AccountId: 011433970860
ContactId: d090c1fd-044b-45c4-9895-2c2ecc565867
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 685030 ms
Total Talk Time (AGENT): 249734 ms
Total Talk Time (CUSTOMER): 289251 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/d090c1fd-044b-45c4-9895-2c2ecc565867_20250523T17:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I need to find out if some of my claims or if y'all got any claims on some bills that I got.
[AGENT][NEUTRAL] I can help you with claim status. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] It is 1462947.
[AGENT][NEUTRAL] Alright, one moment while I look that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And can I get you to verify your date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And your address and phone number that we have on file?
[CUSTOMER][NEUTRAL] OK, it's [PII], that's [PII], and then what did you say the phone number?
[AGENT][NEUTRAL] The phone number we have on file?
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have the claim numbers or the date of service?
[CUSTOMER][NEUTRAL] I have the data search.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, let me a claim number. OK, it'd be 3725.
[AGENT][NEUTRAL] One moment while I look that up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] I'm not any you said um [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm not showing anything for that date of service.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, it's not showing like they paid anything.
[AGENT][NEUTRAL] Right, I'm not even showing that a claim is on file.
[CUSTOMER][NEUTRAL] Like an ex.
[CUSTOMER][NEUTRAL] OK, I don't know if uh the insurance ones are.
[CUSTOMER][NEUTRAL] OK, well, I got some bills and that's what I was trying to find out because doesn't the APL, will it not cover like train and stuff like that and that the APL kind of does. I know it don't do doctor copays, but don't it pay for like stuff like that, like labs and X-ray.
[CUSTOMER][NEUTRAL] Sonograms.
[AGENT][NEUTRAL] So this
[AGENT][NEUTRAL] Um, so this policy is a secondary gap policy. So when submitting a claim, we'll need the primary, um, explanation of benefits showing that the primary did accept and pay partial payments, um, because this policy goes towards co-pays, co-deductibles, and co-insurance. So if your primary insurance denies it, this one will deny it, um, and I can see what all you have on here.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, because I know it looks like some of it's been paid. Like I have one that went to Comanche County Hospital and it says total insurance adjustment and then it leaves me paying 80, but I don't know if they if that's just sent through the Blue Cross Blue Shield or any of it came through y'all.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, because I don't have an uh a claim for that data service typically you file a claim with this one after your primary has paid because we need that explanation of benefits from them, um.
[CUSTOMER][NEUTRAL] OK. Well, don't they do that cause they can.
[AGENT][NEUTRAL] And since I'm not seeing one on file.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, so don't they, are they supposed to do that if they take both insurance cards, right?
[AGENT][NEUTRAL] Right, if they took both insurance cards, it would come through to us as well um if your provider.
[CUSTOMER][NEUTRAL] The name
[AGENT][NEUTRAL] Submitted the claim they might not have submitted it yet they might have been waiting for your primary first um I don't know for sure what they do.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, because I just got one and I know it's only $10 but that's not the point when there's they should be filing, but they keep sending me over $10 and I'm like, I'm trying to wait to see if it's came through y'all because I know that should be coming.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] From what I understood that you know you all pay for that kind of stuff. I've had stuff like that and I know.
[AGENT][NEUTRAL] Yeah and even if they submitted the claim we would still be able to see the claim and see if it was paid or denied.
[CUSTOMER][NEGATIVE] Right, so not showing up being submitted at all.
[CUSTOMER][NEGATIVE] If y'all can't see anything, that means they have not submitted it to y'all at all.
[AGENT][NEUTRAL] Right, I'm not showing anything for that date of service.
[CUSTOMER][NEUTRAL] OK, OK, that's what I needed to find out. All right, I'm gonna get a hold of them and see what they've done.
[CUSTOMER][NEUTRAL] I just want to check with y'all first.
[AGENT][NEUTRAL] All right. And
[AGENT][NEUTRAL] Certainly, and feel free to call us back if you need anything further or um.
[AGENT][NEUTRAL] If they won't file the claim.
[AGENT][NEUTRAL] Then you're all you are allowed to file the claim on your behalf as well.
[AGENT][NEUTRAL] So I, I would see what they say.
[CUSTOMER][NEUTRAL] OK, and then what did you say I would have to do?
[AGENT][NEUTRAL] I'm sorry, what?
[CUSTOMER][NEUTRAL] OK, and then what would I have to have to file it on my own if they won't do it?
[AGENT][NEUTRAL] Um, depending on what it is, you'll have a claim form that you need to go to on our, uh, website.
[AGENT][NEUTRAL] Uh, this is so depending on what type of claim you're filing for and the type of insurance you're filing it for, um, it'll tell you typically we need itemized bills or an itemized invoice, uh, to show procedure codes on what was done.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we will need your primary insurance explanation of benefits showing what procedure codes they paid for um and how much they paid towards it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And see that's where I'm confused because it's showing like they adjusted this this payment or whatever but yeah Blue Cross Blue Shields telling me that they don't pay anything until my deductibles met that's how our insurance is this year.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I don't unders I understand, I don't understand how
[AGENT][NEUTRAL] Then we would
[AGENT][NEUTRAL] Yeah, um,
[CUSTOMER][NEUTRAL] If they made an adjustment, is that just an adjustment made because I have the insurance, or did they submitted to that? that's why I'm confused.
[AGENT][NEUTRAL] Yeah, I don't know you'll you'll want to call them because even if the I mean they could still file the claim on your behalf um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] To have on file but I'm, I'm not showing anything for that date of service.
[CUSTOMER][NEUTRAL] OK, is there any for any, any dates this year?
[CUSTOMER][NEUTRAL] Because like I said, there should have been one, let me see what date that was I went.
[CUSTOMER][NEUTRAL] I know the one is the.
[CUSTOMER][NEUTRAL] Should be like [PII], it should be like the [PII] and then there should be 1.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] [PII], did y'all pay anything on [PII]?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That should be for an ultrasound.
[AGENT][NEUTRAL] Was the ultrasound done on [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I am showing a claim for that day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see how much or who it went to.
[AGENT][NEUTRAL] Oh, give me just a second.
[AGENT][NEUTRAL] Um, and you said, where did you get that done at?
[CUSTOMER][NEUTRAL] It was Comanche County Hospital.
[AGENT][NEUTRAL] OK, it looks like that one was received and we did pay the provider, so Comanche County Memorial, it looks like we did pay them.
[CUSTOMER][NEUTRAL] OK, because I got a bill saying like I owe 8018. Do y'all know what y'all paid on it or or did y'all pay the whole bill?
[AGENT][NEUTRAL] So for this claim we paid $268.82. Um, I don't know what it was charged for you um I don't do patient responsibility um it looks like there might have been a balance. let me see what's going on.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because it says total charge was 258.
[CUSTOMER][NEUTRAL] And then it says total insurance adjustment was 17782.
[CUSTOMER][NEGATIVE] So did they only take so much of y'all's money that you paid now they're trying to get $80 more dollars out of me?
[AGENT][NEGATIVE] I would call them for that because all I'm showing is what we paid to them. Um, I can't see what your major medical pay. I, I can't see that.
[CUSTOMER][NEUTRAL] OK, and you also
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] The major medical is not paying anything. I do know that they're they will not pay anything until my $3500 deductible is paid.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So y'all paid 26882, right?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] To this Comanche County Memorial Hospital.
[AGENT][NEUTRAL] Yes, I am seeing that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, I'm gonna check with them and see where this went because the total bill that they charged me was $258.
[CUSTOMER][NEUTRAL] So if that's the total bill, how did they charge you 268?
[AGENT][NEUTRAL] Yeah, I would, I would talk to them for the service on [PII], yeah, and then your service that we don't have the claim for, I would definitely contact them too.
[CUSTOMER][NEUTRAL] Yup.
[CUSTOMER][POSITIVE] OK. OK, that sounds good then.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, I just wanna make sure that they wasn't ripping y'all off.
[AGENT][NEUTRAL] OK, OK, well, uh, let us call us back if you have any questions or if there's anything that comes out from this that you have questions on, OK?
[CUSTOMER][POSITIVE] OK all right thank you ma'am.
[AGENT][POSITIVE] Great. Have a great day, bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.