AccountId: 011433970860
ContactId: 8d1a883a-10ae-4876-b473-340c1f190897
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1041818 ms
Total Talk Time (AGENT): 423136 ms
Total Talk Time (CUSTOMER): 430924 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/8d1a883a-10ae-4876-b473-340c1f190897_20250502T17:25_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, um, I'm calling regarding um some bills I have for my daughter, um, and just seeing if I've called before and I'm just um checking up on seeing if the insurances have put my APL insurance through, so, um.
[CUSTOMER][NEUTRAL] Yeah, anyway, I just need some help here.
[AGENT][NEUTRAL] OK, I can help you with that. And your name is?
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][POSITIVE] Thank you. [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Um, it is one second 02549425 ML 8.
[AGENT][POSITIVE] OK, thank you so much, give me one moment.
[AGENT][NEUTRAL] OK, and Ms. [PII], verify your date of birth and the mailing address, please.
[CUSTOMER][NEUTRAL] [PII] is my birthday [PII].
[AGENT][NEUTRAL] OK, thank you ma'am and you say you're calling to see if we received claims for your dependent?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, what's that patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, wait, and do you happen to have a data service?
[CUSTOMER][NEUTRAL] Yes, I do 9:25, 24.
[AGENT][NEUTRAL] 92524. OK, thank you, ma'am and I forgot. I'm so sorry, uh, do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] OK thank you let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is from Radiology Associates of South Florida.
[AGENT][NEUTRAL] I don't sure we received the claim for that, uh, data service and also just to let you know, since she is over the age of [PII] for any claim status or uh for we would need her permission.
[CUSTOMER][NEUTRAL] OK, can, can we call her right now so that you can put that I have um permission to talk on her behalf? Is that OK?
[AGENT][NEUTRAL] Uh, that's fine, uh, but it's only for the date unless we receive a third party authorization form that she can sign and date, um.
[AGENT][POSITIVE] But yes, we can.
[CUSTOMER][NEUTRAL] Oh, you mean it's only for today?
[AGENT][NEUTRAL] Uh, as far as any verbal communication, yes, ma'am.
[CUSTOMER][NEGATIVE] OK, um, well, I'm planning on asking you a bunch of questions, so about a bunch of bills, so, um, so I can get, I, I just called her about another one I had to, uh, because I'm getting now debt collectors because nobody, the these people will not put the APL through. I don't know what else I don't know how to make.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't know how to make the companies uh take my insurance.
[AGENT][NEUTRAL] And our, um,
[CUSTOMER][NEUTRAL] That's, that's where.
[AGENT][NEUTRAL] I'm so sorry. Um, when you're giving them the information, are you telling me it's a gap policy or a secondary policy?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Does it matter?
[AGENT][POSITIVE] It, it kind of helps if you.
[CUSTOMER][NEUTRAL] Is it what do you mean gap or secondary?
[AGENT][NEUTRAL] Yes ma'am. If you give the policy number and information to the provider, it is kind of best to just let them know it's a secondary policy instead of GAP because most GAP plans don't pay the provider, so most part providers won't submit the claim if we're not going to pay any benefits towards them. So it's just kind of just use different wording and it usually helps.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Different, yeah, I see what you're saying. I mean, I probably use both, both of those words honestly I I didn't know there was a difference until I just heard that from you, so, um, I will make sure to use secondary insurance, um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So this is for let me ask you, oh I can't ask you. I get, can I call her and see if because she just answered a second ago and gave permission for another thing. Can I do that now?
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello? Hey, can you, ma'am, can you hear me?
[AGENT][POSITIVE] I can, yes ma'am.
[CUSTOMER][NEUTRAL] OK, this is my daughter [PII].
[AGENT][NEUTRAL] OK. And [PII], verify your date of birth for me, please.
[CUSTOMER][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much and you're giving us permission to speak with your mom today in regards to any claims?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][POSITIVE] OK, uh thank you so much.
[CUSTOMER][POSITIVE] Thank you, thanks [PII], yeah, no problem, bye.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, so, um, because this is, uh, this bill, I, um, I don't, well, you don't have the bill, so you wouldn't know, so they did, um, a, an MRI, so would that even be covered on possibly on my APL insurance?
[AGENT][NEUTRAL] Uh, [PII], if it, if performed in an outpatient facility, and I will say this, since we got permission from [PII], we did receive a claim for that data service, but it wasn't for diagnostic, it was for facility charges.
[CUSTOMER][NEUTRAL] With any part of that.
[CUSTOMER][NEUTRAL] Right, yes, I do that was for the hospital, correct? That was for um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, what was that for? That was for Country Walk was that Country Walk Hospital? Let's see, [PII] emergency visit.
[AGENT][NEUTRAL] Uh, let's see, it shows [PII] Kindal Baptist. It was for an ER visit, yes ma'am.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK, um, and you've already paid out on that, correct?
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] And that was, that was $500 with that um I have two bills from there, wait, one from 925 and one from, oh they're both from $925.
[CUSTOMER][NEUTRAL] Oh wait, no, that's the same dog. Where's the other one?
[CUSTOMER][NEUTRAL] I don't know how people do this all the time. It is, so.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] I'm sure it's extremely frustrating, yeah.
[CUSTOMER][NEUTRAL] It's insane.
[CUSTOMER][NEUTRAL] Oh, it really is, um, OK, so that bills from 9/25. OK, so you have paid out on that, so I do owe that one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I do owe this 10.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Get
[CUSTOMER][NEUTRAL] Correct because you paid on that one for West [PII].
[AGENT][POSITIVE] Correct, we paid 500.
[CUSTOMER][NEUTRAL] OK, and what was the, does it show the original bill?
[CUSTOMER][NEUTRAL] Or, or can I verify with an account number or anything?
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Give me one moment let me pull up this claim.
[AGENT][NEUTRAL] So sorry, my computer is deciding that wanna celebrate Friday by being slow.
[AGENT][NEUTRAL] It's either Friday or Monday it seems um.
[CUSTOMER][POSITIVE] Exactly
[AGENT][NEUTRAL] It looks like a total charge amount of $19,691 and then.
[CUSTOMER][POSITIVE] Yes, yes, yes, yes.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] And it looks like after primary.
[AGENT][NEUTRAL] It looks like they applied um 4000.
[AGENT][NEUTRAL] 57411 towards the deductible and $500 towards the copay.
[CUSTOMER][NEUTRAL] OK, so that means we owe the $4,574.
[AGENT][NEUTRAL] Yes ma'am, but let me look at something real quick give me one moment.
[CUSTOMER][NEUTRAL] OK, I'm sorry I skipped another bill, but I was.
[AGENT][NEGATIVE] Uh no.
[AGENT][NEUTRAL] OK one moment.
[AGENT][NEUTRAL] Looks like it only just pay the 500, but.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It looks like that possibly more could be paid on the claim since it was a big chunk was applied towards the deductible.
[AGENT][NEUTRAL] And we pick up deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] So this one can be reprocessed and I can send a request to the provider to reprocess the claim.
[AGENT][NEUTRAL] But more unlikely,
[CUSTOMER][NEUTRAL] That would be awesome. I never got, I never got anything else on this. So this is, this is what is that bill was it spell it's from.
[CUSTOMER][NEUTRAL] Looking for a date.
[CUSTOMER][NEGATIVE] This is from December and I never got another bill from them so I was just, and I, I, I do have a note now that I see that you guys pay $500 but I'm like they never sent like what I mean yes I can deduct $500 from that. I get that but if my is that include Aetna? Does that include everything? Is that what I owe they never sent another bill.
[CUSTOMER][NEUTRAL] After December to update it.
[AGENT][NEGATIVE] Oh wow, I, I hate to say sometimes they send it slow for some reason.
[AGENT][NEUTRAL] It's like
[AGENT][NEUTRAL] There's both quite I know did process because we can only process after Aetna and they applied that um uh 4,57411 tours deductible and then 500 tours to co-pay.
[AGENT][NEUTRAL] And since we pay 500 then I assume many balance then would be patient responsibility.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, so, but you think something else can be paid out of that 4500 from APL?
[AGENT][NEUTRAL] Uh, yes, ma'am, because, um,
[AGENT][NEUTRAL] It's not a guarantee of payment, just verification of your coverage, but you do have an outpatient benefit max of up to 4000 per calendar year. And let me see if we process any other claims. Give me one moment.
[AGENT][NEUTRAL] Oh, this is for 24.
[AGENT][NEUTRAL] OK, it looks like she is, oh, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] We had it
[CUSTOMER][NEUTRAL] No, no, no, no, no, go ahead. I'll, I'll explain in a minute.
[AGENT][NEUTRAL] No, you're fine. It looks like minus so.
[AGENT][NEUTRAL] OK. It looks like.
[AGENT][NEUTRAL] She's already used um 1,899. 42 of 2024 of the 4000, so there is a balance of 2158 cents that could be processed extra.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, that is a huge uh blessing. I had no idea that they, I, I did not know the exact figure that they would pay up to, so can, can we reprocess this bill?
[AGENT][NEUTRAL] Um, I'll send this claim, uh, back to the claims department so they can review and explain that.
[AGENT][NEUTRAL] It looks like all the copay could have been processed and there is a big deductible amount, but I'll let the examiners know so they can reprocess.
[CUSTOMER][NEUTRAL] So you're gonna send this back to claims?
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] Is that what you're saying? I'm just kind of making notes so I can kind of help myself keep things clear, um.
[AGENT][NEUTRAL] Oh no, you're fine, but yes ma'am, I'm gonna send it back to claims so they can review it and I'm gonna put a detailed notes of what I'm seeing that it possibly can be reprocessed because it was more than 500 applied towards deductible copay or co-insurance.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, and that's.
[AGENT][NEUTRAL] Yes ma'am, I'll send a request today, but I say give it 3 to 5 business days.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, so I would, I would be able to call back by next week.
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so maybe like Friday or Monday of the following week?
[AGENT][NEUTRAL] What's today, I would say about, let's give it Wednesday for next week.
[CUSTOMER][NEUTRAL] Wednesday of.
[CUSTOMER][NEUTRAL] Let me say
[AGENT][NEUTRAL] I'll send a request for them to look at this because I see that more could be paid, but.
[AGENT][NEUTRAL] I just want them to take a second look at it.
[CUSTOMER][NEUTRAL] OK, so that is, I'm sorry, I'm looking, I've got a call coming now. I don't know who it is, um, it's an [PII] number, um, uh, that's the [PII] then or the [PII], no, the [PII].
[AGENT][NEUTRAL] Uh, the date of service?
[CUSTOMER][NEUTRAL] I know that I can call back [PII].
[AGENT][NEUTRAL] Oh, the [PII].
[CUSTOMER][POSITIVE] The [PII], OK, OK, OK, perfect.
[AGENT][NEUTRAL] Yeah, I was off today as far as is it, are we still in May? Well, we just began in May.
[CUSTOMER][NEUTRAL] I know I was like I'm still in April um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can, would you mind holding for just one second? I'm not sure this person, this [PII] number, OK, they, they quit, never mind. I'm not gonna worry about it. Um, OK, so I, we're that on that bill we're gonna send it back to claims, see if they can review it, and then I can call back on Wednesday to see if there's been any changes to it.
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. And then,
[AGENT][NEUTRAL] And more unlikely if it's payable then it'll max out any benefits she has for outpatient for that year.
[CUSTOMER][NEUTRAL] Right, so that would mean even if they haven't gone through on other bills, we would, we would be responsible for the balance.
[AGENT][NEUTRAL] Yes, ma'am, because they'll they'll process it as balance, uh, benefits max for the calendar year.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and I can find that out on Wednesday as well.
[AGENT][NEUTRAL] Uh yes ma'am.
[CUSTOMER][NEUTRAL] OK, perfect. OK um so then maybe I should, should I go through any of these other bills or just wait till Wednesday? What's your thoughts?
[AGENT][NEUTRAL] Uh, the other bills, what year were the service, was it [PII] or [PII]?
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] It was all in um 92524 9 yeah, [PII].
[AGENT][NEUTRAL] Oh, so.
[AGENT][NEUTRAL] OK, um, I would say hold hold off until you receive word Wednesday of the status because like I said, um,
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] If they are able to reprocess this claim more than likely they'll pay.
[AGENT][NEUTRAL] Up to that max benefit, so there wouldn't be anything remaining for 24. So any claims you submit after that will be processed as benefits max for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that that would actually make it pretty simple, then I wouldn't have to call anybody. I just need to pay it.
[CUSTOMER][NEUTRAL] Um, yeah, that would make it a lot simpler actually because I have a stack of bills. I mean, not that it would be simple to pay but simple to not have to spend the time calling. So when I call back Wednesday, I just wanna verify I just asked them to check and see um what what wording should I use to just check how how they reprocessed it or.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes ma'am, you can call and see if the claim for that data service of 925 for [PII] was reprocessed and also we'll let you know more like you probably have to call her then, uh, just to give a confirmation it's OK to speak with you because if it's a verbally we have to do it that day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Every time, OK. All right. OK, thank you so much for your help. I really appreciate it.
[AGENT][POSITIVE] You are welcome and I thank you for calling APO Ms. [PII]. You have a great day.
[CUSTOMER][POSITIVE] Have a great day. Bye-bye.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Trying to hang up and hang up.