uh, you know, like uh 3 months here, 3 months there, you know, it's not, it's not a steady. I need something more permanent, so.
[AGENT][NEUTRAL] Yeah, I understand.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I'm, I'm sorry to hear that you're having a, um, a difficult time, but definitely, um, apply for their, um, you know, their assistance program if you are, you know, um, you have, you know, limited income and this policy that you had was limited, uh, benefits.
[AGENT][NEUTRAL] So it is not considered a major medical, so they should be able to take that into consideration as well because it's not a major medical coverage. It is limited indemnity. Um, so if that is any way helpful, you know, when you include that with your information to them, just let them know it wasn't, uh, major medical coverage, um, but you were limited to what the uh plan allows.
[AGENT][POSITIVE] So I mean hopefully that like I said that information could help as well.
[CUSTOMER][POSITIVE] Yeah, yeah, you know, I mean, they did, like I said, they did understood, I mean, I mean, what you just said that they did, I mean, I do understand that, but, you know, I, I, I, I'm hopefully they understand too as well, but thank you for anyway for your kind words. I know you're trying to calm me down.
[AGENT][NEUTRAL] Yeah, well, I know it can be stressful. I understand your situation, um, been there myself, so I understand, you know, yeah, and, and I mean, I know it's, it's, it's tough when you're trying to deal with multiple things as well, you know, that you've got, um, you know, this, like I said, this kind of stress doesn't help when you're um trying to juggle other, you know, situations and so I understand.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, you've been there? Uh-huh.
[AGENT][POSITIVE] Most definitely, um, but like I said hopefully that information can help with your, uh, you know, the assistance that they're gonna, um, offer to you and if you know, hopefully that works out.
[CUSTOMER][POSITIVE] Yeah, thank you, yeah, me too. I hopefully it does. I mean, they uh, when I went to talk to them and I did apply with them while I was with them anyway, we went ahead and start the whole process, uh.
[CUSTOMER][POSITIVE] But the lady said to me, um, I know you're supposed to pay at the end of the month, but don't worry about it. We're gonna put in your, in your profile that you're getting uh financial assistance, so if they come after you don't, I mean, they shouldn't because I'm putting this, you're gonna, if uh, if you get approved, we'll take care of it, uh.
[CUSTOMER][NEUTRAL] So right now I just have to wait because um hopefully but she says 2nd week of February I should have some news about it to see what's going on, so.
[AGENT][NEUTRAL] OK. Did you have any?
[CUSTOMER][POSITIVE] Hopefully, hopefully it work out.
[AGENT][NEUTRAL] Yeah, I hope so. Did you have any other questions about any dates of service that I could help with?
[CUSTOMER][NEUTRAL] No, no, no, no, um, no, because, uh, you just explained to me that it's been uh duplicate things that it's been previously processed, right?
[AGENT][NEUTRAL] Or no. OK. Um.
[AGENT][NEUTRAL] Right, because it does, and again, because they're limited benefits, you're limited to those 4 visits with the physician. And like I said, there's um other certain services such as the laboratory that aren't covered under the plan, which like I said, it, because it is limited coverage and that's all you're allowed, um, hopefully they'll take that into consideration for the financial assistance because like I said, it is limited and it is not a major medical.
[AGENT][NEUTRAL] Plan so it's kind of like being under insured so you have insurance, it just doesn't cover, um, you know, it doesn't it doesn't have a a lot of coverage so therefore it's can it's kind of like an under insurance so hopefully like I said they can take that into uh account with your financial assistance application so um just make sure they understand that that you are don't have that major medical coverage.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, yeah, I'll make sure I let them know if they need any more information, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, did you have any other questions, Ms. He, I could assist you with?
[CUSTOMER][NEGATIVE] No, no, no, no, no.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] No, just, uh, thank you so much for listening. That's all.
[AGENT][POSITIVE] Oh, you're welcome. You're so welcome. It's my pleasure speaking with you and uh and good luck to you. I hope uh I hope you find some uh secure employment soon and good luck.
[CUSTOMER][POSITIVE] Thank you, thank you. You well. You as well. mm.
[AGENT][POSITIVE] Thank you. Thank, thank you for calling API. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too, you too. Bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.