AccountId: 011433970860
ContactId: b3df9b5c-d56e-459d-8adf-e5f674effc82
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401720 ms
Total Talk Time (AGENT): 216402 ms
Total Talk Time (CUSTOMER): 130698 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/b3df9b5c-d56e-459d-8adf-e5f674effc82_20250528T16:44_UTC.wav
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[AGENT][NEUTRAL] You for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes Ms. [PII], my name is [PII]. I was calling to see if um if y'all had got my um claim and see if y'all had paid anything on a bill that was sent in or a couple of bills.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'll take a look at that for you, Ms. [PII]. Could I get a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And the policy number you're calling on.
[CUSTOMER][NEUTRAL] Oh let's see.
[CUSTOMER][NEUTRAL] 02292696
[AGENT][NEUTRAL] OK, you could verify your date of birth and mailing address.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you so much for verifying your policy and you're calling to see if uh we paid on a claim and if certain bills were received.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the date of service, yeah, date of service is [PII].
[AGENT][NEUTRAL] Mhm, I do not show we have any claims on file for that date.
[CUSTOMER][NEGATIVE] Oh, do you know what? I talked to AMed yesterday and they said that y'all had sent to them and said y'all were not paying anything else, OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] And that would be [PII].
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] No, it says date of service [PII].
[CUSTOMER][NEUTRAL] Mhm, it'd be Thomas Ceres uh urinary surgery.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For my husband [PII].
[AGENT][NEUTRAL] Oh, for your husband. OK, that I was looking under you.
[AGENT][NEUTRAL] OK, let's see [PII]. So yes, I do see uh a few claims received, um, so let's see, we did receive the facility claim first, um, your policy, um, pays $500 per day for outpatient services and so we did pay the maximum amount to, uh, the facility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Uh, we made a payment of $500 to them and so that maxed out your per day benefit.
[AGENT][NEUTRAL] Um, we did receive a couple claims after, uh, the anesthesiologist, and of course, that claim was denied, uh, maximum daily amount has already been met.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then we did get another claim. This is from the surgeon, and the claim was denied the same, uh, maximum daily amount met.
[CUSTOMER][NEGATIVE] Well, can you, can you tell me, according to this here, the bill was 1384. Is that what y'all applied anything to because it says my insurance covered 87437, but they're still saying I owe $509.63.
[AGENT][NEUTRAL] OK, let me
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, so the claim received from Amed that we did pay on, it looks like, um, based on what we received, what your patient responsibility from your primary was $2,051.60. We paid $500 towards the patient responsibility.
[AGENT][NEUTRAL] Um, and you're saying, how much are you saying they?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They said um it says um surgery urinary system it said 1384 insurance covered 87437 and it left me $509.63.
[AGENT][NEUTRAL] OK, so that is not, it looks like that is the claim that was received.
[AGENT][NEUTRAL] From
[AGENT][NEUTRAL] Let me see who is on this one.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Doctor [PII].
[CUSTOMER][NEUTRAL] Insurance is so confusing, isn't it? Yes.
[AGENT][NEUTRAL] It can be, it definitely can be. So this one, they did make, uh,
[CUSTOMER][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] As far as 1384, I do show that being the charge, uh, the total charge from the doctor, Doctor [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and so.
[CUSTOMER][NEUTRAL] On the 500 that y'all paid on?
[AGENT][NEUTRAL] No, we paid $500 to the hospital. So the doctor's bill was denied, uh, stating that the maximum amount had already been met. So, uh this one from, um, for 1384, it looks like your primary paid 15469.
[CUSTOMER][NEUTRAL] Is that the one y'all paid on? OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So it looks like you uh of this claim, you did have a balance of
[AGENT][NEUTRAL] Let me see how much it shows you owe from this one.
[AGENT][NEUTRAL] After your primary.
[AGENT][NEUTRAL] You did 0 50963 and on this one we did not pay so yes ma'am.
[CUSTOMER][NEUTRAL] OK, so I have
[CUSTOMER][NEUTRAL] OK, so I probably did go ahead and I need that one and that's probably my remaining balance.
[AGENT][NEUTRAL] Yes, on this one.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, well thank you so much. I I just wanted to make sure because I have already found out if you pay them and then you overpay, they do not give you your money back.
[AGENT][POSITIVE] All right. I understand that. So, yes, I would make sure that that is definitely.
[CUSTOMER][NEUTRAL] Yes, so I don't call. Yes, I'd call and make sure.
[AGENT][POSITIVE] That's a good thing to do. You're welcome, [PII]. You have a wonderful day. Thank you for calling APL.
[CUSTOMER][POSITIVE] OK, thank you so much, ma'am, yes.
[CUSTOMER][POSITIVE] You too ma'am thank you right thank you bye bye.
[AGENT][NEUTRAL] Bye bye.