AccountId: 011433970860
ContactId: d74e8573-de30-4476-b9b0-696db5917bdd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282100 ms
Total Talk Time (AGENT): 91774 ms
Total Talk Time (CUSTOMER): 135815 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/d74e8573-de30-4476-b9b0-696db5917bdd_20250325T17:06_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hey, good afternoon. Uh, my name is [PII]. Um, oh man, you're gonna ask me for my policy number, aren't you?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I just thought about that.
[AGENT][NEUTRAL] How may I assist you today?
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Well, here's what I'm trying to do. I, uh, I submitted a claim for my ambulance bill, and I see that there was a um a partial payment made on it, but I was just trying to find out why opposed to, I'm just trying to figure out, you know, what was the reason for that payment opposed to what I submitted it for.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh sure, I understand. OK, let me have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And do you have the policy number or you don't have it with you?
[CUSTOMER][NEUTRAL] I don't have it on me.
[AGENT][NEUTRAL] OK, um, let me go ahead and do a name search one moment.
[AGENT][NEUTRAL] And what is your address, Miss [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] May I have your date of birth, mailing address and email, I got the mailing address, the email address on file.
[CUSTOMER][NEUTRAL] Uh [PII] the email is [PII].
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK, the ambulance was fully paid. Um, the ambulance charges was $642.99 which we did send the $642.99 and we send the ER visit, which it was 557 88 cents. Um, there is a couple of charges that were not paid. Let me check why. One moment.
[CUSTOMER][NEUTRAL] So, so I think that
[CUSTOMER][NEUTRAL] I'm starting to think that you guys looked at the original EOB that I sent in for the ambulance.
[CUSTOMER][NEGATIVE] And then when I, I called you guys back at another point to, to let you know that the ambulance company had resent the bill back to my insurance company and it because they wanted to appeal it. They didn't like that the contractual adjustment was done showing that there was only, you know, that there was a, but how it works. Uh, so anyways, when it went to my insurance company, they reconsidered and said I was out of network.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm mhm.
[CUSTOMER][NEGATIVE] So I went through the clearing house because I was upset. I'm like, how, how does one be out of network in an emergency situation? I didn't know there was no such thing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But uh anyways, they, the EOB that I got from them showing that it was out of network. I submit, as a matter of fact I uploaded it again yesterday to you guys so that you could see it.
[CUSTOMER][NEUTRAL] Um, showing that I was responsible for the entire bill.
[CUSTOMER][NEUTRAL] And not just that $600 some dollars.
[AGENT][NEUTRAL] Ah
[AGENT][NEGATIVE] Oh boy, OK, Miss [PII], if it's not payable by your major medical, it's not payable by us.
[CUSTOMER][NEUTRAL] 00, really? Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, now, as of today, do you see anything that came in from the physical therapy, uh, people? Uh, I can't remember the name of the company. Well, it was benchmark when I went, but I think they um something else.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, I don't see any submissions from the provider. Um, I only got your submissions here, so that's the only thing we have right now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so they haven't sent it.
[AGENT][NEGATIVE] Mm mm, no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Is, is there anything else? You're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] All right. Well, I appreciate it.
[CUSTOMER][POSITIVE] No, that'll do it. Thank you so much.
[AGENT][POSITIVE] OK. You're welcome, Ms. [PII], and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] All right you too bye bye.
[AGENT][POSITIVE] Thank you.