AccountId: 011433970860
ContactId: 837939fe-0627-4744-b1c5-8132a16af8ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1036540 ms
Total Talk Time (AGENT): 373699 ms
Total Talk Time (CUSTOMER): 624084 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/837939fe-0627-4744-b1c5-8132a16af8ba_20250220T20:04_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Well, good afternoon, [PII]. It's my pleasure to talk to you. You sound just very bubbly today.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] And I appreciate that I can understand you.
[CUSTOMER][NEGATIVE] Sorry, I shouldn't, I shouldn't be that way.
[AGENT][POSITIVE] I'm glad you can too. Well, it's the truth.
[CUSTOMER][NEGATIVE] I know, I know, but I get in trouble for saying the truth.
[AGENT][NEUTRAL] Well, it's OK.
[CUSTOMER][NEGATIVE] People, people don't like it when you tell the truth. You're supposed to sugarcoat it and make them feel good about themselves anyway, let's not go there.
[AGENT][POSITIVE] Well, we like the truth of APL.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have a question. I didn't know I had coverage through y'all. Um, I had an outpatient procedure done and they hit me with a $2500 bill, but now I'm finding out that I, um, have $1500 worth of coverage through you guys.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, well, I can definitely look into your policy for you and let you know what the coverage is and the benefits, um, and you said it was yesterday that you had the procedure?
[CUSTOMER][NEGATIVE] No, no, no, no, no, it was um it was last year, but my policy with you guys expires I think the end of this month and I just found out about it today and I'm just like oh I better get on this.
[AGENT][NEUTRAL] Oh, actually, OK.
[AGENT][POSITIVE] OK, um, well, I definitely can help you. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, my name is [PII] My last name is [PII], and I'm at work right now, so I'll give you that number. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] I have 230-419-6.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK, I have the group number if you need that too because I just talked to we just had a Zoom meeting about the new insurance that's gonna start [PII] and I'm just like so I called the agent and I was like I didn't know I had this coverage tell me how to get some money.
[AGENT][NEUTRAL] OK, and I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] My date of birth is [PII]. My email address is [PII], and my mailing address is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. Um, so yes, for outpatient, you do have $1500 per calendar year. There is no deductible, and that does include surgery in a hospital outpatient facility or freestanding outpatient surgery center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so to file a claim, well, you really have two options, depending on the facility, you can let them know you have this policy and give them the policy number and our phone number, um, for them to call and verify benefits and then file the claim, or you can file it on your own. Um, which one would you prefer?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I think because we're kind of in the 11th hour, um, I'm gonna do it and because it was like I said, $2500 and I've already set up a payment plan with them where I've already paid them a nice chunk of change, um, I'm just gonna file it myself because if I file it you'll reimburse me, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It depends on the paperwork. Um, so we require the explanation of benefits from primary insurance, the itemized bill from the provider, and then the claim form. So the explanation of benefits will show us everything that was charged, everything primary paid, everything you paid and what's left over. Um, once we get that claim is when we then can reimburse you or something still owed to the provider, pay them.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it, it just depends on what's on the, the paperwork when they examine it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, so I do need to get a detailed bill from them because I've been trying to get a detailed bill from them for months now and they sent one to me in the mail and I saw it come through my informed delivery through USPS but I never got it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And I'm just like, and I clicked on it in the informed delivery through the post office and said I never got it and I still didn't get it.
[CUSTOMER][NEUTRAL] And I'm just like, so I don't, I'm about half tempted to drive to the surgery center and say, look y'all print me one.
[AGENT][NEUTRAL] Yes, but when you do, make sure you tell them or let them know that you needed to show the diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The procedure codes and then all the charges.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, because
[CUSTOMER][NEUTRAL] OK, because I never did. I don't have a card from you guys to show them so that they can submit it now if they submit it, will they submit everything that you need um the um detailed bill and the EOB?
[AGENT][NEUTRAL] Yes, um,
[AGENT][NEUTRAL] When they give us a call or, or, you know, once they contact us to verify the benefits, we're going to tell them what we need for the claim to, um, for when they send it in for processing. So they'll like they have their own claim form for providers and then they'll send the bill and the explanation of benefits.
[CUSTOMER][NEUTRAL] Oh, OK. I, I'm just worried that they'll take their own sweet time, but I mean, does it matter even though my policy ends the end of this year as long as they submit the claim?
[AGENT][NEUTRAL] Right, there's no um like timely filing limit or like a deadline to file a claim with us. So as long as the policy was active on the date of service, you can file the claim at any time.
[CUSTOMER][NEGATIVE] Oh, OK, OK, um, I'm just worried if you guys overpay them that it'll be like pulling teeth for me to get any of the money back.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Which I know you can't really answer for me um and if I submit the claim there's no guarantee that they'll reimburse me versus sending money to them anyway.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's true. Now, I mean,
[AGENT][NEUTRAL] Eventually they'll have to, it's just gonna be, it might be hard.
[CUSTOMER][NEGATIVE] And I don't want, I don't want you to say something that's gonna get you in trouble, yeah.
[AGENT][NEUTRAL] Oh, no, I won't. I'm just, I'm just thinking and talking at the same time, but
[AGENT][NEUTRAL] But yes,
[CUSTOMER][NEGATIVE] That never worked out well for me.
[AGENT][NEUTRAL] As long as, um,
[AGENT][NEUTRAL] You have the documents now, they might give you a hard time to reimburse is what you're saying with the heart, you know, tooth and nail, but I mean, that's kind of up in the air. That's hard to, that's hard to say.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah yeah no I I get it worst case scenario I mean they're here locally I know that their billing um company is somewhere else because I know that the envelope came from I don't know where it came from but I'll look up on it and see um if they can.
[CUSTOMER][NEUTRAL] See how much I owe them and if it's still around the if it's around the $1500 then I'm fine with that, um.
[AGENT][NEUTRAL] See how much.
[AGENT][NEUTRAL] Right, I just don't want to have them overpaid.
[CUSTOMER][NEUTRAL] But I
[CUSTOMER][NEGATIVE] Yeah, yeah, because you know how it is getting money back from these corporations.
[AGENT][NEUTRAL] Mhm. It's gonna be hard. Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But now if you happen to pay and we pay them, then we
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Yeah, if you pay them and then we pay them and they're double paid.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, like I said, the charge was on the EOB it was $2500.
[CUSTOMER][NEUTRAL] So, and I've been, um, because the procedure was back in March of last year.
[CUSTOMER][NEGATIVE] But it took them forever to file the claim, so I didn't get a bill from them until I want to say.
[CUSTOMER][NEUTRAL] May
[AGENT][NEUTRAL] Oh Lord.
[CUSTOMER][NEGATIVE] So and it's just like when I got well I didn't know that there was a a charge for outpatient procedures when I went in there they're just like, oh you have a $1000 deductible they made me pay that and I'm just like, OK, good insurance is gonna cover the rest of it and then next thing I know two months later I get a bill for $2500 and I'm like what the heck is this?
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And then I log into my insurance portal and down there on one of the funny pages it says outpatient surgery $2500 per visit, you know, so in other words if I do something else it's $2500 every time I have outpatient surgery and I'm just like whoa.
[CUSTOMER][NEUTRAL] Way to bury the lead.
[AGENT][NEUTRAL] Yeah, that's a lot now.
[CUSTOMER][NEUTRAL] I, that's what I said, but having your coverage kind of offsets it a little bit, but so basically I'm paying two deductibles of $1000 which is better than paying for all this other stuff, but.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I shouldn't complain. Some people don't have insurance, so.
[AGENT][NEUTRAL] Well, I mean, that's true, but also that's still a lot of money.
[CUSTOMER][POSITIVE] I need to be thankful.
[CUSTOMER][POSITIVE] Oh, I trust me, I know.
[CUSTOMER][NEGATIVE] It's like jeez and they and they don't care I mean they were almost they wanted to put it on my credit card to bill it every month for a certain amount and I'm like no I will send you what I can send you when I can send it to you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Because somebody had told me they, they can't put you in collection as long as you're paying them even $25 a month.
[AGENT][NEUTRAL] Right, I mean, even if you're paying 1015, as long as you're paying to it, they not a, not a medical bill.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEGATIVE] Yeah, yeah, so, no, but they like to scare you and make you think they can.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so they can get their money and they don't, I, I think, well, they might give you a hard time because it's been a year.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] In a lot of instances they make enough money.
[AGENT][NEUTRAL] Or more than enough.
[CUSTOMER][NEUTRAL] Yeah, well, because they're, you know, you, I see on the EOB what they charge the insurance company and then it's negotiated down to another rate and I'm like, well then if you can take that amount in the first place, why do you send a bill for $800 if you're willing to take two?
[AGENT][POSITIVE] It's just a racket, but I'm glad you have your um your Medlink policy to offset it because that that's a lot, especially now, well, anytime, but definitely now.
[CUSTOMER][POSITIVE] Yeah, yeah, $1500 helps.
[CUSTOMER][POSITIVE] Yeah, it, it definitely.
[AGENT][NEUTRAL] Well, the good thing is there's no deadline, so you, you still can use it and even if you had other claims, you really, as long as your policy has been active, you can file claims and this policy has been active since 23 and you had one before that too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I wasn't aware of it though. I don't think I had any outpatient um.
[AGENT][NEUTRAL] But it's not just outpatient, um, an outpatient isn't just outpatient surgery, I mean, emergency room, urgent care.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's all
[CUSTOMER][POSITIVE] Well, knock on wood I've been blessed and not had to have any of that until last year, but it's good to know that it exists.
[CUSTOMER][NEUTRAL] Um, because I may need to have another procedure this year and apparently um it's gonna have we're gonna have another policy this year when it starts, um, [PII], so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I, I did talk to the agent and it's like, OK, well it'd be nice if you would send out cards for this policy so that when you do do an outpatient surgery or emergency room visit you can give the card.
[CUSTOMER][NEUTRAL] Then at the same time you give your insurance card so that the um.
[AGENT][NEUTRAL] They can bill it.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] So you never received cards for this policy?
[CUSTOMER][NEUTRAL] Not that I'm aware of.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] But I mean I don't blame y'all. I blame my um company and the insurance agent.
[AGENT][NEGATIVE] I just hate that because, so it's [PII], that's correct?
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Uh-huh, uh-huh.
[AGENT][NEUTRAL] OK, because that's where we sent it to.
[CUSTOMER][NEUTRAL] But your company name is APL?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Well, and maybe I did get it and I didn't know what it was.
[CUSTOMER][NEUTRAL] I mean, I'm not, I'm not gonna say definitively, you know, that I absolutely didn't get, maybe I got it and I just thought.
[CUSTOMER][NEUTRAL] This is my dental or vision or something and I just tucked it away.
[CUSTOMER][NEGATIVE] Maybe I didn't understand what it was, which again I blame the insurance agent for that.
[AGENT][NEUTRAL] Possibly.
[AGENT][NEUTRAL] Well, do you have? Oh, I'm sorry. No, no, you're fine. I was just trying to see, do you, do you have a copy now if you needed to file anything, but you have your policy number now because I know it's ending next month.
[CUSTOMER][NEUTRAL] Because had I not been
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Um, yeah, I, I think it ends the end of this month. I think I may, I remember seeing something, but like I said, I may, and it may be in my wallet because if it was a card and it was insurance related, I may have thought that it was my, my vision or my dental and I may have just stuck it in my, in my wallet. I'll go look.
[CUSTOMER][NEUTRAL] And see and if uh if I have that then I probably will just take it down to the surgery center and ask them or maybe I'll just scan it to the billing service and say you need to file this claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And would you like me to send you like a digital copy of it, like to your email?
[CUSTOMER][POSITIVE] Well that would be awesome, yes, just in case.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then once I see it, I'm probably gonna go, oh yeah, you put that in your wallet, ding dong.
[AGENT][NEUTRAL] Let me see. OK.
[CUSTOMER][NEUTRAL] But sometimes I look at stuff and and I'm just like I don't know what this is but it looks important so I put it in my wallet.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] I just want to make sure it's a copy available before I make a promise and can't follow through.
[CUSTOMER][POSITIVE] OK, I won't be mad at you, I promise.
[AGENT][NEUTRAL] OK, so yeah, I can go ahead and email this copy to you, um, so you'll have at least a digital version if you need it, um, for your claim.
[CUSTOMER][POSITIVE] You seem too nice
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah and then I'm sure I can print it out if I wanna take it or I can attach it to an email and send it to the billing service.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, you can, and then they'll be able to bill us that way also. All they'll need is that.
[CUSTOMER][NEUTRAL] Yeah, worst case scenario, I'm gonna take it to the surgery center on on tomorrow because tomorrow is my day off and I got to go to Hobby Lobby.
[AGENT][NEUTRAL] OK, and then on the back of the card, it, it, it shows them all the ways to file the claim as well.
[CUSTOMER][NEGATIVE] Send all my money.
[CUSTOMER][POSITIVE] Awesome, I think, I think I'm gonna do that tomorrow because their surgery center is right on my way to Hobby Lobby.
[AGENT][NEUTRAL] OK, well, I'm sending this to you now. Did you want to wait to receive it or you're OK?
[CUSTOMER][POSITIVE] I'm I'm absolutely fine. You have been amazing. I don't know if they'll send me a survey, but if you can tell your supervisor my name and that I said that you're awesome, um, you feel free to do that because you're awesome.
[AGENT][POSITIVE] Thank you very much. I appreciate you. Well, we don't have surveys yet, but if you'd like to um give that information to my supervisor, I can definitely get it for you.
[CUSTOMER][POSITIVE] Absolutely, you put her on the phone.
[AGENT][NEUTRAL] OK, and if she's not available, it's OK to leave it on her voicemail. She'll check it and shout me out.
[CUSTOMER][POSITIVE] Absolutely, because I, I, your job is hard enough people give you a hard time for things out of your control, and I just wanna take a minute to let somebody know how awesome you are and how helpful you are.
[AGENT][POSITIVE] Well, I, I really do appreciate that and we appreciate you taking the time to give the kudos, so I appreciate that. Um, before I transfer you over to [PII], was there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, and your name was [PII], correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] All right, I just wanna make sure that I get it right um no you have answered all my questions you have been, like I said, you've been awesome. I really, really appreciate your time.
[AGENT][POSITIVE] Thank you so much. Well, thank you for calling APL and hold on one moment, OK?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][POSITIVE] Hello, you've reached the desk of [PII] in the [PII]. I'm currently away from my desk, but please leave your name, telephone number, and a brief message to indicate how I can help you. Your call is very much appreciated. Thanks and have a great day.
[CUSTOMER][NEUTRAL] Please leave a message after the tone.
[CUSTOMER][NEUTRAL] When you have finished, please hang up or press the pound key for more options.
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. My phone number is [PII]. You don't need to call me back unless you have, um, some questions. I just wanted to take a minute to let you know I just finished speaking with [PII].
[CUSTOMER][POSITIVE] I had some questions and I just wanted to let you know that she is extremely helpful, courteous, and I just really enjoyed my conversation with her and wanted to let somebody know she is a valuable asset to your company thank you take care bye.