AccountId: 011433970860
ContactId: 969762ab-5493-4d9f-8f46-20db88b1b94f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 805799 ms
Total Talk Time (AGENT): 293112 ms
Total Talk Time (CUSTOMER): 391430 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/969762ab-5493-4d9f-8f46-20db88b1b94f_20250210T23:29_UTC.wav
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[CUSTOMER][NEUTRAL] Back up OK when I get someone.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Oh definitely.
[CUSTOMER][NEGATIVE] Hi, good evening. I'm calling because I'm at the urgent care right now and um they're stating that I have a copay when I normally don't because American public picks it up. Apparently something about you guys are not responding.
[CUSTOMER][NEUTRAL] And so they wanna charge you $125.
[AGENT][NEUTRAL] OK, do you have a policy number? I can double check your policy.
[CUSTOMER][NEGATIVE] How do I fix this?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I have a group number. I have the card with me. um, I have an in hospitals benefit number and an outpatient benefit number which number do you like?
[AGENT][NEUTRAL] You can give me either one, ma'am and I can pull it up.
[CUSTOMER][NEUTRAL] OK honey, I'm gonna give you the outpatient one. It's uh 01369.
[CUSTOMER][NEUTRAL] 754.
[CUSTOMER][NEUTRAL] M like in Mary, L like in Larry, and the number 8.
[AGENT][POSITIVE] Alright, thank you so much. Let me pull this up. Let me.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Do you need me to speak to the receptionist there to verify the benefits for them?
[CUSTOMER][NEGATIVE] Yeah, yeah, because apparently um it's not picking up for, for if she's saying and it's not her fault, the system is not um accepting the fact of, I mean, I, I've come here before so I know it works it's just I guess something not processing properly.
[CUSTOMER][NEUTRAL] So yeah, I will put you on speaker and you can talk to her.
[AGENT][NEUTRAL] OK, yeah, if, if I need, yeah, if I need to verify something with her, I can do that.
[CUSTOMER][NEUTRAL] Yeah, OK, hold on one second.
[CUSTOMER][NEUTRAL] I put you on speaker. I hear you. She's on hello.
[AGENT][NEUTRAL] Hi, this is [PII] with American Public Life. What information would you need to verify benefits and eligibility?
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Um, there, there isn't any other information that I need. It's just that my system still, it's [PII] is, um,
[CUSTOMER][NEUTRAL] Written as her primary and American public life as her secondary insurance, but it still shows me a co-pay of 125.
[AGENT][NEUTRAL] Yeah, so the secondary that she has with us picks up deductible co-pay co-insurance that the primary does not. That's the purpose of her secondary plan, so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Like her outpatient benefits per calendar day on the plan or $1000 so that would cover any deductible, co-pay or co-insurance.
[CUSTOMER][NEGATIVE] Correct. So then why would it show me 125 the secondary supposed to pick up the copay that Cigna doesn't pay.
[AGENT][NEUTRAL] Hm. Yeah, I mean, it should pick up anything that her primary doesn't.
[AGENT][NEUTRAL] As far as that, so I'm not sure why it's showing you that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can you, can you check if her plan is still active?
[AGENT][NEGATIVE] Yeah, her plan is still active. There's no lapse in the policy. The effective date is [PII] still active, so yeah, I'm, I'm baffled as to why it's showing that, so.
[CUSTOMER][NEUTRAL] And this payment.
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] Made any missed payments?
[AGENT][NEUTRAL] No, I'm not showing any sort, like I said, no lapse in coverage.
[CUSTOMER][NEUTRAL] OK, the company.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm checking with my supervisor too.
[AGENT][POSITIVE] OK, not a problem.
[CUSTOMER][NEUTRAL] If there's anything
[CUSTOMER][NEUTRAL] OK, he's fine. It's. Oh, the lady, she's on the phone. Yeah. Yeah, so what does your supervisor say? OK, that's it.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Is there a code you need to give um the receptionist here so that.
[CUSTOMER][NEUTRAL] It shows I have policy.
[CUSTOMER][NEUTRAL] Is she there? Hello?
[AGENT][NEUTRAL] Um, a coding to show that you have a policy.
[CUSTOMER][NEUTRAL] Ma'am?
[CUSTOMER][NEGATIVE] Yeah, like to cover it, or if I have to end up paying $125 then because there's a glitch somewhere, which can happen, then what do I need to do to get the money back because
[CUSTOMER][NEGATIVE] I shouldn't have to pay.
[AGENT][NEUTRAL] You would just file the claim, yeah, you would just file the claim yourself, get a receipt from them from the amount paid, um, and then your, uh, you could file the claim yourself and then we would just send reimbursement to you instead of to them.
[CUSTOMER][NEUTRAL] And that's why I called you.
[CUSTOMER][NEGATIVE] Yeah, I know, but I haven't filed a claim in years. I, I even forgot how to do that because I never had this problem.
[AGENT][NEUTRAL] Yeah, I mean,
[CUSTOMER][NEUTRAL] That's the first time I'm having.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I, yeah, I don't, I'm, I don't know why it's coming up because like I see that you went to like an MD now.
[CUSTOMER][POSITIVE] That's where I'm at right now, exactly where I am right.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yeah, so that was on 7 data service was 71824 and we paid the claim.
[CUSTOMER][NEUTRAL] OK. And then you have, no, I went recently a couple of days ago, but I need more medicine cause they didn't give me all the right medication or they didn't give me all the medication I need, so, and I don't feel well, so I came back.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] I mean, yeah, I mean if you went recently, they may not have billed us yet for it, you know, that's why it may not show on my side, but that's the most recent thing that I see that was paid for that amount.
[CUSTOMER][NEUTRAL] OK, so she's single.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, I just don't know what else I can do on my end, [PII] because like I said, I, you know, like your policy's been active. I told her like there's no lapse in coverage anything like that so.
[CUSTOMER][POSITIVE] Yeah, my company pays for for everybody.
[AGENT][NEUTRAL] So, yeah, I mean, I, I was hoping that just telling her that it, it will cover that would, would suffice, so I'm not sure what else I can do on my end.
[CUSTOMER][NEUTRAL] Uh, and, OK, and anything else to be done, or no, so my, uh, coordinator also um, um, we still need to collect primary insurance copy and once the claim goes to the secondary and they pay it, you gotta.
[CUSTOMER][NEUTRAL] OK, but we don't know how long that takes, right, for the refund?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, can you do me a favor? Can you email me that claim form?
[CUSTOMER][NEUTRAL] If you don't mind.
[AGENT][NEUTRAL] Yeah, let me just make sure one second here, [PII]. So the email I have is [PII]. Is that a good email for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, you could talk about you.
[AGENT][NEUTRAL] OK, I will email you instructions on how to file the claim in the claim form.
[CUSTOMER][NEUTRAL] OK, that's fine. Yeah, yeah.
[AGENT][NEUTRAL] All right. Anything else I
[CUSTOMER][NEUTRAL] I'm sorry, go ahead. OK, go ahead. So I'm gonna have to end up paying this outright first, so I guess, um, I have no choice. They won't take me otherwise.
[AGENT][NEUTRAL] I'm sorry [PII].
[CUSTOMER][NEUTRAL] And the thing is I was here before.
[CUSTOMER][POSITIVE] I know, I figured by calling you guys you make my life a lot easier, but I said no, let's call him. I said because I've never had to pay.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You believe that?
[AGENT][NEUTRAL] Yeah, OK, well, like I said I'm gonna send you the claim form now and then also the user guide on how to do it online, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if that
[CUSTOMER][NEGATIVE] Do I need a user ID and password because it's, I, I don't even remember logging into the American public in a hot minute.
[AGENT][NEUTRAL] Yeah, I
[AGENT][POSITIVE] I'll send you all those instructions and then when you get ready to file this if you need help just give us a call and we'll walk you through it, OK?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] All right thank you I appreciate it.
[AGENT][POSITIVE] You're welcome, [PII]. Anything else I can do for you?
[CUSTOMER][POSITIVE] No, we're good, thank you. 01 thing actually back in when was it?
[CUSTOMER][NEUTRAL] When you, when I had um I had my colonoscopy and my endoscopy done right, uh, a few months back and I had to pay the doctor.
[CUSTOMER][NEUTRAL] Some money on the side. It was like 400 something. I know you guys covered something. I think the anesthesiologist.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I don't, I don't know if you guys ever covered some of the doctor too, but I know someone else in my job that had their husband do the same procedure but paid so much less.
[CUSTOMER][NEUTRAL] And I couldn't figure out why.
[CUSTOMER][NEUTRAL] So I don't know if it was the
[CUSTOMER][NEUTRAL] I don't know. I don't I didn't understand, so I just figured out.
[AGENT][NEUTRAL] So for the colonoscopy, like for those things that were done, if anything was denied, um, we could definitely look into it. We would need to know like the date of service so we can look for the specific claim.
[CUSTOMER][NEUTRAL] Oh boy.
[AGENT][NEUTRAL] Um, so,
[CUSTOMER][NEUTRAL] Well, it was, it was, uh, because the, the, the colonoscopy is covered but the endoscopy was not, yeah, hold on, the endonoscopy was, I guess it's not because you know what I mean, because it's not like a.
[CUSTOMER][NEUTRAL] I don't remember the date. It was somewhere in October. Thanks.
[CUSTOMER][NEUTRAL] Somewhere in October from Pina. Oh, hold on a second. I, I don't know if you 0888.
[CUSTOMER][NEUTRAL] Um, you do, you still need a data service for that?
[AGENT][NEUTRAL] It was in October of last year, you think?
[CUSTOMER][NEUTRAL] Oh yeah, yeah, it was last year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] All they said OK.
[CUSTOMER][NEUTRAL] I just need the receipt.
[CUSTOMER][NEUTRAL] I need to receive it, OK.
[CUSTOMER][NEUTRAL] Who's that?
[CUSTOMER][NEGATIVE] It wouldn't take the tap, and maybe I'm doing something stupid, that's probably me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I figure I'll just check with the endoscopy so that.
[CUSTOMER][NEUTRAL] I mean, I gave the doctor, I mean, I didn't pay the um.
[CUSTOMER][NEUTRAL] Anesthesia. I, I think anesthesia I didn't have to cover, but then I had to cover um some of the doctor.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] I don't even know how much I paid.
[CUSTOMER][NEUTRAL] But I know you guys did pay something because I got a letter stating that you did I think you paid the anesthesia or something like that.
[CUSTOMER][NEUTRAL] Some, some
[AGENT][NEUTRAL] Yeah, so there was one for Galloway Anesthesia and Associates, that was in [PII], that paid.
[AGENT][NEUTRAL] Um, it paid to the anesthesiologist for 2[PII].
[CUSTOMER][NEUTRAL] How much did they pay?
[CUSTOMER][NEUTRAL] OK, that's the same day I had that procedure. Whatever that day is, that's the day I had to go.
[CUSTOMER][NEUTRAL] The colonoscop endoscopy done. OK.
[CUSTOMER][NEUTRAL] OK, see if it's copy, but OK, so, um, here you go, OK.
[CUSTOMER][NEUTRAL] He's receipt yes, it has the logo and how much you paid. OK, alright, thank you, yeah, so.
[AGENT][NEUTRAL] So then the other claim that I see shows the way it was coded, it was an office visit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so that claim was for like [PII] it this claim denied. It's the only one that I see for that time frame that denied just states that the office visit is not covered.
[CUSTOMER][NEUTRAL] The one, the one that you guys paid the 400 and change is the same date of service for both the colonoscopy and the endoscopy.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It was done the same day.
[AGENT][NEUTRAL] OK. Well, there's no uh
[CUSTOMER][NEUTRAL] So you have the anesthesiologist and we have the doctor.
[AGENT][NEUTRAL] Yeah, but there's no other claims for that date of service, so if, if, if they're sending you a bill then it wasn't submitted to us, OK.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEGATIVE] No, they're not. They sent me, they made me pay a bill.
[CUSTOMER][NEUTRAL] Before I even had they said half of the bill before I even had some.
[AGENT][NEUTRAL] Yeah, so yeah, there's no, there's no other claims on file, just that one that was paid towards the anesthesiologist.
[CUSTOMER][NEUTRAL] That's so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK alright well thank you for trying. I appreciate it.
[AGENT][POSITIVE] Yeah, you're welcome, [PII]. I hope you have a nice rest of your day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.