AccountId: 011433970860
ContactId: 7cf1325c-de6d-4ad1-b00e-bfd2ed82c55d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 866580 ms
Total Talk Time (AGENT): 336071 ms
Total Talk Time (CUSTOMER): 290926 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/7cf1325c-de6d-4ad1-b00e-bfd2ed82c55d_20250408T22:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, how are you [PII]? Um, the reason why I'm calling is I, I see that my claim was received today, uh, well, was received a couple days ago and it was processed today, and still the amount paid is 0. So I was wondering what was wrong with the claim this time.
[AGENT][NEUTRAL] OK, I can help you with the claim status. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yeah, it's uh 230-1155.
[AGENT][NEUTRAL] OK, 2301. What was the last part? I'm sorry.
[CUSTOMER][NEUTRAL] OK, 230-1155.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And what is your name and your date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, I just need to verify a few other pieces of information. What is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then lastly, what's your email address?
[CUSTOMER][NEUTRAL] Um is uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then do you have a good callback number just in case I lose you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, let's see what's going on with your claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Was that for the [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII], exactly.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Um, it looks like the, the explanation we received from your primary insurance, it showed that it paid in full.
[AGENT][NEUTRAL] So, therefore, we did not pay anything on the claim.
[CUSTOMER][NEUTRAL] Um, no, that can't be in.
[CUSTOMER][NEGATIVE] In there it shows that it's paid by me that I'm responsible for, for the 1500 and it says met on the, on the, on the remaining amount. It says med because I paid that and I gave you guys, I have submitted 3 times. I gave you guys an explanation. I wrote a letter to you guys to, I sent you everything, the bill that was charged to.
[CUSTOMER][NEGATIVE] Me in the other claims. I have sent everything. I called you guys and the the thing that you guys told me that I was missing on the last call was use this um uh bill that you guys needed from my main insurance to process the claim, and that was the only reason why it was rejected the other times because I didn't have this. And now that I have this, you guys told me that it's canceled because I have made the payment. I had to make the payment and if not, I I wouldn't have gotten the surgery.
[AGENT][NEUTRAL] Um, let me look.
[CUSTOMER][NEGATIVE] Doesn't make sense.
[AGENT][NEUTRAL] Let me see what we've got going here.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it shows.
[AGENT][NEUTRAL] It shows for the surgery for [PII], and this, this is from United or let me see, this is United Healthcare, OK?
[AGENT][NEUTRAL] So what it shows is
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The total charges were $6,696.
[AGENT][POSITIVE] And then it showed that the amount saved.
[AGENT][NEUTRAL] Um, which this is the discount that they have.
[AGENT][NEUTRAL] Um, that they write off. So, 4,48179.
[AGENT][NEUTRAL] They, they wrote off, it's a discount.
[AGENT][NEUTRAL] And then the balance that was left over was 221421.
[AGENT][NEUTRAL] So they, so UnitedHealthcare paid in full.
[AGENT][NEUTRAL] So if you paid, if you paid.
[CUSTOMER][NEUTRAL] They, they, they paid in full on, on, on their part. If you see at the beginning plan balances balances for [PII], it says deductible 1500 progress for 1500 remaining amount met.
[AGENT][NEUTRAL] OK, but we're going off of the claim that was submitted, which the total balance the total submitted was 6000. This is what we received. So we received the claim, it shows what they billed was 6,696.
[AGENT][NEUTRAL] They wrote off 404. This is the only page that we're looking at, OK, because this shows us what the charges were.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] What they wrote off as a discount and then what they paid.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] If you paid them 1500, we, we don't know that. We just, we just know what you.
[CUSTOMER][NEUTRAL] You do. It's on the first page. Is the, what you're looking is for the claim details on that it was paid for the, for, for, for the hospital, what they paid for the hospital. The other part, I paid it to them, to the insurance.
[CUSTOMER][NEGATIVE] The, the, the co-pay that I have to pay and it says it in there deductible 1500 met on the first page. You cannot tell me that you can only focus on the third page when the whole document is submitted and in the first page by a document that is from them, from my insurance company, it says 1500 deductible and it's met.
[AGENT][NEGATIVE] I, I understand what you're saying, but that's, that doesn't show that you paid them that money. It shows that the deductible was met. We don't know how that was met and who.
[CUSTOMER][NEGATIVE] That was bad by me? Uh, what do you mean you don't know how it me?
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] I, I submitted on the other documents, on the other claim before that, how much I have paid.
[AGENT][NEUTRAL] So
[CUSTOMER][NEGATIVE] On the second claim, I it was showed on the other documents how much I paid, and you guys said that it wasn't sufficient. So what is the plan? You guys never gonna pay me back for an insurance that I have been paying for 10 years. This doesn't make sense.
[AGENT][NEUTRAL] United Healthcare was, they paid this claim in full, so we don't owe you any money. The provider, your provider.
[CUSTOMER][NEUTRAL] They didn't play that they didn't, no, I'm, I'm, I'm, I'm sorry.
[CUSTOMER][NEUTRAL] No, they didn't pay the, the claim in full. They paid the services and I had to pay a deductible. The deductible is shown on the, the, the first page that is met and on the other documents that I submitted, uh, a couple of weeks ago when you guys denied the claim, you can see the documents in there that said that I paid the um, you help the 1500.
[AGENT][NEUTRAL] It just
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Or can you, so what, what hospital?
[CUSTOMER][NEUTRAL] What do you guys need? The, the bill from my bank? What do you guys need?
[AGENT][NEUTRAL] Oh, what hospital did you go to? What hospital did you pay?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What hospital do you?
[CUSTOMER][NEUTRAL] I went to Bas on Palmer.
[AGENT][NEUTRAL] OK, so that hospital is going to owe you back the money because United Healthcare paid in full on this claim.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No, cause I have a deductible that was met. It's not the hospital. United knows that it's not the hospital. United gave me the bill of $1500 that was met.
[CUSTOMER][NEGATIVE] You cannot tell me that that the hospital is wrong. It doesn't make sense.
[AGENT][NEUTRAL] OK, I
[AGENT][NEUTRAL] I'm not sure
[AGENT][NEUTRAL] I'm not sure how else to explain it to you. We, this is a secondary policy, so whatever your primary does not pay, we will pick up to a certain dollar amount. Your primary, your primary explanation of benefits showed it paid in full at 100%. That's what we received and that's how it's been.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEGATIVE] No, it doesn't. No, it doesn't. No, it doesn't. No, it doesn't. You're looking at uh uh just one paying a specific.
[AGENT][NEUTRAL] You want to talk to a claims examiner who can explain how the claim was processed according to.
[CUSTOMER][NEUTRAL] I wanna speak to your manager.
[AGENT][NEUTRAL] OK, OK. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh dang.
[AGENT][NEUTRAL] Mm, I can't hear.
[AGENT][NEUTRAL] Alright, let's see.
[AGENT][NEUTRAL] Hey, I've got a guy on the line that wants to talk to a supervisor. Um, he's really, really distressed. Um, let's see. Do you need the, let me give you the policy number.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I'm sorry, you're here till 6, right?
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So this is on um a claim we received the primary explanation of benefits he has Medin.
[AGENT][NEGATIVE] The primary explanation of benefits indicated that the claim was paid at 100%, and he is just extremely distressed that we need to pay him his deductible amount. I tried to explain, like, we, we don't know what he paid to the hospital. We don't know that. We just know this is how UnitedHealthcare process the claim.
[AGENT][NEUTRAL] And since they paid in full, we're not going to pay on the claim. And so I said to him, now they would owe you money back if you paid them, but as from us, as a secondary plan, and since your primary has paid at 100%, we're not going to pay on the policy.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh, policy number is 2301155.
[AGENT][NEUTRAL] 3586302, yeah.
[AGENT][NEUTRAL] And then so, do I, how do I transfer him to you?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK, so transfer it to that.
[AGENT][NEUTRAL] 601. Will you give it to me? I'm sorry.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, OK, it's fine. It should pop up, right?
[AGENT][NEUTRAL] 3204. OK.
[AGENT][NEUTRAL] I don't have to. I don't have to dial 9. OK, alright, I'm gonna get him, um, on the line and then transfer him through. So, um, like I said, I mean, I don't you and as you know, we don't know what he pays to other people and we just go off primary EOB. So but he's extremely, he's extremely distressed, but maybe since he knows you're a supervisor, he'll, I mean, you know what I mean, you know how they could calmed down.
[AGENT][POSITIVE] I know, right, right, OK, all right. I'm gonna get him back on the line and transfer him over, OK?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And I, and I did, I verified him, so.
[AGENT][POSITIVE] OK, thank you. OK, bye.
[AGENT][NEUTRAL] OK, [PII], I'm gonna transfer you over to [PII] and she's gonna be able to help you, OK?
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] Yes, I'm here. OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hi can I help you?
[AGENT][NEUTRAL] OK, I've got him on the line. Are you ready?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, I am thank you thank you.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi [PII]?
[CUSTOMER][POSITIVE] Hi, yes, how are you doing?
[CUSTOMER][POSITIVE] Oh, I'm doing wonderful. Hi, my name is [PII]. I am the customer experience leader. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, so.
[CUSTOMER][NEUTRAL] I have been trying to submit a claim, a claim.