AccountId: 011433970860
ContactId: cc064d60-14fc-4c4e-8d76-9bb9c91ce895
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 768299 ms
Total Talk Time (AGENT): 292153 ms
Total Talk Time (CUSTOMER): 319723 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/cc064d60-14fc-4c4e-8d76-9bb9c91ce895_20250220T17:33_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I have some questions regarding a claim that was placed in uh a year ago. It looks like I'm receiving a bill now from the, the office that I did a procedure with. And back then, actually, before I continue going into details, do you need any information from me?
[AGENT][NEUTRAL] OK, so first off, if you could give me your name again.
[CUSTOMER][NEUTRAL] Yes. First name is [PII]. It's [PII] and last name is [PII], which is [PII]
[AGENT][POSITIVE] Thank you. So, [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And so you have a question regarding a claim that we have received and processed for you? Are you wanting to verify if a claim was ever received, is that correct?
[CUSTOMER][NEUTRAL] Right, so back then I did have
[AGENT][POSITIVE] Yes, ma'am. I can.
[AGENT][NEUTRAL] Oh, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Well, back then I did have multi-plan when I had this procedure done. And this procedure done was, was done in May of last year.
[CUSTOMER][NEUTRAL] And it's just now I'm getting a bill from this clinic almost like a year later. And from my understanding.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Everything should have been covered for this procedure when I talked to the office and when I called um multi-plan when I was um right after I got the procedure done.
[AGENT][NEUTRAL] OK, so just ma'am, I can help check claim status for you. Um, what is a good, do you have your policy number in the back from when you had this coverage?
[CUSTOMER][NEUTRAL] Um, let me see, because, uh, I don't have the coverage anymore. It switched up because.
[AGENT][NEUTRAL] OK, so I can look it up with your social if you were the primary policy holder.
[CUSTOMER][NEUTRAL] Alright, so, oh, the policy number was 02437483.
[AGENT][POSITIVE] OK, thank you, so give me a moment please to get all of your information pulled up.
[AGENT][NEUTRAL] OK, and [PII], I will need to verify several things with you first for security and also any information that is provided would be a verification of benefits and not a guarantee of payment. So first off, um, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][POSITIVE] Thank you, also your home mailing address.
[CUSTOMER][NEUTRAL] It should have been uh let me see because I think the billing one I was using [PII].
[AGENT][NEUTRAL] No, that's
[AGENT][NEUTRAL] Mm, that's not what we have.
[CUSTOMER][NEUTRAL] OK, then it
[CUSTOMER][NEUTRAL] OK, and then it was the old uh apartment that I lived at when I was using multiplan.
[CUSTOMER][NEUTRAL] It should have been, let me see.
[CUSTOMER][NEUTRAL] Give me a second, let me pull it back up.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] This does not, this address, just for your information, does not have an apartment number associated with it. It may just have been left off, but we do not have an apartment number on file for you.
[CUSTOMER][NEUTRAL] Hold.
[CUSTOMER][NEUTRAL] OK, maybe I didn't put the apartment number on there, but let me see it was like 2 apartments ago, so let me see really quick.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Me.
[CUSTOMER][NEUTRAL] Was it [PII]?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Uh yes, ma'am, that is the address that we have on file and the phone number that you gave me is also the same phone number that we have on file and lastly your email address?
[CUSTOMER][NEUTRAL] My email address is [PII] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you so much for verifying all of your information. So what is the date of service that you're calling about, [PII]?
[CUSTOMER][NEUTRAL] I did this procedure. I wanna say it was May. Let me see.
[CUSTOMER][NEUTRAL] Let me and look at this. Um, I believe [PII].
[AGENT][POSITIVE] OK, thank you. So give me one moment.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, so we have a claim, we do have a claim on file for you for that data service, uh, the, is this for Lake dermatology, is that correct?
[CUSTOMER][NEUTRAL] Mm, it should, maybe they go by that, uh, you know, swagger dermatology group, but maybe they go by like like on the and.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK, so I can see that we did receive a claim for that data service and there was a benefit paid in the amount of $250.
[AGENT][NEUTRAL] And with that payment, the maximum benefit payable for this data service was met.
[AGENT][NEUTRAL] This was not major medical insurance that you had and that this was a limited benefit plan that pays specific amounts for certain services.
[AGENT][NEUTRAL] And so with that claim, the $250 was the maximum benefit for surgery in a physician's office.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] OK. I guess I'm just a little confused because like with the doctor's office and at that time I had called and they said that it would be covered that I had a 2, I'm not mistaken, they said 2,
[CUSTOMER][NEUTRAL] What was the word?
[CUSTOMER][NEUTRAL] 022 cystic lipoma removals that are covered by my insurance.
[CUSTOMER][NEGATIVE] That's why, and I had made sure with everything and they said that everything should be covered. They didn't.
[AGENT][NEUTRAL] OK, then you would have, yes ma'am, you would have to speak to them based on the claims information we did pay the maximum benefit that your policy allows for that data service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Talk to who, no, it was, it was the insurance, it was multi plan that I had called.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, multi plan was your network provider but they wouldn't have, you know, I don't know about giving you benefit information that would be to determine whether the provider you were using was in your network or not.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I mean, I'm, I'm honestly, I'm not really sure. I just know like the number on my like medical insurance card is the number I called and like went over everything, so I mean I just thought everything was called like multi plan. Uh it was whatever number was on my card which was this number that I had called into.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Cause I was looking back to see.
[AGENT][NEUTRAL] And I don't say where you had ever spoken.
[AGENT][NEUTRAL] To someone here at APL. I was looking through the notes.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] So, unfortunately, I can't say.
[AGENT][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] I can't know for certain who you who you spoke with.
[CUSTOMER][NEUTRAL] Um, what was the, the total of the bill that was placed in by the, the strider dermatology office?
[AGENT][NEUTRAL] For this claim, yes ma'am, for this claim that I was just giving you the information on which is the only claim we have for that data service, um.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] Bear with me, it's taking a moment to pull that in to pull the claim up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And while that pulls up, do you know why it is because I got this procedure done almost a year ago. Why is it that I'm receiving a bill for?
[CUSTOMER][NEUTRAL] A year later
[AGENT][NEUTRAL] Now that, I'm so sorry, [PII], but I cannot answer that. That would be a question for the, you know, the provider's office.
[AGENT][NEUTRAL] Um, it looks, uh, according to the claim though it just pulled up the information, the total charge on this claim was $2390.
[CUSTOMER][NEGATIVE] OK, um, and then this and this bill just doesn't really make sense then.
[CUSTOMER][NEUTRAL] Um, typically, how, what's the time frame that you should be billed with for like any medical bills because, you know, I, I get it taking like, you know, maybe 30 days or whatever, but a whole year to send an invoice.
[AGENT][NEUTRAL] Again, I'm so sorry but we're not a major medical carrier so we do not determine, you know, your, your responsibility as far as that or any of the billing information that would be a question for that provider's office.
[CUSTOMER][NEUTRAL] So is it that I should reach out to because I guess it's it's different um multi plan I don't I.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, the bill that you received, you would need to reach out to whomever sent you your bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To find, you know, so that you could ask them as far as the time frame.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEGATIVE] And you just now receiving this and I can tell you that this claim was actually not even received by APL or processed until September.
[CUSTOMER][NEUTRAL] Until September.
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEGATIVE] OK, that just, that doesn't even make sense. That's months later. So, OK, what, what is the protocol that a business should put in a claim to you guys if this happened all the way in May and they didn't place it in until September.
[AGENT][NEUTRAL] We do not have a timely filing limit like some insurance companies do, so even if, you know.
[AGENT][NEUTRAL] A year from now, you discovered there was a claim that didn't, you could still, that had not been filed, you could still follow up with us.
[CUSTOMER][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] All right, let me try to reach out to their office again.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with, [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well then thank you again for calling APL and I hope that you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thank you so much. Bye.
[AGENT][POSITIVE] Yes ma'am. You're welcome. Bye bye.