AccountId: 011433970860
ContactId: 8d007906-fce5-40ec-99af-e9e54c64b32e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 891010 ms
Total Talk Time (AGENT): 250415 ms
Total Talk Time (CUSTOMER): 563100 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/8d007906-fce5-40ec-99af-e9e54c64b32e_20250324T17:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], hey, this is [PII]. How are you?
[AGENT][POSITIVE] I'm good how are you today, [PII]?
[CUSTOMER][POSITIVE] Doing pretty good. I'm actually following up on the EOB that I got from you guys, so I'm just trying to figure out where we are, who I need to fight now, not you guys, but.
[AGENT][NEUTRAL] Let's take a look. It's
[CUSTOMER][NEUTRAL] So this, this has been a little ongoing for a minute here now.
[AGENT][NEUTRAL] Oh, OK. All right. Is this for a patient of yours or?
[CUSTOMER][NEUTRAL] No, I am the patient.
[AGENT][NEUTRAL] You are the patient, OK. What is your policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 0245.
[CUSTOMER][NEUTRAL] 5082
[CUSTOMER][NEUTRAL] I hope I didn't cross those 5s.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Thank you, [PII] and then do you have a good callback number just in case if something happens on our call we're disconnected?
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] All right, thank you for that. I will need to verify your date of birth and address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the last thing I need is just your email.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] OK, so this was a recent claim. Was it under your name?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK, alright, let me.
[CUSTOMER][NEUTRAL] It, it look like this claim is spreading because what happened was in the, the initial uh claim that I submitted was for the ambulance ride, right? uh where I got injured on [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What happened was the insurance company sent me the EOB from everything that happened on [PII] including the um ambulance. You saw the hospital bills, you saw the physical therapy stuff. Anyway, so everything started being sent to you guys. Uh, then I was interned asked to also send the CMS 1500 for physical therapy people.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I called them. They in turn said that they would send it to you guys themselves, and I believe that's what y'all are in search of now. They're saying that the claim is they acknowledged, but they still need, let me see, for further consideration, and you claim we still need a procedure code. I'm guessing for physical therapy. So I don't know if you guys have gotten uh.
[CUSTOMER][NEUTRAL] What you need from them as of yet.
[CUSTOMER][NEUTRAL] But it seems like I talked to them about a month ago.
[AGENT][NEUTRAL] Let's see 42.
[CUSTOMER][NEGATIVE] To send that over to you guys cause they wouldn't send it to me directly, uh.
[CUSTOMER][NEUTRAL] Who did send me the UB? Somebody whenever I've gotten, I've, I've uploaded onto your portal.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEGATIVE] Yeah, so the re the recent claim that I see it looks like there are so part of it looks like paid and then there were, it looks like some denials um on here.
[CUSTOMER][NEUTRAL] But uh.
[AGENT][NEUTRAL] So, let me go back.
[CUSTOMER][NEUTRAL] Yeah, the insurance company, well, wait a minute, let me see who got did anybody really get paid because I wanna say things were were applied to my deductible and I started receiving bills, um.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] That was.
[CUSTOMER][NEUTRAL] Because the ambulance bill, when I talked to the insurance company, they initially did a contractual adjustment. It was like a little bit over $1000 and they were saying that the patient responsibility was $600 and some dollars, but the ambulance company in turn went back and re appealed it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They said, they said because they said I was out of network.
[CUSTOMER][NEUTRAL] And I said, I didn't know there was a such thing in an emergency situation because who knows they're out of network in any given emergency situation. Yeah, anyway.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You know, and who has time to fight that? You know, I mean, OK, so that's weird for that to even be there, uh, with, with healthcare, you know, in an emergency situation. But anyway.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So they in turn sent the bill back to the insurance company and the insurance company now saying that I'm responsible for the entire.
[CUSTOMER][NEUTRAL] Ambulance bill because I was out of network.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So yeah, I, I spent everything.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Did you get any sort, have you received any sort of payment from the claim because I showed that there was the recent claim, there was um a benefit payment made for $1200 1280 dollars.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] To who?
[AGENT][NEUTRAL] It's showing.
[CUSTOMER][NEUTRAL] To the insurance, to the, I mean, to the ambulance people?
[AGENT][NEUTRAL] It's showing to the insured to you.
[CUSTOMER][NEGATIVE] 00 no, I haven't gotten paid anything. They sent money to, oh sorry, who are we talking about at first before I even respond because honestly I haven't gotten a check from nobody, meaning the insurance company because they're supposed to pay the claim, not pay me.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Cause I don't, I'd be, you know, I mean when I go to the doctor, what do they do? They send a claim to the insurance company, right, and then the insurance company gets to pay the whoever I want to, the provider. So no, I haven't gotten anything. That 1200 something you're talking about sounds like the ambulance thing, it sounds like. I don't, I don't have anything in front of me right now, but that's what it sounds like. Uh, if you can see what it was for, I don't, I, I can't tell right now.
[AGENT][NEUTRAL] So yeah, it shows um one of it was [PII]'s, it's showing ER and then Metro Ambulance, um, it looks like and you right and you submitted the claim online on the, on [PII]. Does that sound right?
[CUSTOMER][NEUTRAL] That's the hospital. Mhm.
[CUSTOMER][NEUTRAL] That's the ambulance people. Mhm.
[CUSTOMER][NEUTRAL] So I submitted it to who to y'all?
[AGENT][NEUTRAL] To us, uh-huh.
[CUSTOMER][NEUTRAL] OK, yeah, that, that might be right. OK, go ahead. Uh-huh.
[AGENT][NEUTRAL] OK, so I showed the claim was submitted on [PII] through the online service center and then the claim was processed on [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Saying that it was not what, that I was missing something, right?
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Like y'all needed something for me.
[CUSTOMER][NEUTRAL] Because there was no payment made to me. That was it. I think y'all needed something for me. Uh, I don't, I, I don't know if it was the EOB something from the insurance company, something else I had to do to get uploaded for you guys, and I in turn submitted that.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] For it looks like the um physician, there was a Doctor Voight, a Doctor [PII], there were some charges you submitted for them.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] From the, for the, OK, see, so that's what that's what I'm saying. So, so let's let's back up for a second. I think what happened again is
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] I know what happened. So the part with the ER, anything that's uh uh emergency room related and, and those providers that treated me in the ER, Doctor, uh, who you say Vo and [PII], Doctor Vo and Doctor [PII], they're from the ER I believe, I believe, don't quote me on that, but I believe. So that bill has been paid. They done everything they're gonna do for the ER.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] What part came back to me was about $500 saying that I owe that and I've, I've, I've set up payments for them to take out of my account $25 a month so that $500 is paid. So I'm not, I'm not billing anything to you guys to be reimbursed for that. Only thing I was trying to get help with was that ambulance bill.
[CUSTOMER][NEUTRAL] But what happened is that EOB from the insurance company when I asked for it to show everything that they paid or however they worked it out or worded it in the EOB, they sent one long EOB and I sent y'all exactly what they sent me.
[CUSTOMER][NEGATIVE] So it may have looked like I was submitting claims for all of this stuff when in fact I was trying to, cause I couldn't cut it off. I didn't know how to, you know, where to, I didn't want to touch it because I didn't wanna look like I was fumbling with the EOD.
[CUSTOMER][NEUTRAL] But I wanted y'all to see the ambulance piece of it.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] You have, it looks like bank information on your account. So that's what I'm saying that I'm showing that there was a direct deposit sent. You don't, you haven't seen anything?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, for to, what, what bank do I use? Cause I, I haven't got no name.
[AGENT][NEUTRAL] The account number ends in [PII] and the routing ends in [PII].
[CUSTOMER][NEUTRAL] I got notified.
[CUSTOMER][NEUTRAL] Oh, OK, that's Navy Federal.
[CUSTOMER][NEUTRAL] Well, let's see, let's go see. I think I got a notification from them saying that, that usually anytime somebody touched my account, it would have said I've gotten something, but I can look.
[CUSTOMER][POSITIVE] I can promise you.
[CUSTOMER][NEGATIVE] I don't get money like that and I'm not working. I think I would have noticed that. Does it have a date or anything like that? How, like I know how far back to look is what why I'm asking.
[AGENT][NEUTRAL] Uh, let's see, the claim shows it was processed.
[AGENT][NEUTRAL] On the [PII], so.
[CUSTOMER][NEUTRAL] So recently, OK.
[AGENT][NEUTRAL] It would have been, I would have, I would think because the [PII] was a Friday, so I would think any time probably last week.
[CUSTOMER][NEUTRAL] OK, let me go look.
[CUSTOMER][NEUTRAL] Well I promise I wouldn't be trying to go after something I've already been paid for. Let's see.
[CUSTOMER][NEUTRAL] I'm sorry, I'm going through all these different authenticators to get into my account.
[AGENT][NEUTRAL] No, that's OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let's see. I'm in now, let's see.
[CUSTOMER][NEUTRAL] And it was the amount of what again? 12 something you said?
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] Yeah, it was, it shows $1200.87.
[CUSTOMER][NEUTRAL] Sure did.
[CUSTOMER][NEUTRAL] They sure did.
[CUSTOMER][NEUTRAL] Wow, I ain't even noticed and it posted on [PII], 3:17.
[AGENT][POSITIVE] Oh, OK, good, good, good.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEGATIVE] I swear I didn't even pay no I didn't even get a notification.
[CUSTOMER][NEGATIVE] That's the sucky part.
[AGENT][POSITIVE] Well, I'm glad it's there, that's for sure.
[CUSTOMER][NEUTRAL] Yeah, well, so am I.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Well damn, we just kind of mixed in with the rest of my money. I don't even, I guess I was so busy paying Allstate and I'm home warranties and life insurance stuff that I didn't even pick up on it.
[CUSTOMER][NEUTRAL] OK, so that's that. So my last piece of that is, will they cover the, the physical therapy part?
[AGENT][NEUTRAL] So the first
[CUSTOMER][NEUTRAL] I mean, will you guys cover the physical therapy part.
[AGENT][NEUTRAL] Yeah, so the physical therapy part, let me pull, first, let me pull your plan, but it was asking for
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Procedure codes, right?
[AGENT][NEUTRAL] Yeah, we need a procedure code which corresponds with the submitted claims. So that's still showing denied at this point.
[CUSTOMER][NEUTRAL] Right, so that's, so that's what I was asking. So they have not as of date still have not sent you all the CMS 1500 thing.
[AGENT][NEUTRAL] I don't see any.
[CUSTOMER][NEUTRAL] I get the same guy. I've called him twice. He said, Miss [PII], I talked to you a month ago and I, I shared with you then, you know, type thing.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You know that they, they claimed that they were gonna do it in a certain amount of time. They don't do it the same day you ask because they said because their their billing cycles run every so whatever and that they will send it. So, so here's my question. So will my claim still sit open until y'all get that or uh or is it closed and I gotta start all over again?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] No, you can just resubmit you can just submit the needed information for the claim, yeah, it'll stay there. You don't need to resubmit everything.
[CUSTOMER][NEUTRAL] OK, so then they they sending it to y'all, not me. I, I just, I just have to follow up with you guys to see, have you got it yet, cause I think I went after them whenever it was the very first time y'all told me I needed that C cause that's the way I learned that lingo to see the CMS 1500. I was like, what's that? But anyway, but the guy at the the therapy place knew what I was talking about when I said it, so he said, oh yeah, he said we can send that to them. He asked me for all y'all information, so I gave it to him.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And a fax number. There's someone there supplied me, so, OK, so this is a waiting game. OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Anything else, [PII] I can check on for you?
[CUSTOMER][NEGATIVE] That is still funky to me. I'm just shocked.
[CUSTOMER][NEUTRAL] No, no, that'll do it. Thank you for processing that. I had no idea. No, I feel a little embarrassed.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] No, no worries. I'm glad we figured it out.
[CUSTOMER][NEUTRAL] But uh,
[CUSTOMER][NEUTRAL] The
[CUSTOMER][POSITIVE] But thank you so much. So, uh, yeah, I just kinda keep my eyes open just, I'll follow back up with you guys I guess in a few weeks to see if they sent, sent what they need to send to you guys.
[AGENT][POSITIVE] OK. All right. Sounds good. Well, have a blessed rest of your day, [PII].
[CUSTOMER][POSITIVE] All right, you as well. Thank you.
[AGENT][NEUTRAL] Bye bye.