AccountId: 011433970860
ContactId: b6dfd2a5-2e21-4d8b-a606-688e63ab2a03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 846979 ms
Total Talk Time (AGENT): 289359 ms
Total Talk Time (CUSTOMER): 461471 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/b6dfd2a5-2e21-4d8b-a606-688e63ab2a03_20250127T23:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, um, Miss [PII], uh, my name is [PII], and I'm trying to understand.
[CUSTOMER][NEGATIVE] Why I'm not getting my reimbursement, I'm trying to see if maybe I'm sending over the wrong thing maybe.
[AGENT][NEUTRAL] OK, Ms. [PII], are you talking about a claim that you have submitted and you're looking for the reimbursement for your claim? OK, Miss [PII], I can help you with your claim. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm it's uh [PII].
[CUSTOMER][NEUTRAL] 348.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is your policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, 1140.
[CUSTOMER][NEUTRAL] 98018, well that's an account number.
[CUSTOMER][NEUTRAL] No, that's not it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm looking at account hold on.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I'm sorry, I went into the United Healthcare site to look at the claim.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then I, I got thrown up. I'm sorry, give me one second, uh.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] So this is APL, yeah, um, what's the policy number?
[CUSTOMER][NEUTRAL] I can give you a claim. oh, policy number is 198.
[CUSTOMER][NEUTRAL] 463.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] And my name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is.
[AGENT][NEUTRAL] OK, that
[AGENT][NEUTRAL] That didn't pull up [PII].
[CUSTOMER][NEUTRAL] 1984163
[AGENT][NEUTRAL] Ah, I missed the one, OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Um, I got the explanation benefit.
[AGENT][NEUTRAL] OK, Ms. [PII], can you give me your date of birth again, please?
[CUSTOMER][NEUTRAL] Uh, [PII] and it says.
[AGENT][POSITIVE] Thank you and then.
[AGENT][NEUTRAL] What is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Address [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, email is the [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] What else?
[AGENT][NEUTRAL] Your cell phone number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you. I appreciate you verifying your policy for me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let's look.
[AGENT][NEUTRAL] OK, what day did you send in your claim and you said you had a claim number, can you give that to me and I can look at it for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEGATIVE] I don't know, um, they should have put them all up on the same one.
[CUSTOMER][NEUTRAL] But they didn't, it's
[CUSTOMER][NEUTRAL] OK, so the claim.
[CUSTOMER][NEGATIVE] That I'm worried about is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The OSC 91.
[CUSTOMER][NEUTRAL] 778.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's for data service of 1213 of 24.
[AGENT][NEUTRAL] OK, yes.
[CUSTOMER][NEUTRAL] And so,
[CUSTOMER][NEUTRAL] Yeah, OK, I'll let you pull it up.
[AGENT][NEUTRAL] Oh, that's OK. I've got it pulled up right now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me see what the remarks are on it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] These are the remarks that are on the claim. Office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Insur
[CUSTOMER][NEUTRAL] I know that.
[CUSTOMER][NEUTRAL] But it's not the.
[AGENT][NEUTRAL] Insured primary
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] And it says, please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I did that.
[CUSTOMER][NEUTRAL] And that's what I'm looking at. And I, and it's the visit on [PII]. So it says,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The visit on [PII] that I'm showing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That's the one that said office visits are not covered by the policy and then it also says on [PII], insured primary insurance provided full benefits, there are no benefits payable.
[AGENT][NEUTRAL] That was on [PII] and then on the service date which is on the same claim of [PII], that's the one that's saying please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Yeah, and then the one for January is not gonna be covered because the policy has already exhausted. See, I had an eye injection on the [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] But they're saying that the insurance covered it all.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] OK. I do see that where it says, so they only took my copay.
[CUSTOMER][NEUTRAL] And then your plan page 721.
[CUSTOMER][NEGATIVE] And then the cold insurance, it was nothing.
[CUSTOMER][NEUTRAL] And a plan does not cover it says 0 now. So the total bill though.
[CUSTOMER][NEUTRAL] Was 180.
[CUSTOMER][NEUTRAL] Oh, so you know what they must have done. I'm looking at the United Healthcare explanation of benefits. You, you, you probably got that one too.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I, I can't see the UnitedHealthcare. I can't see anything except for how the claim was processed and the remarks that the examiner gives us, right? I, I don't see what you've sent.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm, so you don't see what I said.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh well, I wonder, OK, so let's go back then on.
[CUSTOMER][NEUTRAL] Alright, let me go back and see when was the last.
[CUSTOMER][NEUTRAL] Amount or last day that you guys paid something which was the last claim that you paid something on.
[AGENT][NEUTRAL] It was claim number 349-4189.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that was paid to you.
[AGENT][NEUTRAL] And the amount of 19835 for [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So uh and so what was the date of service on that, you see what, what, uh.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK. So see, I had some other injections.
[AGENT][NEUTRAL] I'm looking at um claim that was sent in.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] On, let's see.
[AGENT][NEUTRAL] That's you. There's another one that was sent in by you on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Claim number 355.
[AGENT][NEUTRAL] 6286.
[AGENT][NEUTRAL] And that data service is.
[AGENT][NEUTRAL] [PII] of [PII]. That was also [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] I think that's the same one, ma'am.
[AGENT][NEUTRAL] Yeah it's a duplicate. It was a duplicate of the previous one that we first looked at.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that's what it is because I, I call myself sending the explanation of benefits, but what they're saying is because I didn't have any out of pocket cost, that's what you guys are saying since I didn't incur any out of pocket cost other than the $75 which is my.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, office visit.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] See, then they can't, you guys can't reimburse anything because I did not have any amount out of pocket.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] On that on that visit.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right, because the office visits are not covered.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][POSITIVE] You're, you're correct.
[CUSTOMER][NEGATIVE] OK, I'm trying, I, I had to see, I didn't know what the, what it was saying, so, and I did get something oh no they didn't send me nothing either on the [PII].
[CUSTOMER][NEGATIVE] Yeah, they, so maybe the insurance must have covered those or something. I don't know because you guys didn't reimburse me for the eye injection on the [PII].
[CUSTOMER][NEUTRAL] Um, on that, I've sent it on [PII].
[AGENT][NEUTRAL] Let me look and see.
[CUSTOMER][NEUTRAL] But it say I don't have any files, anything filed on that one.
[AGENT][NEUTRAL] You have a data service that the um Health Texas providers Network sent in for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] On [PII] and that one was denied um.
[AGENT][POSITIVE] The 335-33, yes, was office visit. Yes, you're correct.
[CUSTOMER][NEUTRAL] Cause it was an office visit as well.
[CUSTOMER][NEUTRAL] I don't know, I think you know what I think that was the MRI. I just gave it to them. I just gave them that card.
[CUSTOMER][NEGATIVE] Um, because they told me it was supposed to be covered, so I don't know what happened. I hadn't seen the bill on that one.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm not gonna call him and ask him about it, that's for sure.
[AGENT][NEUTRAL] I feel you.
[CUSTOMER][NEGATIVE] I got too many of them. I'm not coming. That's mm mm.
[CUSTOMER][NEUTRAL] Oh, OK, um, so alright well.
[CUSTOMER][NEUTRAL] Let me see, last 6 months, let me see. I'm trying to see if I have that one. If I have anything else. I don't see anything else on here.
[CUSTOMER][NEUTRAL] For Doctor [PII], OK, I'm not gonna worry about it. I guess I don't think y'all owe have but $100 left on the policy after they paid the $90.
[CUSTOMER][NEUTRAL] I think I got about $100 left. I need the $100 but.
[CUSTOMER][NEGATIVE] Evidently it's not anything payable.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][MIXED] Yeah, and the company got rid of that. That sucks. That was a good little service.
[AGENT][POSITIVE] It is, it is a good little, it is a good little, it helps. It really does. With that deductible, co-pay and co-insurance, those are the things that they usually make you pay upfront and if you've got insurance to cover it, it helps so much.
[CUSTOMER][NEUTRAL] Yeah, it does.
[CUSTOMER][NEUTRAL] Uh, yeah, it does.
[CUSTOMER][NEUTRAL] Yeah, so, alright, well, I, I guess I ended up resolving my own issue once you told me.
[CUSTOMER][NEUTRAL] But it was. I read it.
[AGENT][POSITIVE] That's all right. Some
[AGENT][NEUTRAL] Sometimes you just need somebody to walk through it with you. I'm not, I'm like that.
[CUSTOMER][NEUTRAL] Yeah, I just needed another set of eyes and
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, well, since I'm having problem with my eyes, yeah, oh,
[AGENT][POSITIVE] Yes, it helps sometimes. I do that here at work sometimes I'll look at something and I know what I'm looking at, but I'll second guess myself, you know, and, and then, yes, and so then I'll, I'll call one of my coworkers and I'm like, look at this with me. Tell me if what I'm looking at is what I'm looking at, or do you see something different?
[CUSTOMER][NEUTRAL] I can guess.
[CUSTOMER][NEUTRAL] And I work in healthcare too, so I was like not when I'm now I'm trying to resolve my own stuff and everything is just all over the place.
[AGENT][NEUTRAL] Uh-huh, yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Yeah, I appreciate your help so thank you so much.
[AGENT][NEUTRAL] I understand.
[AGENT][POSITIVE] You're very, very welcome, Ms. [PII].
[CUSTOMER][POSITIVE] Mhm and have a good night, OK.
[AGENT][NEUTRAL] Is the
[AGENT][POSITIVE] You have a good night too, and thank you so much for calling APL. You have a blessed one.
[CUSTOMER][POSITIVE] Alright thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.