AccountId: 011433970860
ContactId: c38daf0a-8f98-4560-8ea3-9868c29b5fde
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 877570 ms
Total Talk Time (AGENT): 488842 ms
Total Talk Time (CUSTOMER): 334800 ms
Interruptions: 6
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/c38daf0a-8f98-4560-8ea3-9868c29b5fde_20250620T21:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII]. Um, I work for, um, Girl Scouts in [PII]. Um, and on ago I had APL, uh, supplemental insurance, um, through my place of employment, and I just got a bill for, uh, a health service that happened in [PII]. Um, so I, I don't even know that I.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh gosh.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, and so I had thought that, um, my insurance covered some of it and then my supplemental insurance had kicked in and covered the rest, but I now have a bill for $2,334 and I can't even like really log in. Um, I don't even reme like I think I threw out my card, um, like about a year ago when I moved, so can I, can you help me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, absolutely, um, I'm so sorry that's yikes. OK, so, um, first we can go ahead and get it pulled up just to make sure we did in fact receive that claim, um, it's possible we were missing some information we could definitely see what's going on with that. um, [PII], before we go any further, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. I know you said you don't have your policy number anymore but um I can start using your social.
[CUSTOMER][NEUTRAL] OK, um, so [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, and I'm just gonna verify some information really quick. Can I get your date of birth please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] You might have my mailing address in [PII] still. Uh, it was, is it [PII] or [PII]?
[AGENT][NEUTRAL] Oh, yes, yes, sorry, I was gonna say.
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] OK, so it was [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you. Looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] OK, I was gonna say it's either my work or it's my Gmail. So Gmail would be [PII]. [PII]
[AGENT][NEUTRAL] Got it. OK, thank you so much for verifying all of that. Alright, so I know you said this was in [PII] on that bill, does it happen to show the exact date of service?
[CUSTOMER][NEUTRAL] Yes, uh, it was [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] All right, looks like we got.
[AGENT][NEUTRAL] 3 claims from that date of service, so let's take a look here. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you think if I tried to log in with my Gmail account I would still be able to log in? I can try.
[AGENT][NEUTRAL] No, unfortunately, if you were, well, our website recently did undergo quite a big change, and with that it was making all users have to create new accounts. However, since you don't have policy with us at this time, it wouldn't allow you to, um, but if you need any sort of record, I can send you. So I do see one it looks like all of these for [PII] were from the same provider as uh, Broward Health North.
[CUSTOMER][NEUTRAL] Ah, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and I do see the first one we received was for $5,584.23. Uh, we paid a benefit of $3250 and for the notes on this claim, it does state that that met your outpatient maximum for the calendar year, so there are.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, that looks like that's the same one twice. I'm not sure if this might be the same one you're referring to, but let me take a look here. I mean that would make sense if that was the remaining balance because you did say 2000 something correct?
[CUSTOMER][NEUTRAL] Yeah, can you tell me what the original, um, was, or you said 5500 and then I then you I lost a lot so.
[AGENT][NEUTRAL] Oh sorry, sure, um, $5,584.23.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and you paid out 3250, is that correct?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Alright, uh, and that took me to my maximum for the is it a calendar year? Like is it January to December? OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, absolutely, and I'm looking right now just for good measure, OK, so that 3250, that is your calendar year maximum, so that one claim met that maximum, um, give me just a moment though just to see because I do see another claim that we received twice, um, and I'm gonna see it looks like it's from the same provider so I'm not sure.
[AGENT][NEUTRAL] Bear with me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh OK it was the same uh they just submitted the same claim multiple times. OK, so it's really just the one, so there shouldn't be any other surprises hopefully, but I'm sorry about all the confusion.
[CUSTOMER][NEGATIVE] OK, and when you say there was another claim, it was that was just them attempting more than once. It's not like they've been paid 3250 more than once, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, it, yeah, and I do see record of that as well. They, I guess they were just, you know, didn't try contacting. They just kept resubmitting.
[CUSTOMER][NEUTRAL] OK, just keep hitting the enter button and seeing if it does something different, um.
[AGENT][NEUTRAL] Maybe they'll pay it this time. I know.
[CUSTOMER][NEUTRAL] I mean, listen.
[CUSTOMER][NEUTRAL] I, I wouldn't argue, um, OK, so, I, I, this is my gap insurance from work way, way, way back when, so I should probably just go back and confirm that the absolute maximum for the gap insurance at that time was 3250 because I mean if it's gap insurance, that seems like that's a relatively low number like does that seem like what's it.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You're fine. Um,
[AGENT][NEUTRAL] I did go ahead and look. I will say um for the secondary medical that we offer there are tons of different options that we have and those options are then you know filtered out through whoever your employer was, uh, they would select those.
[AGENT][NEUTRAL] Specific plans that the employees would then be able to choose from. So for this particular one that you have the inpatient benefits for calendar year was uh 6500 and then outpatient was 3250 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Interesting. So if I had been inpatient, it would have actually covered it, but because I was outpatient, it did not.
[AGENT][NEUTRAL] Up to that specific dollar amount.
[CUSTOMER][NEUTRAL] That's about, OK.
[CUSTOMER][NEUTRAL] OK, and I had no other claims against for outpatient in that year like there were other things that were gap insurance that was covered or?
[AGENT][NEUTRAL] Um, let me see, I only know a few claims honestly that was the only payment that I'm showing that you had, and this policy was active from [PII] and now I do see one claim. I'm gonna take a look at this one because this is from the date of service was [PII].
[CUSTOMER][NEUTRAL] Is that my only payment?
[AGENT][NEUTRAL] Give me just a moment, let me look at that.
[CUSTOMER][POSITIVE] Yeah, that, that sounds right.
[CUSTOMER][NEUTRAL] That one probably should have been inpatient.
[AGENT][NEUTRAL] Oceanside elite surgical uh does state it was outpatient, but I'm gonna go ahead and take a look here.
[AGENT][NEUTRAL] Yeah, it's just stating that the outpatient benefit for the calendar year had been met, so those are the only two dates of service that we've received.
[CUSTOMER][NEUTRAL] So what the
[CUSTOMER][NEUTRAL] Uh, so that is making me feel like there's another, there's another bill on the way. Um, so for that, for the first one, the [PII], I was, it, it was an out outpatient service like I went in and left, um, but for the [PII], I was there in the hospital for 2 days, so I'm wondering why they would have asked for inpatient, um, when I, uh, for outpatient when I was inpatient.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You know, I mean you can resubmit that information if you think that that's incorrect. We would simply need a um the itemized statement uh that shows any diagnosis and procedure codes of course the explanation of benefits from your major medical, uh, whoever your primary is, what they contributed to that. And then if it was inpatient, we would need the admission dates and times and then the uh discharge date and time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] Oh God, I mean, I, I, why these people are coming to find me two years later? I do not know, but OK, um.
[AGENT][NEUTRAL] Listen, we get calls from providers and they'll ask to check on a claim and they'll say like 2020 or something and um.
[AGENT][NEUTRAL] So I mean they could just be going through their stuff you never know.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, OK, and so what was the amount of the [PII] that that.
[CUSTOMER][NEGATIVE] You did not pay anything on.
[AGENT][NEUTRAL] Looks like they were, yeah, it looks like there were a couple line items. One was for uh $6,111 and then the other was $4520.
[AGENT][NEUTRAL] And that one states, uh, let's see, that was Oceanside Elite Surgical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Interesting. OK.
[AGENT][NEUTRAL] Well, and you could always if you're concerned, you know, and you don't want any surprises, you could always give them a call but I will say we um our company, we don't ever say what is patient responsibility, um, that would be left up to the provider so the provider could also put that as a write off so it's not like this is saying you do owe something, um, just so that you're aware.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah yeah OK all right um is there anything that you can send me um so that I have a record of what was sent, what was denied, what was paid, um, so I can.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Maybe go back to my work and find out if, if that was.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, I don't know. I guess I was under the impression that the gap insurance had covered more, but, but you're right, there's different categories.
[AGENT][NEUTRAL] You're fine. I've even got a copy of the.
[AGENT][NEUTRAL] Yeah there was a a bunch of different ones um and I can do a couple of different things for you. I can send you a copy of the original, your actual policy that you had with us, um, so you could see, you know, it would have your name, the policy number, uh, dollar amounts, frequencies, things like that, um, and then I can also send you, I've got a total of 4 claims that we've received for you, um, and I can send those to you as well if you'd like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, that would be very help. Can you just send them to the email that you already have, which is [PII].
[AGENT][NEUTRAL] OK. Sure.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Yes, absolutely I could go ahead and send that to you.
[CUSTOMER][POSITIVE] OK, thank you so much. This is probably one of the more.
[AGENT][NEUTRAL] Now, I will say, um, because.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][POSITIVE] Helpful conversations I've had.
[AGENT][NEUTRAL] Oh well I'm glad to hear that. I'm sorry that for all the confusion, um, but I wish there was more I could do. I will say just so that you're, um, just so that you can expect this, um, you will probably get let's see 5 separate emails from me because I can't send them all in one, so you'll get one that's gonna be the policy and then 4, for the different claims.
[CUSTOMER][NEUTRAL] Just put
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] That's fine. And is there like a.
[AGENT][POSITIVE] And if you get them you have any questions or anything, definitely give us a call back and we'll do our best to walk you through any confusion.
[CUSTOMER][NEUTRAL] Yeah, do I need to know about like a statute of limitations on this, um, on this other $6500 inpatient? Like if I do go and get an itemized statement and the discharge papers and all that, like there is still a possibility that if I am owing, which they haven't come to find to me about yet, um, but like what's the limit?
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Well, that's the yeah and of course we have right we have no way of knowing you know that we just see what they've sent we couldn't pay a benefit and we do tell them that we don't say what is patient responsibility so and that that's left up to the provider so they could you know potentially come to you for the money or they could just simply write it off unfortunately we, I have no way of knowing that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, and but in terms of me submitting the paperwork to you like we're talking about something that happened two years ago, so.
[AGENT][NEUTRAL] Oh yeah, no, no, no, that's.
[AGENT][NEUTRAL] No, that's fine. um, so there's no timely filing limit at all. So even if this policy terminated, if you come across anything, any sort of treatment that you've received within the time that your policy was active to the time that it terminated, you could still send us that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right, well, that's also very helpful. Thank you so much. Um, could you just tell me your name so I can write down who I spoke to?
[AGENT][NEUTRAL] Yeah, of course.
[AGENT][NEUTRAL] Sure, [PII], it's [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, [PII]. You were very helpful.
[AGENT][POSITIVE] You are very welcome absolutely happy to help. I hope you have a great weekend. If you have any other questions definitely give us a call back.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yeah, I know where I can find $2,334.23.
[AGENT][POSITIVE] I don't worry about it, really. I think you, I would not worry about it.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] All right have a great weekend.
[AGENT][POSITIVE] You too, [PII] thank you bye bye.
[CUSTOMER][NEUTRAL] Bye.