AccountId: 011433970860
ContactId: c0e1a77e-f18e-4e76-9692-8c05dafb0def
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 731479 ms
Total Talk Time (AGENT): 468726 ms
Total Talk Time (CUSTOMER): 286321 ms
Interruptions: 10
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/c0e1a77e-f18e-4e76-9692-8c05dafb0def_20250206T19:05_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling to check the status of my claim.
[AGENT][NEUTRAL] I can certainly help uh on your claim status. What is your policy number, please?
[CUSTOMER][NEUTRAL] Um, 241, no, I'm sorry, 2461873.
[AGENT][NEUTRAL] 1873. Thank you. And if I could just verify your name, uh date of birth, and a phone number, please?
[CUSTOMER][NEUTRAL] [PII] [PII] [PII]
[AGENT][POSITIVE] Oh, I do appreciate that. Thank you. Now, you just sent in a claim, is that correct? On the [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, earlier this week, yeah.
[AGENT][NEUTRAL] OK, so this is for um Frick Hospital for data service, uh, [PII]. Does that sound right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so a payment of $350 was processed.
[AGENT][NEUTRAL] Today, your claim number is 35.
[AGENT][NEUTRAL] 60343 and uh let me just check here. It looks like you have um
[AGENT][NEUTRAL] Direct deposit with you do?
[CUSTOMER][NEUTRAL] Yeah, can you tell me why it was only for $350? Because I had to pay out like $4000.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure, let's look at your.
[CUSTOMER][NEUTRAL] And between
[CUSTOMER][NEUTRAL] Um, my deductible and my co-pay.
[AGENT][NEUTRAL] Of course, let's just look at it and see what we've got here.
[AGENT][NEUTRAL] So 5.
[CUSTOMER][NEUTRAL] Like $4,491 I think it was that I paid. And my plan is for $5000 for my gap.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So let's see what we have here.
[CUSTOMER][NEGATIVE] I because I could not afford to pay all of that without the gap.
[AGENT][NEUTRAL] Oh no, I, I do understand. Um, let's see, I'm just going through the paperwork now so the cost.
[CUSTOMER][NEUTRAL] Yeah, so I know that they said I had $350. The rest of it was um towards my deductible. There was one part of it, I think was like $110 or $1200 towards my deductible, and then there was one part that was like $3000 something towards my deductible.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] Um, and I'm still just looking at what they do is they break these down into a line item line by line and so I'm just looking at those just to see what we've got here, um.
[CUSTOMER][NEUTRAL] OK, I'm looking at the paper I sent to my EOB or whatever that is, um.
[AGENT][NEUTRAL] Right. Let's look at that very first page. Yeah, let's, where it says uh current status claim processed Frick Hospital. This is, um, it says claim payment breakdown. Is that what you're looking at?
[CUSTOMER][NEUTRAL] So I can kinda
[CUSTOMER][NEUTRAL] Yeah, so there's where it says my total amount owed the $4,491.23. I paid that, so it got marked paid and then part the portion of that $4,491 was uh like there was the $350 copay.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And then if I scroll down, I can't remember what line it was. There was so much stuff. I, cause I had 1 ft done last year, I have 1 ft done this year. So under there under deductible, there's $1,141.23 and that is on the 4th page.
[AGENT][NEUTRAL] There is
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, now, wait, I
[AGENT][NEUTRAL] OK, yeah, but I, OK, let me tell you what I've got on my 4th page and then we can, uh, maybe, I think that might be where we're. I have, uh, so the very first, let's, let's go over what I've got as, as opposed to what you have. So, so, uh, it says Frick Hospital, uh, this is the very first one, it has that $350. Now, going immediately into, that's on page 3, on page 4, it says claim provided services, um, provided service July.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, so that's my 2nd page.
[AGENT][NEUTRAL] OK, um, it says 2265.
[CUSTOMER][NEUTRAL] OK, so if now if you look.
[AGENT][NEUTRAL] Yeah, I'm still looking. I'm still.
[CUSTOMER][NEUTRAL] Right, OK. So then go down to there's 4680, 619.
[CUSTOMER][NEUTRAL] 11 6 1237 35 1 59. OK, when you get to the next one after 15,970.
[AGENT][NEUTRAL] Oh, OK, OK, OK. All right, let's see, um.
[CUSTOMER][NEUTRAL] And go over in the deductible column there's 11:41 23.
[AGENT][NEUTRAL] Uh, OK, yeah, let me see if I can't find that again because I, I see where, I see what has happened here. Um, OK, so let me just, uh, jeez. Here we go. OK, so the OK, so I've got your, your 4th page or whatever is gonna be like my 5th or 6th. So let me go down here again and let's, while I have you on the phone, let's see, because what we can do is we can always uh revisit this and, and pay additional fees. So let's just see. I think this got missed in the processing.
[CUSTOMER][NEUTRAL] time
[CUSTOMER][NEUTRAL] OK, sure, yeah.
[CUSTOMER][MIXED] OK, uh, thank God you had me scared for a second. Well, the way that they do it.
[AGENT][NEUTRAL] Oh no, I'm sorry, OK.
[CUSTOMER][NEGATIVE] Like it confused me because the way that they write these things up, I'm like, why is it so it doesn't break it down that that was deductible. It just says I paid this.
[AGENT][NEUTRAL] Yeah, so let's see what I do. Um, let's see, so what I'm, I see on page, what is my page 6, I see um $1,141.23. Now, I'm just want to keep on scrolling, that's on page 6. I'm gonna keep on scrolling.
[CUSTOMER][NEUTRAL] You know what I mean?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, and then the next one, so it's 12345678.
[AGENT][NEUTRAL] If we forget something here.
[AGENT][NEUTRAL] I think they must have gotten jumbled up when we scanned them.
[CUSTOMER][NEUTRAL] And 11, OK, so 12 down from that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It'll say [PII], $14,000.
[AGENT][NEUTRAL] $3350. All right. There we go. OK, and that's on page 10. OK, so where this is uh my handwriting.
[CUSTOMER][NEUTRAL] Right, and that was deductible.
[CUSTOMER][NEUTRAL] I could have just said last page now that I look at it.
[AGENT][NEUTRAL] Oh, no, that's OK, that's OK because I'm going to.
[CUSTOMER][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] Uh, no, no, I'm sorry. Uh, boy, that's, uh, OK, so what I'm gonna do is I'm going to send this back to the examiner and uh we're gonna see what we can do about getting this um resolved. Uh, so let's see what we have so far so that we'll know what's going on. So we paid 350. We're, we're just going to hang on to that, that's 350.
[AGENT][NEUTRAL] Um, you, you have, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For outpatient services, this is an outpatient service, wasn't it? $3000 total. OK, for outpatient services. OK. So what we can do.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Wait, it should be 5000 this year.
[AGENT][NEUTRAL] 5000, OK. Well.
[CUSTOMER][NEUTRAL] Like we had to get new and we had to repick insurance policies this year. So,
[AGENT][NEUTRAL] Let me see. OK, 2461873.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] What I'm saying.
[AGENT][NEUTRAL] OK, I'm seeing $3000. So what um
[CUSTOMER][NEUTRAL] Yeah, that's what it was last year.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let me ask you this, if they do it for the 3000 and then.
[CUSTOMER][NEUTRAL] Like, because when I called about it initially to find out how to put a claim in because it wasn't showing me like a new policy for this year.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, they said go ahead and put the claim in and it could be like that they're pro they said that they put me on hold and they called somewhere else I guess, or talked to someone else and they said it was processing the new policy.
[CUSTOMER][NEUTRAL] But to go ahead and put the claim in and then whatever didn't pay, it would go to the new policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's true. Yes. That does sound right. So what, so what I have up here is the old policy. So if you are in renewals.
[CUSTOMER][NEUTRAL] Does that sound right to you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, so we'll just go with that for now and then hopefully once the new policy is processed fully for you guys.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] We'd have to revisit it. Yeah. Yeah, we'd have to revisit it.
[CUSTOMER][NEUTRAL] Then yeah, I can call and you can relook at whatever balance is left.
[AGENT][NEUTRAL] OK, so what we're going to do right now is we're going to take this, we're gonna uh we're going to um go over this claim and we're going to send it back to the examiner and we're gonna pay the, the additional fees that are due up to your maximum as of right now.
[AGENT][NEUTRAL] So, um, uh, see, inquire claim 560343.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Examiner.
[AGENT][NEUTRAL] OK additional fees.
[AGENT][NEUTRAL] OK, and so we're going to do that and then uh we'll revisit.
[AGENT][NEUTRAL] Policy.
[AGENT][NEUTRAL] New with newer benefits, OK, because they do one of the things that that we do is as soon as we renew with and let's just say that your, your group as a group changes, um, we invariably go back and, uh, um, send it back to you uh.
[AGENT][POSITIVE] To let you know that there that there's a, that there are additional fees that are being paid and then what they do is they actually give you get a new EOB that says these were uh reconsidered and paid I think is the the way that they put the the wording. um, so let me go ahead, the the, the, first of all, let's see that we can get this other bit process. Um, thankfully you do have uh um the uh uh direct deposit, so we're not gonna have to hang around waiting for a check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, now is this the only one that we're looking at? And is there anything else that any other part of your policy?
[CUSTOMER][NEGATIVE] Yeah, I haven't received any more yet. I haven't received. I'm, they said I'm gonna receive probably 1 or 2 more bills, but I haven't received them yet, so I didn't pay anything else yet.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. All right. OK, um, and they do know that you obviously they know that you have a gap insurance, so that's always good. OK, well, I apologize for the inconvenience. Um, we will get that taken care of today.
[CUSTOMER][NEUTRAL] Just that.
[AGENT][NEUTRAL] Uh, I would, uh, if you want to, uh, feel free to call us tomorrow just to be absolutely certain that it's, that it's gonna show up in your direct deposit, um, because that's, uh, you know, it just.
[AGENT][NEUTRAL] It should show up as soon as we do this. It should show up by tomorrow morning. Um, but if you do have any other questions, if there's anything else about your policy or this visit in particular that we need to look at, let us know. So, um, I will go ahead and take care of this now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I
[AGENT][NEUTRAL] Just let us know if there's anything else we can do.
[CUSTOMER][POSITIVE] I appreciate your help so much.
[AGENT][POSITIVE] OK, [PII], thank you very much for calling us. OK, well, thank you and uh just look out for your direct deposit and we'll get this resolved, OK?
[CUSTOMER][NEUTRAL] No, that's all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So will it be 2 deposits then instead of 1?
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] No, it's what we're gonna do is we're going to max out, yeah, what we're going to do right now is we're going to try and max out the benefits you have for this policy. And then, um, if you, when you renew for a higher benefit if it if it dates back to this data service and it should, um, then we will, uh, we'll go from there. But right now the only thing I can tell you, the only thing I can tell you for sure is that, um, is that we're gonna, we should be able to max out all your benefits for the existing policy that I'm looking at right now, that $3000.
[CUSTOMER][NEUTRAL] If they already did this.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So less than 350 that we've already paid. Yes, ma'am.
[CUSTOMER][NEUTRAL] So I should just get one deposit for 3000.
[AGENT][NEUTRAL] Yeah, well, yeah, less than 350 you've already gotten.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The less than 350 you've already gotten because I can't pull that one back out.
[CUSTOMER][NEUTRAL] So it'll be a, there'll be a deposit of 350 cause I didn't get it yet.
[AGENT][NEUTRAL] You haven't got.
[CUSTOMER][NEUTRAL] So they must have done it today.
[AGENT][NEUTRAL] They must, yeah, it was just done today. So, um, so when it's, when you do get it, uh, you, you will have, well, let's see. OK, so they're not, what they're not going to do is take off that 350. So you'll have one for 350 and then another 126, 2650, yes, yeah.
[CUSTOMER][NEUTRAL] And then one for 2650.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, that's what that will be and it's, and I didn't, I don't see a problem with that because it looks like we've gone, uh, your, your bill has gone over your, your gap insurance here, so I think we can max it out and get that to you. And then like I said, we'll just, we'll have to revisit the new policy when it gets, when it gets approved.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK sounds good.
[AGENT][POSITIVE] OK, well, thank you for contacting ATO. You have a very good day. Thank you for letting us know about this problem.
[CUSTOMER][POSITIVE] Thank you so much