AccountId: 011433970860
ContactId: 93245bdc-4cbf-4279-8ad2-4afc2bf2d339
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 5424770 ms
Total Talk Time (AGENT): 656766 ms
Total Talk Time (CUSTOMER): 1523525 ms
Interruptions: 12
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/93245bdc-4cbf-4279-8ad2-4afc2bf2d339_20250127T20:25_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] Hi, [PII]. My name is [PII]. Um, we are covered by American Public Life as a supplemental policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have a payer ID and the reason I'm calling is because.
[CUSTOMER][NEGATIVE] Um, there seems to be a like a miscommunication or disconnect between my children's pediatrician.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] American Public Life.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Where apparently.
[CUSTOMER][NEUTRAL] I, I'm not really sure what's going on, but they didn't even have American public life right now in their system.
[CUSTOMER][NEUTRAL] And so my son cannot get seen right now because my account is in collections.
[CUSTOMER][NEGATIVE] And without them having American public life, that, that tells me that it hasn't even been processed through American public life.
[AGENT][NEUTRAL] Right. OK.
[CUSTOMER][NEUTRAL] How do I speed up this process?
[CUSTOMER][NEUTRAL] And I'm at the pediatrician's office now.
[AGENT][NEUTRAL] OK. Well, first, let me um pull up the policy. You said you have the group number?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, [PII]. Yes, can you hear me?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I can hear you now.
[AGENT][NEUTRAL] OK. May I have your policy number or you said you have the group number?
[CUSTOMER][NEUTRAL] I have a payer ID number. I have a group number. Which one do you prefer?
[AGENT][NEUTRAL] Do you have the policy certificate number?
[CUSTOMER][NEUTRAL] I have an in hospitals benefit certificate number and I have an outpatient benefit certificate number. I mean we're not in the hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, they're the same, that ML 7 or 8 is different. I just need the numbers.
[CUSTOMER][NEUTRAL] Which one?
[AGENT][NEUTRAL] It's the same.
[CUSTOMER][NEUTRAL] The in-hospital benefit certificate number is not the same as the outpatient benefit certificate number.
[AGENT][NEUTRAL] OK, what's the 02 or 01 number that you see for outpatient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] For outpatient I see 02443500 M as in Mary L as in Larry 8.
[AGENT][NEUTRAL] And what is it for inpatient?
[CUSTOMER][NEUTRAL] Um, yeah, my son is being checked. He's being checked his ML8 for outpatient. OK, thanks.
[AGENT][NEUTRAL] It should be like an ML.
[AGENT][NEUTRAL] It's OK, it's OK. I got it. The numbers in the beginning are the same, but I pulled it up. Hold on one moment.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And I'm in the policy, I just need you to verify um your son's first and last name and date of birth.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And the mailing address on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, I'm just looking at the um policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what's the name of the provider's office, the facility?
[CUSTOMER][NEUTRAL] Pediatrics associates.
[CUSTOMER][NEUTRAL] Pediatric Associates.
[AGENT][NEUTRAL] Matric Associates. OK, hold on one moment.
[CUSTOMER][NEUTRAL] I wanna understand if any claim has ever been brought to American Public Life.
[AGENT][NEUTRAL] Right, I'm looking through them now. Hold on one moment.
[AGENT][NEUTRAL] Right, so I only see claims from [PII] Children's Pediatrics and then let me go, let me go back out. Hold on one moment, there was one more.
[AGENT][NEUTRAL] Kids Medical Services Incorporated, but those are the only two providers that have filed claims. So the only, so there's no um timely filing, like there's no deadline or anything to file a claim, as long as the policy was active on the data service, they can file at any time. So do they need like, I can give you the the fax number, the mailing address, whatever they need, I can provide it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] I, I mean they're asking for payment if not they won't see my son.
[AGENT][NEGATIVE] Well, they can't do that because they haven't filed a, can I speak to someone there? They can't, they can't do that to you because they didn't file the claim. It would be different if they filed and, and it was denied and you just didn't pay, but that's not what happened.
[CUSTOMER][NEUTRAL] The thing is, is that
[CUSTOMER][NEGATIVE] The office here is is not billing the office here is not billing, so I don't know what they can do.
[CUSTOMER][NEUTRAL] And I'm on hold on another phone on another line with billing for pediatrics associates.
[AGENT][NEUTRAL] So, OK, so what I'm, what I'm trying to explain to you is as your secondary insurance, if they're not going to, first of all, they, they, I don't know why they're not billing is a problem because you have a secondary insurance. So if
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I know, but it wasn't in their system, and I've been at this for 2 years with them, and for whatever reason, the secondary insurance does not stay in their system.
[AGENT][NEUTRAL] That is not of your control and you should not be in collections because there's exactly, that's, I'm on your side. I'm that's what I'm saying. Is there someone, you said you're there now, right?
[CUSTOMER][NEGATIVE] That's that's out of my control.
[CUSTOMER][NEGATIVE] And they can't tell me why it's not in the system.
[CUSTOMER][NEUTRAL] I'm here now.
[AGENT][NEUTRAL] Is there a receptionist, somebody, because if you're in collections and they're not going to see your son, then they, they can't do that.
[AGENT][NEUTRAL] They, they have to file the, so then I need to, would you like me to speak with someone?
[CUSTOMER][NEUTRAL] I mean they're doing it.
[CUSTOMER][NEUTRAL] I mean you can try and I've got [PII] I'm still on hold for billing.
[AGENT][NEUTRAL] Because if they're not going to um listen to you, like,
[CUSTOMER][NEUTRAL] Let me see if I can
[CUSTOMER][NEUTRAL] You wanna get on the call with my American Public Life?
[CUSTOMER][NEUTRAL] There there's never been one claim submitted to American public life.
[AGENT][NEGATIVE] That doesn't make any sense.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I've had it over 2 years I provided it.
[CUSTOMER][NEUTRAL] Fine
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Who's they?
[CUSTOMER][NEUTRAL] I'm at 14 minutes already.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Does she not have an S?
[CUSTOMER][NEUTRAL] I wish that I can tell
[CUSTOMER][NEUTRAL] It's in collections right now, so she, there's nothing she can do.
[AGENT][NEGATIVE] Well, she's gonna have to figure it out because it should have not, it can't be, it shouldn't have been sent to collections. They never filed the claim, that's them. That's not you.
[AGENT][NEGATIVE] If you see what I'm saying, like it would be different if they filed the claim and it was denied and then you didn't pay and it went to collections, but you can't just send something to collections and you didn't file all of the insurances and then and then not see them. That's not right.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Well, I can hold if you like. I can speak with whoever.
[CUSTOMER][NEUTRAL] This happened to me in June and I ended up paying it here because I needed to have my kids see it.
[CUSTOMER][NEUTRAL] But I provided American Public Life back in June.
[CUSTOMER][NEGATIVE] Not even like in the massive.
[CUSTOMER][NEUTRAL] I don't know. The only thing we can do, like I said just pay it and then you try to get and what happens if I pay it?
[CUSTOMER][NEUTRAL] Ma'am?
[AGENT][NEUTRAL] Oh, me, I'm sorry, I thought you were talking to her. You said what happens if you pay it?
[CUSTOMER][NEUTRAL] Hello? Yes. Yeah.
[AGENT][NEUTRAL] I mean, you can still, the claim can still be submitted and then you can be, you know, reimbursed after processing.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I did.
[AGENT][NEUTRAL] Or they can file the claim and have us pay them, but
[CUSTOMER][NEUTRAL] OK, I will have to see. But nobody answers in the billing department. Nobody answers in the department. Been at this since yesterday, OK, because.
[AGENT][NEUTRAL] I just
[AGENT][NEGATIVE] I shouldn't be this.
[CUSTOMER][NEGATIVE] They weren't even gonna allow me to schedule my son for the appointment because of the of this.
[AGENT][NEUTRAL] Have they, but you always gave them, but they've always had this information, right?
[CUSTOMER][NEGATIVE] I haven't been able to get through billing.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] No, it hasn't. Of course, I've had American public life for over 2 years now.
[AGENT][NEUTRAL] I mean, you know, they're saying about their system, but you gave it to them. Is that correct?
[AGENT][NEUTRAL] OK, I just want to make sure, so.
[AGENT][NEUTRAL] I'm just asking, so if someone asks me, I can give them all the details.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][POSITIVE] Yes, 100%.
[AGENT][NEUTRAL] OK, what is the, um, do you have a phone number for them? I can try to call as well. I mean, they should, she should be doing more. This is escalated like um it doesn't seem like there's any urgency.
[CUSTOMER][NEUTRAL] Um, so I have a billing number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna place you on just a brief hold and call on the other line, OK?
[CUSTOMER][NEUTRAL] I mean you get through for me.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] This is ridiculous. And they're gonna turn the baby away.
[AGENT][NEGATIVE] Terrible.
[CUSTOMER][NEUTRAL] You have reached the pediatric Associates administrative office. Please listen carefully before making a selection.
[CUSTOMER][NEUTRAL] Our office hours are [PII] Monday through Friday.
[CUSTOMER][NEUTRAL] If you know your party's extension, you may dial it at any time.
[CUSTOMER][NEUTRAL] If you are patient with a question about a bill or your insurance, please press one.
[CUSTOMER][NEUTRAL] If you are a vendor calling accounts payable, please press 4. For marketing, please press 5. For purchasing, please press 8. For human resources, please press 9.
[CUSTOMER][NEUTRAL] If you would like our company directory, please press 6.
[CUSTOMER][NEUTRAL] Thank you for calling Pediatric Associates Patients accounts department. For quality assurance purposes, this call may be monitored. If this is a medical emergency, please hang up and dial [PII] or [PII].
[CUSTOMER][NEUTRAL] Our patient accounts department office hours are Monday through Friday 8:00 a[PII] Eastern Standard Time, excluding holidays. You may also contact us for any questions, concerns, or to make payments by visiting us online at [PII]. Your inquiries will be answered within 24 to 48 hours, not including weekends and holidays. To speak to a customer service representative, choose one of the following options and have your account number available.
[CUSTOMER][NEUTRAL] To make a payment or set up a payment plan with a patient account representative, press 1. To provide or update insurance information, press 2. For questions on a bill you have received, press 3. For status on a refund, press 4. If you are calling from an insurance company, press 5.
[CUSTOMER][NEUTRAL] If you're a. Your call may be monitored or recorded for quality or training purposes.
[AGENT][NEUTRAL] I'm on hold.
[CUSTOMER][NEUTRAL] I've been on hold for 19 minutes now.
[AGENT][POSITIVE] Well, hopefully we get, so I use the insurance one, so hopefully that will help.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm still here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean, I've been waiting already 25 minutes.
[AGENT][NEGATIVE] I just can't believe that they're not, that they're not assisting you in the office with even trying to get someone.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEGATIVE] That's terrible.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] OK, so I got through to them on my end. Hello.
[CUSTOMER][NEUTRAL] Ma'am, what's the account number please?
[AGENT][NEUTRAL] OK, I hear them.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Hold on one second, let me get the account number because I'm actually here at the office.
[CUSTOMER][NEUTRAL] What's the account number? Can you write it down?
[CUSTOMER][NEUTRAL] Hi, yes, who am I speaking with?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, I'm here as well.
[CUSTOMER][NEUTRAL] OK, the account number is 598342.
[CUSTOMER][NEUTRAL] Uh, [PII] 0402-2009.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, and I have my, I have my insurance company on the other line.
[AGENT][NEUTRAL] Is there a way that she can maybe call me?
[CUSTOMER][NEUTRAL] Hold on because I'm gonna put both of you guys on speaker. I'm gonna step out of the office. I'm sorry ma'am.
[CUSTOMER][NEUTRAL] I need to get out first.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, we're here.
[CUSTOMER][NEUTRAL] Are you all here together?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, this is [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] And uh, OK, hold on one second because.
[CUSTOMER][NEUTRAL] And I don't know what happened to this call.
[CUSTOMER][NEGATIVE] I cannot believe this.
[CUSTOMER][NEUTRAL] Are you still on hold?
[AGENT][NEUTRAL] No, I can give them a call back.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] Yes, please call them back. I lost them.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Account
[CUSTOMER][NEUTRAL] You have reached the pediatric Associates administrative office. Please listen carefully before making a selection.
[CUSTOMER][NEUTRAL] Our office hours are [PII] Monday through Friday.
[CUSTOMER][NEUTRAL] If you know your party's extension, you may dial it at any time.
[CUSTOMER][NEUTRAL] If you are patient with a question about a bill or your insurance, please press [PII].
[CUSTOMER][NEUTRAL] If you are a vendor calling accounts payable, please press [PII].
[CUSTOMER][NEUTRAL] Thank you for calling Pediatric Associates Patients accounts department. For quality assurance purposes, this call may be monitored. If this is a medical emergency, please hang up and dial [PII] or [PII].
[CUSTOMER][NEUTRAL] Our patient accounts department office hours are Monday through Friday [PII] Eastern Standard Time, excluding holidays. You may also contact us for any questions, concerns, or to make payments by visiting us online at [PII]. Your inquiries will be answered within 24 to 48 hours, not including weekends and holidays. To speak to a customer service representative, choose one of the following options and have your account number available.
[CUSTOMER][NEUTRAL] To make a payment or set up a payment plan with a patient account representative, press 1. To provide or update insurance information, press 2. For questions on a bill you have received, press 3. For status on a refund, press 4.
[CUSTOMER][NEUTRAL] If you are calling from an insurance company, press 5.
[CUSTOMER][NEUTRAL] Thank you. Your call may be monitored or recorded for quality or training purposes.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I just want to make sure I still had you.
[CUSTOMER][NEUTRAL] I mean this could be another 30 minutes before they pick up the phone.
[CUSTOMER][NEUTRAL] Your call is important to us. Please remain on the line and your call will be answered by the next available agent.
[CUSTOMER][NEUTRAL] My insurance
[CUSTOMER][NEUTRAL] She's still trying to get to
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] what we can do. There's some people that are on payment plans. There are some people that you know.
[CUSTOMER][NEUTRAL] It wasn't.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] My.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Why
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] It wasn't
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] I shouldn't have had to have made that payment.
[AGENT][NEUTRAL] I thought somebody was about to answer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, what did you say? I couldn't hear you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Will they be able to, will they be able to call you directly if the call gets dropped like it just did?
[AGENT][NEUTRAL] Yes, if they have the, yes.
[AGENT][NEUTRAL] You want me to give you that, that.
[CUSTOMER][NEUTRAL] How will they be able to call you directly?
[AGENT][NEUTRAL] So it's [PII].
[CUSTOMER][NEUTRAL] Hold on, this is if the call gets dropped again we can call you directly.
[AGENT][POSITIVE] Right, the number I'm getting ready to give you, yes.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] Um, so it's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] is that correct?
[AGENT][POSITIVE] Yes, that's right.
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To 12 minutes now.
[AGENT][NEGATIVE] I'm going to connect this all. I just can't believe that they're not even trying to help. This is, I'm so sorry that you have to go through that.
[CUSTOMER][NEUTRAL] Well, the, the lady at the front desk already sent just sent an email now to the billing department.
[AGENT][NEGATIVE] That's terrible. Even if they had a hold or something, they still need to take it off until they file the claims like they can't and then to not see it.
[CUSTOMER][NEUTRAL] Because she says there's nothing that they can do, not in this office.
[AGENT][NEUTRAL] Well, I understand that part because they're front desk, not really like billing, but hold on one second, I'm just gonna, uh,
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] Reconnect, they're on hold on the other line.
[CUSTOMER][NEUTRAL] Don.
[CUSTOMER][NEUTRAL] 22 minutes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Has she received a response from the email?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, do you know if she's, yes, do you know if she's received a response from the email? Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Did you get a response?
[CUSTOMER][NEUTRAL] Well, my son is checking now
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello, [PII]?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Nothing on your
[AGENT][NEUTRAL] This is the, yeah, we're on hold.
[CUSTOMER][NEUTRAL] I mean they close in 40 minutes.
[AGENT][NEUTRAL] Do you want to try again tomorrow, or you think you wanna hold?
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Today
[AGENT][NEGATIVE] This is terrible.
[CUSTOMER][NEUTRAL] Thank you for calling Pediatric Associates billing office. My name is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII]. My name is [PII]. I'm, we're calling from American Public Life. I have the insured on the line as well. This is the billing department, correct?
[CUSTOMER][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yeah, where are you calling from?
[AGENT][NEUTRAL] American Public Life, for her insurance company. The patients on the line as well.
[CUSTOMER][NEUTRAL] OK. Hello, [PII].
[AGENT][NEUTRAL] So the
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So this is
[AGENT][NEUTRAL] So there's several claims that have not been sent to us that are now in collections, but they were never sent to her secondary insurance and the facility is refusing to see her son. So I'm trying to see what we can do to help her because the claims need to be filed so that we can get a chance to pay or at least give a decision.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that insurance, uh, a gap insurance?
[AGENT][NEUTRAL] Yeah, it's a secondary insurance, yes.
[CUSTOMER][NEUTRAL] Is, is it considered a gap insurance?
[AGENT][NEUTRAL] Supplemental.
[AGENT][NEUTRAL] It's not technically no, it's supplemental. Like on our paperwork, it doesn't say gap, it's a supplemental medical um insurance that goes with our primary.
[CUSTOMER][NEUTRAL] It's a supplemental.
[CUSTOMER][NEUTRAL] It's a supplemental.
[AGENT][NEUTRAL] Do you not bill to secondary insurances?
[CUSTOMER][NEUTRAL] We do, but we don't build gap insurance. That's why I'm asking. So let me, give me a second. What's the patient's last name? [PII]
[CUSTOMER][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] They're calling you.
[CUSTOMER][NEUTRAL] You go inside, please. His first name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Which office do you go to? [PII]?
[CUSTOMER][NEUTRAL] That's 3
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh, take it.
[CUSTOMER][NEUTRAL] I think somebody already worked on this. Somebody reached out from the front office at the [PII] location, reached out to the person that hand.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEGATIVE] Ma'am, I've been waiting here for 1 hour and 24 minutes trying to resolve this.
[AGENT][NEUTRAL] So you're saying that someone
[CUSTOMER][NEUTRAL] OK, did you not hear what did you, did you did not hear what I said? Don't just gotta make sure because although you were waiting on the phone, meanwhile the office reached out to us already regarding the same thing.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, but here's the situation that I have. I've had American public life as my supplemental for over 2 years now. I was in the same scenario in May, and I didn't want to have to deal with insurance and waiting, so I ended up paying it, OK? And that's what happens because people get frustrated and then they just pay.
[CUSTOMER][NEGATIVE] My secondary insurance was not even in the system, and I know that every single physician that we have has this in their system. So why is it that pediatric associates just happens to keep making it disappear?
[CUSTOMER][NEUTRAL] I don't understand either, ma'am. I don't work at the doctor's office. I'm not 100% sure what's going on, why they take it off, but it's on the system right now. No, it's on the system now because the lovely lady that was in the front desk added it on.
[CUSTOMER][NEUTRAL] Oh, OK, but, well, I have no way. I have so many people working on these accounts and a lot of things have changed. There's a lot of things that happen that we don't know, but all you have to do when you get the bill instead of going to the doctor's office because sometimes our system doesn't.
[CUSTOMER][NEUTRAL] Pick up the secondary insurance and we have to manually bill the secondary insurance, so sometimes that's what happens so my suggestion to you is whenever you get the bill instead of going to the doctor's office, all you have to do is call us through here and we'll take care of it for you.
[CUSTOMER][NEGATIVE] Ma'am, I've been trying to get through billing yesterday and now today I waited 30 minutes and then the call got dropped.
[CUSTOMER][NEUTRAL] OK, Ms. [PII], it, I, I'm so sorry. I just took your phone call and I saw that somebody already worked your account. I mean there's nothing else to do to your account. I do apologize for the inconvenience that you had encountered. I do need to understand where my account is.
[AGENT][NEUTRAL] Wait a minute, wait a minute.
[CUSTOMER][POSITIVE] I do understand ma'am. I do understand and I need basically.
[CUSTOMER][NEUTRAL] I need to understand where the status of my account is.
[CUSTOMER][NEUTRAL] Well, your account was already removed from collection, ma'am, and your secondary insurance is being billed.
[CUSTOMER][NEUTRAL] How do I get that confirmed?
[CUSTOMER][POSITIVE] Because I'm letting you know, my name is [PII] and American Public Life was billed. The front office, I confirmed everything for you. The front office at the [PII] location, she already reached out to us and we already worked on the account.
[CUSTOMER][NEUTRAL] It was worked by my co-worker.
[CUSTOMER][NEUTRAL] OK, so what do I do with all the past insurance, I mean all the past claims that have not been put put in American public life?
[CUSTOMER][NEUTRAL] OK, what other, do you have the data services?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I mean, I can go back into the office and she can give me every single date.
[CUSTOMER][NEUTRAL] I don't know how far back they can go um I can send um.
[CUSTOMER][NEUTRAL] I can send another inquiry regarding the same thing letting them know uh if they can look up uh I don't know what dates or services you're referring to that's the only thing you probably will have to tell me what data services that you are talking about to see and I will give you every single day for the last 2 years.
[AGENT][NEUTRAL] So is the sun being seen today though, because that was the main concern.
[CUSTOMER][NEUTRAL] Yeah, the child can be seen.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm. And the only claims that she's probably referring to is what we just removed it was removed from um transfer to transfer to.
[CUSTOMER][NEUTRAL] She has to tell me the date of service that she that she's been here for the last 2 years, just all the dates so that billing can have a record because not once has my secondary insurance been billed.
[CUSTOMER][NEUTRAL] And it's probably because back in May, maybe she thought it was a gap insurance and she didn't even put it in. OK, let me see.
[CUSTOMER][NEUTRAL] I mean for [PII] and [PII].
[CUSTOMER][NEUTRAL] You said the past 3 years, 3 years.
[CUSTOMER][NEUTRAL] [PII], can you tell me how long we've had American Public Life [PII].
[AGENT][NEUTRAL] Um, hold on.
[CUSTOMER][NEUTRAL] I think it goes back to [PII].
[CUSTOMER][NEUTRAL] On the card it says [PII].
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] No, but that just could be for this policy please.
[AGENT][NEUTRAL] So originally you had it, originally you had it um from [PII], and then the current one that's active now uh has been sent.
[CUSTOMER][NEUTRAL] [PII], from [PII].
[CUSTOMER][NEUTRAL] So do you want the [PII] to out? Yes.
[CUSTOMER][NEUTRAL] So that the billing department has it all.
[CUSTOMER][NEUTRAL] Yeah, but I'm, I'm scanning the account, ma'am, and I don't see any bills that needed to be filed in [PII].
[CUSTOMER][NEUTRAL] It would have started December, so you would have had. OK, [PII], [PII]. OK. Sure.
[CUSTOMER][NEUTRAL] So anything that started [PII], the last claim was [PII], and then everything started um forward on [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Do I have to
[CUSTOMER][NEUTRAL] To go that way or?
[CUSTOMER][NEUTRAL] For the corn?
[CUSTOMER][NEUTRAL] Yeah, OK, mm.
[CUSTOMER][NEUTRAL] OK, the lady from the insurance company, can I have your name again?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] OK, can you give me the effective date of the policy again?
[AGENT][NEUTRAL] Yes, um, originally or they currently active?
[CUSTOMER][NEUTRAL] No, anything after [PII].
[AGENT][NEUTRAL] So these
[CUSTOMER][NEUTRAL] For [PII] because the claim for [PII], the only thing that I have for [PII], which was the last day of service was November, so anything after that one won't count.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So then that policy that was active in [PII] termed on [PII].
[CUSTOMER][NEUTRAL] I just
[AGENT][NEUTRAL] And then there's now an active policy that became effective [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so the insurance was effective [PII], I'm sorry, let me go back. [PII] through. What was, what was it again?
[AGENT][NEUTRAL] So the first policy was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The second policy was [PII] till now, it's still active.
[CUSTOMER][NEUTRAL] 10
[CUSTOMER][NEUTRAL] [PII] through current or through present.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, give me one second, thank you, thank you. I'm gonna go in.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Have you seen the doctor?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And um, the insurance, you said it was affected [PII] through what through what date?
[AGENT][NEUTRAL] The first one was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the parent didn't have any insurance for [PII] because they came back on January, what day?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] So there's two policies. So if you have any claims from [PII], you can file it with the first one. Anything after [PII], you will file with the currently active policy number. Did you need them both?
[CUSTOMER][NEUTRAL] No, it
[CUSTOMER][NEUTRAL] OK, what was the, what was the ID number for the [PII]?
[AGENT][NEUTRAL] So it's 182.
[AGENT][NEUTRAL] 2314.
[CUSTOMER][NEUTRAL] And the [PII]?
[AGENT][NEUTRAL] The [PII] um policy is 2,443,500.
[CUSTOMER][NEUTRAL] Are you saying [PII]?
[AGENT][NEUTRAL] Yes, the second policy became effective on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And you said 244-3500?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, give me a second, thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh hello I know and I was in one. I'm so sorry. Oh, OK, hold on, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yeah, yeah.
[CUSTOMER][NEUTRAL] that to be.
[CUSTOMER][NEUTRAL] And that policy number that you just gave her.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How come I don't see that policy number on our card?
[AGENT][NEUTRAL] Which one, the 244?
[CUSTOMER][NEUTRAL] Oh, because it's together with the ML 244,350.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] You see it?
[CUSTOMER][NEUTRAL] I see, I see.
[CUSTOMER][NEUTRAL] Yeah, it's just a longer version that we have on our cards.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um, ATL, so it's a little confusing. Um.
[CUSTOMER][NEUTRAL] But I would like for you to give me the number of the policy before [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, that one is 182.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 182.
[AGENT][NEUTRAL] Mhm. 2314.
[CUSTOMER][NEUTRAL] 2314 and putting in a claim there's no limitation.
[AGENT][NEUTRAL] Not for us because we're not like your major medical, um, we're your your secondary, so we don't have a timely filing as long as the policy was active on the data service.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and that was [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so I'm gonna go back.
[CUSTOMER][NEUTRAL] OK, I hope she did not confuse like the January date because she said January again.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Even, well,
[CUSTOMER][NEUTRAL] Yeah, because she, she thought that maybe there was a gap between December and January.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] I mean, hopefully she's not confused.
[AGENT][NEUTRAL] Yeah, even if she does put January with the 2nd 1 though, it'll still be fine.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Like I have made so many payments because they failed to
[CUSTOMER][NEUTRAL] Reach out to you guys.
[AGENT][POSITIVE] I'm definitely sorry for that experience, and so they were able to see him?
[CUSTOMER][NEUTRAL] Um, yes, we're in the room now.
[AGENT][POSITIVE] Good.
[AGENT][POSITIVE] OK, good.
[AGENT][NEUTRAL] When I heard that, I was like, wait a minute, what? No, no.
[CUSTOMER][NEUTRAL] Well, apparently it's the, it's the policy that if an account is in collection, they can't, the patient cannot be seen.
[AGENT][NEUTRAL] Well, yeah, that, I mean, that makes sense, but after you've done your part to collect, you haven't, they didn't even bill all your insurances.
[AGENT][NEGATIVE] And I wonder how it keeps deleting.
[CUSTOMER][NEGATIVE] Yeah, that's what concerns me the most is why it doesn't stay in the system.
[AGENT][NEUTRAL] Maybe it's because maybe they put it as gap initially.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Oh, no.
[AGENT][POSITIVE] But hopefully, after this, it'll stay in there and you won't have these issues anymore and your baby can be seen w[PII] he has to be.
[CUSTOMER][POSITIVE] Yeah, I hope so.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] I think I said it was time again [PII].
[CUSTOMER][NEUTRAL] I should know.
[CUSTOMER][NEUTRAL] Yes, but don't lose the cost.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And here's a call.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So I don't know if they're going, if they going to do it.
[CUSTOMER][NEUTRAL] 1 hour, 17.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And are we still on hold with billing?
[AGENT][NEUTRAL] Yes, I, I believe so. Yes, she put us.
[AGENT][NEUTRAL] Let me see if the, yeah, they're still on the line.
[CUSTOMER][NEUTRAL] 65.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient credit card.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] OK ma'am thank you so much for holding so I scanned it the both of the children with the um claims that I feel that they qualify, which I see where you've made some payments but still they're gonna have to work it um so [PII] has more claims than [PII], OK? So I send it over to my general department letting them know you're concerned and how the insurance company needs to be billed so they can go ahead and work on that.
[CUSTOMER][NEUTRAL] OK, I don't have any update to give you right now because there's another department doing it and I don't know how busy they are over there and how fast they're gonna work on the account.
[CUSTOMER][NEUTRAL] OK, but how do I know? because I got a printed copy of everything from [PII], so I can see everything that I have paid.
[CUSTOMER][NEUTRAL] So how do I know that everything that I have paid.
[CUSTOMER][NEUTRAL] OK, because the claims that I just claim, the claims that I scan it, ma'am, unfortunately for, for patient [PII], I only have two, which is [PII] and [PII].
[CUSTOMER][NEUTRAL] And then for [PII] I have [PII], [PII]. I'm sorry, hold on.
[CUSTOMER][NEUTRAL] For [PII] you have?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For how much?
[CUSTOMER][NEUTRAL] I don't have the amount. I kind of just scanned it where I saw your payments being made.
[CUSTOMER][NEUTRAL] I will have to go back to that.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] How about [PII]?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] [PII] of 21 months, I see a payment for $45.
[CUSTOMER][NEUTRAL] In [PII] there isn't a payment, no ma'am, that was a copy of a chart that you requested.
[CUSTOMER][NEGATIVE] That's $6. The insurance is not gonna cover that. Mhm.
[CUSTOMER][NEUTRAL] [PII] was not a claim. That was not a claim, ma'am.
[CUSTOMER][NEUTRAL] OK, what's the next one?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] $45.
[CUSTOMER][NEUTRAL] [PII] you mean [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That was $45.
[CUSTOMER][NEUTRAL] But you said [PII]?
[CUSTOMER][NEUTRAL] I don't see [PII].
[CUSTOMER][NEUTRAL] [PII] 9 the [PII].
[CUSTOMER][NEUTRAL] Yes, [PII] I have.
[CUSTOMER][NEUTRAL] And then you said [PII].
[CUSTOMER][NEUTRAL] I just said [PII], ma'am. I don't have the [PII] it's September, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, what's after [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then after that, it's um [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For 125.
[CUSTOMER][NEUTRAL] And 37 cents? No, that's what it looks like, yes ma'am, 125 37.
[CUSTOMER][NEUTRAL] July and it was processed in May.
[CUSTOMER][NEGATIVE] Right, because of course that was probably another collection payment that I had to make in order for my kids to be seen, for no reason.
[CUSTOMER][NEUTRAL] So, ma'am, so that's why I'm saying this, when you get your bill, make sure you call the billing office before you get to the doctor's office because if you get there, they're not gonna bill your secondary insurance and they're gonna be really quick to collect your balance. So try not to do that.
[CUSTOMER][NEGATIVE] Oh, I don't understand why would they not bill my secondary insurance if it's if it's because they don't, they're not equipped, they're not equipped to do that.
[CUSTOMER][NEUTRAL] Your billing department is not equipped?
[CUSTOMER][NEUTRAL] The doctor's office.
[AGENT][NEUTRAL] The doctor's office is not equipped to build their 2 insurance?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right, that's what I'm saying, yes ma'am.
[AGENT][NEUTRAL] So she's always going to get bills and have to call y'all to tell y'all to bill us even though you have the information on file.
[CUSTOMER][NEUTRAL] So what
[CUSTOMER][NEGATIVE] There's a mhm. It, it doesn't bill automatically, ma'am, no. Unfortunately.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK ma'am, so we're pretty much set, OK? So I'm gonna go ahead and send the email over with all those dates, OK? I, I'd like to see [PII]'s account, [PII]'s account.
[CUSTOMER][NEUTRAL] [PII] on that only has 2 [PII] and [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Here we go, $45.
[CUSTOMER][NEUTRAL] OK, and then uh what about the [PII]?
[CUSTOMER][NEUTRAL] Right, I have that down correct, and that's the last one, correct.
[CUSTOMER][POSITIVE] service adjustment. Oh wonderful with your billing department.
[CUSTOMER][NEUTRAL] With my my family has that's why I'm like I don't.
[CUSTOMER][NEUTRAL] OK, yes, I still have the money.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK, so what happens now?
[CUSTOMER][NEUTRAL] Oh, I already explained it to you. I'm gonna send an email over to my general department so they can go ahead and look at the account for those data services and they're gonna bill it to the insurance company.
[CUSTOMER][NEUTRAL] OK, and how do, what's the best way for me to follow up?
[CUSTOMER][NEUTRAL] OK, the number here is [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, and is there a specific department that I should be reaching? That's directly here to the billing office.
[CUSTOMER][NEUTRAL] Billing office, OK.
[CUSTOMER][POSITIVE] All right, hopefully this clears everything.
[AGENT][POSITIVE] OK. Hold the line for me, um, Ms. [PII]. Thank you so much for your assistance, ma'am.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] You're welcome. Bye-bye.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][POSITIVE] OK. Um, well, I'm glad we got to the bottom of it. I'm sorry, I'm so sorry you had to go through that.
[CUSTOMER][NEUTRAL] That's OK. It's, I needed to do it once and for all.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] I'm glad he was able to be seen. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] No, that's it. Hopefully this gets resolved.
[AGENT][NEUTRAL] All right. I hope it does too. Um, you also can check with us if you want to, um, to see, you know, if the claim's been received. I would just give us a call, our [PII] number, we can um let you know if we have received anything. Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How do I check with you?
[CUSTOMER][NEUTRAL] Understood.
[AGENT][NEUTRAL] And try to check for you.
[CUSTOMER][POSITIVE] OK, perfect. Thank you. OK, [PII], thank you very much.
[AGENT][POSITIVE] You're very welcome. Well thanks for calling APL. You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] OK bye bye.
[AGENT][NEUTRAL] Bye bye.