AccountId: 011433970860
ContactId: b970cfac-0457-4314-86fc-25cf6d154989
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 808710 ms
Total Talk Time (AGENT): 236791 ms
Total Talk Time (CUSTOMER): 377020 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/b970cfac-0457-4314-86fc-25cf6d154989_20250528T19:27_UTC.wav
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[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Hi there. How are you today?
[CUSTOMER][NEUTRAL] Ah.
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][NEUTRAL] I'm doing fine. I have a question about a payment that was made um for a service that I have for for radiology.
[AGENT][NEUTRAL] OK, may I have your name and a call number?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And may I have the call back number please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] I do. It is 0123.
[CUSTOMER][NEUTRAL] 665-5.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], I do need to verify your date of birth and then the mailing address listed on file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, [PII]. The address is [PII].
[AGENT][NEUTRAL] OK. And could you give me your month and the date for your date of birth again, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And we do have an email address. Could you verify that to make sure that is correct as well?
[CUSTOMER][NEUTRAL] I'm sorry, say that again.
[AGENT][NEUTRAL] We have an email address on file. Could you make sure that is correct as well?
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Oh yeah, [PII].
[AGENT][NEUTRAL] OK. Now, that's not the one that we have on file.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, it may be [PII].
[AGENT][NEUTRAL] Yes, now do you want it to be that one or do you want it your as your personal?
[CUSTOMER][NEUTRAL] No, it can be my personal.
[AGENT][NEUTRAL] OK, could you repeat that one for me so I can get that updated in the system?
[CUSTOMER][NEUTRAL] [PII], like my last name, [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, I will get that updated for you and thank you so much, [PII] for verifying your policy. How may I assist you?
[CUSTOMER][NEUTRAL] OK, so I received the bill uh for radiology service which I paid, um, and I called um that company.
[CUSTOMER][NEUTRAL] And they didn't have this gap information, so I provided it to them. And then today I received an EOB telling me that um
[CUSTOMER][NEUTRAL] That the gas insurance also paid.
[CUSTOMER][NEGATIVE] That same bill, so I called them back to ask them about refunding me the money I paid, but they can't magically now find me in their system.
[AGENT][NEUTRAL] OK, do you have that date of service?
[CUSTOMER][NEUTRAL] Um, it was [PII].
[AGENT][NEUTRAL] And this is a claim for you or someone else listed up under the policy?
[CUSTOMER][NEUTRAL] No, it's, it's, no, it's only on the policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do see that claim. We did receive it from the provider on [PII] and that payment was issued out on [PII] to the provider.
[CUSTOMER][NEUTRAL] The [PII], right.
[CUSTOMER][NEGATIVE] Yeah, but now they're telling me that they can't find me in their system, so I paid them and you paid them they can't find me all of a sudden in their system.
[CUSTOMER][NEUTRAL] So I don't, I mean, I don't know what to do other than to call my credit card company.
[AGENT][NEUTRAL] OK. Uh, do you have a statement or anything that has your account number listed?
[CUSTOMER][NEUTRAL] Uh, can you, can you?
[CUSTOMER][NEUTRAL] Well, I have the um I actually have a screenshot of the confirmation that they sent me and they can't send me by name nor the account number that I have on that screenshot with my payment.
[CUSTOMER][NEGATIVE] They have an account number, but they're telling me that it's not my account.
[CUSTOMER][NEUTRAL] Under the number that I'm giving them that they sent the receipt to me.
[AGENT][NEUTRAL] OK, I'm pulling that image up that we have from that provider.
[CUSTOMER][NEUTRAL] Can you, um, can you tell me, um, the provider was Ray Associates of Hollywood?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, I, I, so I'm not sure what to do.
[CUSTOMER][POSITIVE] that funny.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, the only thing
[AGENT][NEUTRAL] Since we received the claim, we just made the payment because we did receive it from that provider, so you will have to contact the provider to see if you can reimburse if there was considered an overpayment. Now, with the information that you have, would you like to verify the account number that we have with what you have?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the phone number that they gave me was [PII].
[CUSTOMER][NEUTRAL] Uh, hold on, let me look at this again.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the phone actually went out. Could you repeat that?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, that's not the account number that they submitted in for your patient account number for this bill.
[CUSTOMER][NEUTRAL] OK, is it possible for you to give me that number or no?
[AGENT][NEUTRAL] The account number showing is ZDH.
[AGENT][NEUTRAL] VRRD.
[CUSTOMER][NEUTRAL] OK, yeah, I'll have that on this paper.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One month. OK, I'm gonna call them back.
[CUSTOMER][NEUTRAL] And see if that's the account number I should be giving them because the account number that I received on on the payment that I made.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and would you like the check number as well for them to see if they can pull that up that we did issue payment?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Yes, that would be perfect.
[AGENT][NEUTRAL] OK, are you ready for that information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] The check number is 204.
[AGENT][NEUTRAL] 5782.
[CUSTOMER][NEUTRAL] 204.
[CUSTOMER][NEUTRAL] 204-578-23045782.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the payment that was made was $63.66.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Now, I have another question.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, I wanted to know if you received a claim because I just received an email for another.
[CUSTOMER][NEUTRAL] to be paid.
[CUSTOMER][NEUTRAL] From a place called Envision.
[CUSTOMER][NEGATIVE] And I received a bill for.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Let me get the bill.
[CUSTOMER][NEUTRAL] All right, so I received this um bill.
[CUSTOMER][NEUTRAL] 06 28 2272.
[CUSTOMER][NEGATIVE] OK, now I'm receiving a bill.
[CUSTOMER][NEUTRAL] For an anesthesia bill on Memorial West.
[CUSTOMER][NEUTRAL] I just wanted to know for services on for [PII]. Just wanted to know if you received anything for that yet.
[AGENT][NEUTRAL] And do you either have a provider listed or charge?
[CUSTOMER][NEUTRAL] Um, it only lists, um, the provider as Memorial West.
[AGENT][NEUTRAL] OK, do you have that total bill charged for that data service?
[CUSTOMER][NEUTRAL] Um, what they're sending me is 270, 240, but I'm pretty sure it's much more than that.
[CUSTOMER][POSITIVE] Yeah, pretty interesting.
[CUSTOMER][NEUTRAL] So I know that they would have had to send this to my primary insurance first.
[AGENT][NEUTRAL] OK, so it looks like we do have a claim on file that we have received for the data service of 418.
[AGENT][NEUTRAL] Let me see when did we receive that information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It looks like we just received it yesterday, so as of right now it hasn't been processed.
[CUSTOMER][NEUTRAL] OK, can you tell me the amount that they sent of that bill?
[AGENT][NEUTRAL] The total bill charged for that bill?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, that they're billing you for.
[AGENT][NEUTRAL] Well what we received is just the amount that they.
[AGENT][NEUTRAL] The amount of the ser the amount of the services that was rendered. So as of right now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's the only thing that we have is that total bill charge. We don't have anything to show that you had a patient's responsibility.
[CUSTOMER][NEUTRAL] No, no, no, I know that. I just wanted to know the amount that you're billing is for because they should only be billing you after my first insurance have paid them.
[AGENT][NEUTRAL] Well, what I'm trying to advise is we have what we have to do we have to receive the complete total bill charge and then the EOB will show us what amount is your responsibility. Yes, so as of right now we just claim showing the total bill charge.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] From my primary, right, got it.
[CUSTOMER][POSITIVE] Got it. That's what I wanna make sure. OK.
[CUSTOMER][NEUTRAL] Right, no, the reason I'm asking is because they're, see, um, like because I didn't know the same thing for the other bill, I was, I paid it.
[CUSTOMER][POSITIVE] So, um, I just wanna make sure that I don't pay anything until they have sent it to you, but I'm glad now that they sent it to you.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Yes, we do have that claim.
[CUSTOMER][POSITIVE] That, that's perfect. OK. All right. I thank you very much. Oh, I have another question.
[CUSTOMER][NEUTRAL] I'm sorry. I know I'm taking a lot of your time. Um, so this, this, um, policy that I have, I know that my, my policy match used to be $5000 and they increased it this year to $10,000.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's no problem.
[CUSTOMER][NEUTRAL] For inpatient, yes.
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So in regards to your inpatient benefits verification of coverage does not guarantee the payment of the claim. It looks like you still only have the amount of $5000 per calendar year.
[CUSTOMER][NEUTRAL] For inpatient, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. So, um, when I was in the hospital, I had, I had my procedure done on the [PII] and then I went home on the [PII], but, um.
[CUSTOMER][NEUTRAL] I, I think they classified it in a weird way, even though I was there for more than a day, part of it was an observation.
[CUSTOMER][NEUTRAL] So I don't, I wanna know what that, how, how, what does that count as?
[AGENT][NEUTRAL] We will have to receive the facility bill in order for us to know if it is considered as inpatient or outpatient, but as of right now, we haven't received that bill.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][POSITIVE] OK. All right. OK, thank you very much.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, no, that's it. Thank you so much.
[AGENT][POSITIVE] You're welcome thank you for calling American have a great day as well bye.
[CUSTOMER][POSITIVE] Alright have a good day, OK.
[CUSTOMER][NEUTRAL] You too. Bye-bye.