AccountId: 011433970860
ContactId: 84de430d-7205-4e7d-a8f1-a40f456ee76c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 886849 ms
Total Talk Time (AGENT): 401563 ms
Total Talk Time (CUSTOMER): 445966 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/84de430d-7205-4e7d-a8f1-a40f456ee76c_20250226T22:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, good afternoon. My name is [PII]. I'm calling regarding to a claim.
[AGENT][POSITIVE] OK, well, I can definitely help you with your claim and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] It's 02.
[CUSTOMER][NEUTRAL] 08
[CUSTOMER][NEUTRAL] 82
[CUSTOMER][NEUTRAL] 41
[CUSTOMER][NEUTRAL] It must a month
[CUSTOMER][NEUTRAL] L as in loud, 7.
[CUSTOMER][NEUTRAL] Mm I will put it.
[AGENT][NEUTRAL] Thank you for that. And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the the the mail address is [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how may I assist you today?
[CUSTOMER][POSITIVE] OK, I'm gonna put also my husband here with me. He's gonna help me with.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] We're ready.
[AGENT][POSITIVE] Hey, hi, how are you doing? Um, and how may I assist you? Actually, I think I spoke with you earlier today.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Oh yes, yes.
[CUSTOMER][NEUTRAL] Yes, like 30 minutes ago.
[AGENT][NEUTRAL] About your explanation. Yes, OK.
[CUSTOMER][NEGATIVE] OK, OK, OK. We need to find out what, what's really going on. OK. We just, we just talked to uh [PII], the, the, the hospital. OK, they said that, they said that they sent this claim to, to American public life 3 times. Uh, all 3 times it was denied.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] OK, uh, and then my, if you spoke to my wife earlier today, you, you told you, you told my wife that APL never got anything from, from Memorial. So Memorial said that they sent it 3 times.
[AGENT][NEUTRAL] That's not what I said.
[AGENT][NEGATIVE] That's not what I said. I advised of all three times.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, OK. What is it?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] And I advised, I advised of all three claims and why they were denied. We sent the provider twice a request for for a detailed explanation of benefits. What they sent to us just shows the charges, but what we need to know what was paid to those charges. So if we owe you all a reimbursement, we can pay you, or if we, if there's something left over and we can pay the provider, we can pay them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] But they just sent us the charges. They didn't send us what was paid to those charges.
[CUSTOMER][NEUTRAL] OK, but OK, but I just, we just talked to them and they said that that's illegal. They said that they can't send uh medical records. They, they, they can send it, that they, they can't send the, the, the patient's personal information to anybody. That, that they can only send it, that they, they can only send the claim like uh like uh like they said that they did.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] So that's not true. That's not true. It is not illegal for an insurance company to ask for a bill. We use the bills to pay the claim, but if you like, you can give me their phone number and I'll be more than happy to call them for you.
[CUSTOMER][NEUTRAL] OK, OK, I, I will, OK, I will give you the, the number, but OK, so what is they, they, they, they, they told me, they told us, OK, call them back, I ask them exactly what they need. OK, so because they they mentioned some, some, some type of bill the, the, the itemized bill is.
[AGENT][NEUTRAL] Itemized, mhm.
[CUSTOMER][NEUTRAL] Is that the one that you need?
[AGENT][NEUTRAL] Yes, the itemized bill, because what they're sending, well, the itemized bill and the explanation of benefits, we both need, but what we're asking for is the explanation of benefits. But if you want to give me their phone number, we can just cut the middle man and I can call them and speak with them directly.
[CUSTOMER][NEUTRAL] OK, OK, OK, OK.
[AGENT][NEUTRAL] I mean with you on the phone, but I'm saying I can call and, and, you know, speak with them.
[CUSTOMER][NEUTRAL] OK, so because they say that they say to call, to call you to call, uh you got uh American and then they say, OK, ask them exactly what they need if they need if they need uh itemized uh itemized bill or if they need uh the, the, the patient's medical record, and that, and that's, that's up to you if you authorize that. I'm like, yeah, but.
[CUSTOMER][NEUTRAL] Ame American public life have, have, have made some payment some payments before. So I like, how come before they, they, they didn't request any of these and they make payments and now they, they're requesting this. So that's, that's the question too.
[AGENT][NEGATIVE] We requested it previously, but they sent it in, so we didn't have to go through all of this because they sent what was required. The problem with this time is they're sending a, it looks almost like a copy of what your insurance company gave them like it.
[AGENT][NEUTRAL] It doesn't even have, you know how your explanation of benefits lists like everything that was done and has codes and it's none of that is on there. It just shows like dollar amounts. But when I spoke with Ms. [PII] earlier, even the dollar amounts that she was saying wasn't on what they sent, but I can speak with them. I don't mind and I can make it very clear.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, OK, OK, and this is, and this is for services of [PII], right?
[AGENT][NEUTRAL] Um, let me pull up the claims and get the data service. Hold on one second.
[CUSTOMER][NEUTRAL] Yeah, because that's another thing, yeah, uh and also.
[CUSTOMER][NEUTRAL] We received an an exponential benefits from, from American public just yesterday and on this exponential benefits that we got in the second in in, in page two, it says the above reference claim appears to be a duplicate of previously submitted expenses. So what exactly does that, so that means that American public indeed got claims about these claims before, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] Right, we did that and we haven't, we haven't denied that we did. We've received this claim 3 times and they keep sending the same thing, so that's why it keeps being denied. What is their phone number? I can call them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, OK, let's check, uh, first of all, let's check the, the date of service because like I said, this date of service on [PII].
[AGENT][NEUTRAL] Yes, the date of service on this claim is [PII] and [PII].
[CUSTOMER][NEUTRAL] OK, so the phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and do you, do you mind if I place you on just a brief hold while I reach out to them?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Go ahead, go ahead. No problem.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And let me get this up to.
[AGENT][NEUTRAL] So that I can.
[CUSTOMER][NEUTRAL] Thank you for calling Memorial Health Care Systems Patient Financial Services. Our offices are currently closed. Please press one to pay your bill and access additional accounts.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, so their offices are closed, so this is what we can do. I work um every day from [PII] Central time to [PII] central time.
[AGENT][NEUTRAL] I'm sorry, it's [PII] central time?
[AGENT][NEUTRAL] Keep saying central. I'm sorry, [PII]. I work, um, you all can call me, call this number and ask to speak with me. I would say to call in the morning so that we can give them a call and
[CUSTOMER][NEUTRAL] Uh uh huh.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] This um rectified for you, but I can explain to them exactly what we're looking for is not what they're sending, and it's not illegal to send an insurance company, an itemized bill, universal bill, or an explanation of benefits. That's what we use to process claims.
[CUSTOMER][NEUTRAL] Yeah, because I don't know why, I don't know what they, what, what they've really been sending, uh, and also what, what they said before. Because like I said, like I, like I said before, American Public Life has, has, has made some payments already, you know, from previous claims, from previous date of date of services. So, so what did they get back then that they pay.
[CUSTOMER][NEUTRAL] Um, and, and, and what is the American public getting now that, that they're not, they're not paying, so that's, you know, that's my question now.
[AGENT][NEUTRAL] The, so the answer to that question, the difference between the pay claim and the denied claim is the pay claim provided all the information that we needed, so we were able to pay out. We're not saying that we won't pay out on this claim, we just need to see that we have to see the billing because how do we know what you paid to know what to reimburse you and how do we know what primary pay to the provider to know what's left over, to know what to pay them so you don't receive a bill. So that's why we need the billing.
[CUSTOMER][NEUTRAL] OK, OK, so, so you said to call you tomorrow, OK, what's your name?
[AGENT][NEUTRAL] My name is [PII]. I'm the only [PII] here.
[CUSTOMER][NEUTRAL] OK, but are you gonna answer the call or or or somebody or you, you don't know or.
[AGENT][NEUTRAL] I don't know, I don't know that I'll answer, but if you ask for [PII] and there's going to be now 2 notes on this policy, so they'll know exactly who I am and they can get you to me.
[CUSTOMER][NEUTRAL] OK, OK, um, uh, another thing that they just told us was that they, that they, they, they gave.
[CUSTOMER][POSITIVE] My wife, you know, uh, for this account that they gave her a discount.
[CUSTOMER][NEUTRAL] That a 20% discount. So I don't know is that is is, is that gonna affect something or because look, the, the, the previous, the bill was, was for 40.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For.
[CUSTOMER][NEUTRAL] According to this.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, the bill was previously almost $4400. OK, so they said that they gave a 2020% discount. I went down to $826 so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is, is that gonna affect anything or, or, or, or, or, I don't know, because now, like I said, the bill went.
[AGENT][NEGATIVE] It shouldn't.
[AGENT][NEUTRAL] It it sounds like they just made an adjustment, but all of, so all of that that you just explained is on the billing. So when the examiner gets that, that, that all goes into consideration, but you shouldn't, that won't affect your
[AGENT][NEUTRAL] Like your payout.
[CUSTOMER][NEGATIVE] No, yeah, because we don't want that, of that, because if the American public is gonna pay something.
[CUSTOMER][NEUTRAL] So it's gonna pay pay something out of the 826, uh, you know, out of, out of the discounted amount or out of the, the total the the 4000.
[CUSTOMER][NEUTRAL] $400 of the total bill, you know?
[AGENT][NEUTRAL] And those ques and that, yes, and that question that you're asking, that's exactly why we need the billing, so that we can see what the what the remaining balance was after all the adjustments and discounts, that's usually and after primary pays their part, whatever that amount is, so it sounds like the 820, you know, that total.
[AGENT][NEUTRAL] That amount is what's being, what should be billed to us and we'll be able to see all of who paid what. So that's exactly why we're asking for it, so that we know what to pay.
[CUSTOMER][NEUTRAL] Oh, yeah, because, yeah, they, they, they say because the first thing that this guy, that guy that we spoke to say, oh, the, the hospital gave you a 20% discount so it went from, from $4000 to $800. So you, you know, like, like trying to for us to, to, to settle with that.
[CUSTOMER][NEUTRAL] You know
[AGENT][NEUTRAL] Mhm. And then if that was the outstanding balance and that's being billed to you, then we would apply or you know, once we get all the paperwork and we can apply to that balance as well, hopefully get it to zero, so you don't get a bill or, you know, apply as much as we can, but then you'll get the explanation of benefits.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, OK, and, and, and one last thing, the, the, the, this person that we spoke to, he said that, that, that he's gonna send another bill to to American public. So he, he said, uh, tell them that that they're gonna get 11 more bill, you know, so I don't know what they're probably gonna send the same bill that they've been sending you guys, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, tomorrow after I speak with them, I'm gonna explain it in detail, so they're clear on what we're asking for and even on the top of this, it says, it says remittance, so it's not an explanation of benefits from your primary insurance. It's kind of like a summary of, of the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because our primary insurance, which is uh United Healthcare, they already did their part. They already paid what, what, what they needed to, so, so they, they not, you know, they have nothing to do with this, so.
[AGENT][NEUTRAL] Right, primary has already applied, so they're out of it at this point. We just need to know what they applied and then we'll be able to move from there. They just keep the provider keeps sending the same thing over, so it's getting denied because we still don't have the information we need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So what's the best time to call you tomorrow? You because you said after [PII]?
[AGENT][NEUTRAL] Yes, I'm here at [PII], so I mean, you can call at [PII] if you'd like. Um, I'll be here.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, OK, so they, they probably, you said that they, you said that they close, uh, the, so if, if, if they close at [PII], they probably be there probably [PII] probably.
[AGENT][NEUTRAL] Oh yeah, because it's usually [PII] at the shift. So yeah, you can call me at um [PII] our time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, no problem. OK.
[AGENT][NEUTRAL] Eastern.
[AGENT][NEUTRAL] All right, well, I'll speak with you. Did you want me to give you a call? Is that easier if I give you a call?
[CUSTOMER][NEUTRAL] OK, OK
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] Or would you rather
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, yeah, my wife, she, she will, she will call you. Like that, yeah, OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, well, I'll speak with you all tomorrow. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's it. That's it. Thank you.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. Have a great evening.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you. You too. Thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Oh.