AccountId: 011433970860
ContactId: c48c918d-d945-4e77-b526-61fb1c5ac9d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 494089 ms
Total Talk Time (AGENT): 122712 ms
Total Talk Time (CUSTOMER): 293030 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/c48c918d-d945-4e77-b526-61fb1c5ac9d5_20250505T17:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, this is [PII]. I'm calling from American Bank of Oklahoma broker's office and calling about American Bank of Oklahoma, uh, an employee, and, um, a claim that we've, we uploaded and I've uploaded some more information.
[CUSTOMER][NEUTRAL] Uh, the group number is 26018.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] And OK.
[AGENT][NEUTRAL] OK, and [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] I do [PII].
[AGENT][NEUTRAL] And what is your email address?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number of the member?
[CUSTOMER][NEUTRAL] I, let's see.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If not, I can look it up.
[CUSTOMER][NEUTRAL] Where would I find?
[CUSTOMER][NEUTRAL] Yeah, I don't know. Oh yeah, yeah, I do, yeah, 238-9034.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what uh date of service are we checking on?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me double check because I think it was [PII]. We've been going back and forth trying to get the right codes for her. She was trying to get them from the, the hospital. They weren't, they gave the wrong ones, they weren't very cooperative then we tried to get them from community care.
[CUSTOMER][NEUTRAL] And I re uploaded them last week and we just wanted to see if if that.
[CUSTOMER][NEUTRAL] If that had been looked at yet and if they were correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see. Uh, yes, it looks like we did get that and
[AGENT][NEUTRAL] And you said 115, 2025?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, perfect. Uh, looks like we made a payment to her for $350 and that was on $429.
[CUSTOMER][NEUTRAL] $350.
[CUSTOMER][NEUTRAL] OK question so on that invoice, let me get out of this and go back.
[CUSTOMER][NEUTRAL] So she has to.
[CUSTOMER][NEUTRAL] Like, pay, I'm trying to figure out how this works because I know our deductible covers like the 1st 2000 and so that's what she's gonna be out of pocket.
[CUSTOMER][NEUTRAL] So how does that work? How did she only get paid 350?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Let me pull up what we received, because it was not gonna pay more than
[CUSTOMER][NEUTRAL] I know it yeah and I know it showed members responsibility on that thing 37206 but.
[CUSTOMER][NEUTRAL] But she hasn't
[CUSTOMER][NEUTRAL] And then the Saint John rebill.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so,
[CUSTOMER][NEUTRAL] And she hasn't gotten her finalized, sorry, I didn't mean to interrupt.
[AGENT][NEUTRAL] This, this is for the hospital, um, the, yeah, the 41,000. So it just showed a copay amount of 350, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And so we paid the copay amount of 350.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I'm gonna have to do some further investigation on this because I know that she had to go back and ask them for another rebuild because they they actually sent the insurance like two different statements and one was incorrect, which that was weird um and then.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] She had to ask for a rebill but so I'm thinking she should receive like a final bill from them for what she owes.
[CUSTOMER][POSITIVE] And like she should owe her.
[CUSTOMER][NEUTRAL] You know her full like she owes her deductible or I don't know how that works. I'm just blanking out here on how that would.
[AGENT][NEUTRAL] Um, well, from our, from our end, we, you know, we look at it and see what was allowed by the primary, what was paid, um.
[CUSTOMER][NEUTRAL] How that works.
[CUSTOMER][POSITIVE] Right, yeah, that totally makes sense, absolutely.
[CUSTOMER][NEGATIVE] I'm thinking that she should have received something else.
[CUSTOMER][NEUTRAL] Showing what she owes because to me, she owes, it should show that she owes.
[AGENT][NEUTRAL] More than that, is that what the?
[CUSTOMER][NEUTRAL] That she's right because there's no way they're gonna pay the 40, you know, community care is gonna pay that it's gonna be the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Less her, um her deductible.
[AGENT][NEUTRAL] Yeah, if there's
[CUSTOMER][NEUTRAL] And the deductible on its 2500 and and then you all cover the 1st 2000 so really and truly she should be out of pocket uh 500 so.
[CUSTOMER][NEUTRAL] I have a feeling she's gonna get another invoice so.
[AGENT][NEUTRAL] Yeah, um, and then her primary insurance, if we, if we could get
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I guess if there was another EOB that reflected what her true responsibility was, um, that's that's where we're running into the issue is the it just reflected the 350.
[CUSTOMER][NEUTRAL] Is the
[CUSTOMER][POSITIVE] The true responsibility. OK, I'll reach back out to them. Sure, that makes sense and see what and see if I can ask them and yeah.
[AGENT][NEUTRAL] Yeah, because.
[AGENT][NEUTRAL] OK, yeah. Yeah.
[CUSTOMER][NEUTRAL] And see if they see anything different.
[AGENT][NEUTRAL] Yeah, because that if you look at that explanation of benefits, I'm not sure if you can see it, but under member responsibility all it shows is the 32206 and if if we had something else.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Right, exactly.
[CUSTOMER][POSITIVE] And I get that you, you just gotta go by what it shows that she owes that makes total sense, yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But yeah and I'm thinking why isn't it showing?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] And the thing that's so frustrating is it's now May. Why haven't they sent her something?
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] They apply it to something else?
[CUSTOMER][NEUTRAL] You know something that's more detailed.
[AGENT][NEUTRAL] Um, so
[CUSTOMER][NEGATIVE] There's there's no way they could have.
[AGENT][NEUTRAL] I think I think.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's just
[CUSTOMER][NEUTRAL] Yeah, it's just crazy.
[AGENT][NEUTRAL] physician charges or something.
[CUSTOMER][NEUTRAL] And calling
[CUSTOMER][NEUTRAL] Yeah, I don't know and it it was only that date of service and I've um.
[CUSTOMER][NEGATIVE] And just calling the hospital and I've my I my own personal experience with them. I just, I left them and went somewhere else because their billing department's the absolute worst.
[AGENT][NEGATIVE] Oh yes, it's a common problem.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEGATIVE] Unfortunately.
[CUSTOMER][NEUTRAL] Yeah and just yeah and calling them like just trying to get a hold of somebody like she couldn't um get the codes and so finally we found out that the the uh the community care would give us the codes which I hate to bother them with that nonstop but they will and that's where we eventually got them from because [PII]'s just told her there's too many to give you like really there there weren't so somebody was just being lazy.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] So but OK well I appreciate your help. I will reach back out to community care and see if they have something different that we can we can add because we just wanna make sure that yeah all right I appreciate your help thank you.
[AGENT][POSITIVE] OK, perfect.
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.