AccountId: 011433970860
ContactId: 9c6ba015-50eb-4e4d-9924-1065ca2a0ca1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 315070 ms
Total Talk Time (AGENT): 93809 ms
Total Talk Time (CUSTOMER): 151551 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/9c6ba015-50eb-4e4d-9924-1065ca2a0ca1_20250221T17:47_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling, I guess, uh.
[CUSTOMER][NEGATIVE] I've got a big old bill from my.
[CUSTOMER][NEUTRAL] From a hospital here and they're telling that they didn't get any payments from APL on anything so I'm just trying to sort out this thing just looking for some help.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] 01897856.
[AGENT][NEUTRAL] OK, hold on one moment please.
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify your address and email address, please?
[CUSTOMER][NEUTRAL] Yep, uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my primary email is [PII].
[AGENT][NEUTRAL] Thank you, mister, because I can't say your last name. I'm sorry, can I call you [PII]?
[CUSTOMER][POSITIVE] Perfect.
[AGENT][POSITIVE] Thank you, [PII]. I'm sorry about that. Um, and you were just needing help on some claims.
[CUSTOMER][NEUTRAL] Yeah, I have some claims.
[CUSTOMER][NEGATIVE] That I'm getting billed a ridiculous amount for the physical therapy clinic said they put in both insurances. The hospital says they sent bills to both insurances, but they only got payment from my primary.
[AGENT][NEUTRAL] OK, what, uh, data service was it for, do you know?
[CUSTOMER][NEUTRAL] Yeah, it would be.
[CUSTOMER][NEUTRAL] It looks like the first one is in 35 of 24, OK.
[AGENT][NEUTRAL] 3524, hold on just a second, let me look that up.
[CUSTOMER][NEUTRAL] Yeah, then there's there's.
[CUSTOMER][NEUTRAL] Yeah, there's 123456789, 1011, 12 of them.
[AGENT][NEUTRAL] OK, hold on just a second.
[AGENT][NEUTRAL] So you get $3500 per calendar year.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me see if that's been met.
[AGENT][NEUTRAL] OK, it looks like we didn't pay on those because you had already met your calendar your maximum.
[CUSTOMER][NEUTRAL] OK. Did you, did, did anybody communicate that with the physical therapy clinic or anything throughout the process?
[AGENT][NEUTRAL] They would have gotten an explanation of benefits from us.
[AGENT][NEUTRAL] We send one to the provider and one to you.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it, so PT.
[CUSTOMER][NEGATIVE] OK, because the thing is that frustrated me and I'm not frustrated with you, um, is that at no point in time throughout the whole process did the physical therapy clinic ever tell me that I owed any money at any visit.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And I asked, I'm like, do I owe you guys anything? Is there a copay, right? You know what, because as I told him, if I, if I, if I thought I was getting a $150 value out of.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Physical therapy, then I would continue paying that. If I thought I wasn't, then I would not have gone to physical therapy.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Or just.
[AGENT][NEUTRAL] Yeah, it, it looks like we paid it out um on the facility bill in February, so you had met your maximum February on the [PII] visit.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, got it. OK, and I was assuming that's the case. I was like, well I probably max that out, you know, um, but, but I guess I'm more frustrated is like why would the physical therapy clinic, you said that they would have received a notice.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes sir, we sent them and we always send the provider explanation of benefits of why it's not paid or why we only paid a certain amount.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] So they would always get an explanation of benefits.
[CUSTOMER][POSITIVE] Got it. OK, uh, perfect, that is all I needed.
[AGENT][NEUTRAL] OK, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that'll do.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day.
[CUSTOMER][POSITIVE] Thank you you too.