AccountId: 011433970860
ContactId: db1f486f-4c6b-47c7-ba77-dfc45ef4bfee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 878070 ms
Total Talk Time (AGENT): 301493 ms
Total Talk Time (CUSTOMER): 500139 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/db1f486f-4c6b-47c7-ba77-dfc45ef4bfee_20250402T18:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I had a question regarding a bill.
[AGENT][NEUTRAL] OK and your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your policy number?
[CUSTOMER][NEUTRAL] Uh, let's see here um.
[CUSTOMER][NEUTRAL] Looks like it's 020.
[CUSTOMER][NEUTRAL] 27775
[AGENT][NEUTRAL] And what's a good call back number for you, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, let me pull up your file and we'll have to get you verified and then we can proceed.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] We can verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Your mailing address?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] The city, state and zip code?
[CUSTOMER][NEUTRAL] And that's [PII]?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] State of [PII]?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, and what's your phone, what is your email address?
[CUSTOMER][NEUTRAL] Is [PII]?
[CUSTOMER][NEUTRAL] [PII], that's [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and you said you had a question regarding a bill?
[CUSTOMER][NEUTRAL] Yeah, I'm just trying to figure some things out here, you folks. So it says, so I go, I, I, I, I'm, I'm, I'm getting a notice right now that says like collections or something like that, I guess, you know, they're, they're kind of threatening and, and what I'm trying to figure out is, is when I go to the doctor, um, I understand that I, that this, this policy is gap insurance, but what's happening to me is when I go in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] They either don't enter the gap insurance in their system correctly or when they do, it seems like you're refusing it the first time. And so what's happening is, is then, then, and then what happens is then I call the provider, I call the, the facility and they're like, no, no, no, your insurance is fine, you know, it didn't work. And so, and then I call my broker and he's like, no, no, that's covered, that's covered, you know, that'll work just fine.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so I really don't know what to do. I have like a $5000 bill right now, so do I just send a bill that's in collections to you? Or do I, are you then get turn hang on, let me, let me, let me speak. I know you're in a rush and so or.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. No, I'm not in a rush.
[CUSTOMER][NEUTRAL] OK, so alright, so do I just pay the bill and then after I pay the bill I get an exhaustive level or an exhaustive amount of documentation to prove that I'm me a copy of the check front and back then I send it to you and then I wait 18 months to get to get the money back. I'm just trying to figure out a way that I can expedite the process. Am I just able to send all of the paperwork to you even though it's in collections or at this point am I.
[CUSTOMER][NEUTRAL] Because I've tried to resolve it by sending notification to the hospital and to everybody else that yes, yes, yes, I do have gap insurance. Yes, this is covered and the only response that I get is no it's not covered and I'm finding that hard to believe it was uh it was an emergency room visit and I already met my deductible so I'm just like I said, I'm just trying to figure it out.
[AGENT][NEUTRAL] OK, who's telling you that it's not covered?
[CUSTOMER][NEUTRAL] What, what's the easiest?
[CUSTOMER][NEGATIVE] Well, someone rejected it, and I've got better things to do with my time to just hang out at the hospital billing department all day. They just said it's not covered. So I went to the hospital, I was having stomach pains.
[AGENT][NEUTRAL] OK, what
[CUSTOMER][NEUTRAL] OK. They took some X-rays. They both came out to $5000.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] OK. What's the date?
[AGENT][NEUTRAL] OK, can you give me the date of service that you reported to the emergency room?
[CUSTOMER][NEUTRAL] Um, yeah, it was in January, but I don't have an exact date right now, so just one second.
[AGENT][NEUTRAL] OK. [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'm checking to see if we've received a claim.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I do not see a facility charge for an emergency room visit for you for [PII].
[CUSTOMER][NEUTRAL] OK, one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right, um,
[AGENT][NEUTRAL] Do you have the phone number to the, to the, to the facility?
[CUSTOMER][NEUTRAL] Well, at least you answered the phone.
[CUSTOMER][NEUTRAL] Now I, I'm what I'm gonna do is I like that you wanna figure this out, so I'm confident that I guess we can. So let me get the rest of the information and then I'm gonna call you back. But, um, like I said, it's just that I, I'm just trying to think procedurally when I go into these, you know, when I, when I go to the hospital, which obviously I have better things to do with my time than do so is I'm just trying to figure out is how can I avoid the um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the process because it seems that when I give them my insurance card, Cigna, they're like, oh, OK, and then they automatically build Cigna. But I'm just wondering what the hospital is doing or the doctor doctor's visit is doing at the point that Cigna says, oh no, no, we're not going to pay them.
[CUSTOMER][NEGATIVE] I don't know if it's the provider is in the doctor's office is at that point is just saying no we're just not organized and we're not gonna go ahead and bill APL or do they simultaneously are they supposed to bill you and Cigna at the same time and then you fight it out amongst yourselves, yourselves? That's what I'm trying to figure out.
[AGENT][NEUTRAL] OK. So then I'll explain the process. And so you, the doctor's.
[CUSTOMER][POSITIVE] Great, please do.
[AGENT][NEUTRAL] The doctor or the emergency room, who, whoever is your health care provider will submit the claim to, to Cigna, your primary first. They have to wait until Cigna sends them an explanation of benefits. At that time, then the hospital in this instance would send us a copy of Cigna's explanation and their itemized bill.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the explanation of benefits does indicate what we owe, so any amount that may have been applied towards your calendar, your deductible, um, it could be a co-pay amount or a co-insurance amount, those are the items that American Public Life reimburses.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But I'm thinking it's because we've not received a claim, so the hospital haven't sent it to us for review of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so at this point what I'm, I guess what I'm trying to figure out then is then if it's in collections now what is the process? Am I able to still.
[CUSTOMER][NEUTRAL] Send the bill to you and then you send the payment in or since I'm getting in since I'm getting something from the collections department to their agency is it too late for you guys to step in?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so there is not a timely filing in which to submit in which to submit your documents you since it has gone to collection, the, the hospital is not gonna speak with you or I, but what you can do is if you have an itemized bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you have a copy of sickness explanation of benefits you can get that information to APL and we can review it for payment and if there's an available benefit it'll be reimbursed to you.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] So have you already paid out of pocket?
[CUSTOMER][NEUTRAL] It'll be a reason to move. OK, OK.
[AGENT][NEUTRAL] If you said if you, you send it to us, it will be the benefits if there be any, will be reimbursed to you. So do you have a copy of sickness?
[CUSTOMER][NEUTRAL] So I still have to pay.
[AGENT][NEUTRAL] Do you have a copy of Cigna's explanation of benefits?
[CUSTOMER][NEUTRAL] So I still
[CUSTOMER][POSITIVE] Well, yeah, um, yeah, I believe I do, yes.
[AGENT][NEUTRAL] OK, I'm just curious to know if they applied any dollars towards your deductible or co-insurance and or co-pay amounts.
[CUSTOMER][NEGATIVE] Well, it doesn't appear so is because I haven't received a bill from Cigna. Um, I have, well I'm receiving a bill from the hospital, but I'm not seeing anything that came through from Cigna that says explanation of benefits, so I'm not sure what happened.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so I guess we need to determine first if the if Cigna received the claim.
[CUSTOMER][POSITIVE] Yes, yes, correct. So I.
[AGENT][NEUTRAL] Yeah, so generally do you receive an explanation in the mail from Cigna generally?
[CUSTOMER][NEGATIVE] I get miss I get, I get probably I literally for the mail. I mean I literally get, you know, I would say between my wife, myself, I consider myself in pretty good health. I, we probably get three letters every single week and it, and I would say 99.9% say this is not a bill, which on a consumer level I think it is the dumbest thing any.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Any company can ever send. this is not a bill. It doesn't make sense. I don't know why we would want to waste postage in that at all when you could easily send an email or send other forms, so it doesn't make any sense. The rest of the universe operates in a different way. I understand. I'm sure there's some state law or some regulation that, you know, that does it. I, I, yeah, I, I get that. I get that part of it, but I, I'm just expressing my frustration.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] But you can opt in.
[AGENT][NEUTRAL] I know. You can opt in to receive it electronically instead of by mail.
[CUSTOMER][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Did not know that until this moment. I'm gonna write that down. I'll talk to our insurance broker about it. So did not know that.
[AGENT][NEUTRAL] Yeah, you're, you're, you're not from APL but like Cigna.
[AGENT][NEUTRAL] Um, if you don't want it in the mail, they could upload it if you, you would have to have a portal to access their website, but they can upload it there.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I get my ELBs in my email because I've opted in to have it sent to me electronically because I don't want the paper.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Can they be, OK, can, can, can they, that's fine. So can they be separated into when you receive them if you opt in for no mail, um, and say, OK, fine, but then when you receive them, can they come in, are they able to come in two buckets? One is this is not a bill which would waste, which is I think a complete waste of time and then another one would be is, hey, guess what, there's any.
[CUSTOMER][NEUTRAL] change in your policy or something else that would make sense but anyway, I guess he can read the email. It's we're, you're halfway there. Alright, well, look, I gotta get more information buzz you back, but I, I got the gist of this. The gist of this, it's in collection. I'm writing a check and then I'll have to send this in for reimbursement and you can determine if it's eligible eligible, provided that you have an itemized receipt, correct?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Not a receipt, an itemized bill, and I know that you have to go, but there's.
[CUSTOMER][NEUTRAL] Yes, and I think so.
[AGENT][NEUTRAL] OK. Can I give you the form to request from the hospital? That way we have the right itemized bill?
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] OK, let me know when you're ready to write this down.
[CUSTOMER][NEUTRAL] Got a pencil ready, go ahead.
[AGENT][NEUTRAL] OK, it's an acronym it's U as in university, B as in Bob, 04, so you're, you're gonna request the itemized bill UBO4.
[AGENT][NEUTRAL] And when I was speaking about earlier about opting in to get it via email that's your primary.
[AGENT][NEUTRAL] Insurance.
[AGENT][NEUTRAL] And the one that says this is not a bill is probably the explanation of benefits that we need.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, I see.
[CUSTOMER][NEUTRAL] Well I'm looking at something now that says this is not a bill and it says outpatient expense expenses right now but this is not what I'm referencing so.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Is that from Cigna?
[CUSTOMER][NEUTRAL] Yeah this came no this came from you from APL.
[AGENT][NEUTRAL] OK, so is it an explanation of benefits then?
[AGENT][NEUTRAL] It should say that across the top. OK.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Yes it does and it says this is not a bill.
[CUSTOMER][NEUTRAL] Mhm. So would this, would this suffice as the be what you just said, would this, would this suffice as the BO4?
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] The UBO4, no. The UBO4 is an itemization of what was done while you were in the hospital, so that'll have to come from the hospital.
[CUSTOMER][NEUTRAL] OK, and then when I have that I can send that in to you correct?
[AGENT][NEUTRAL] The itemized bill, yes, and the explanation of benefits that we need, not the one you received from ATL we need Cigna's explanation of benefits because that tells us what we owe if anything.
[CUSTOMER][NEUTRAL] Understood.
[CUSTOMER][NEUTRAL] Yes, got that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then, and then where am I sending that to what address?
[AGENT][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] 248.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 950.
[CUSTOMER][POSITIVE] Yeah, I see it on here too. Got it OK.
[AGENT][NEUTRAL] And, or you can fax it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but I have a question. So when you're referencing Cigna's explanation of benefits, I still need to, I can't just get this from the, I have to get this from Cigna which.
[CUSTOMER][NEUTRAL] OK, because, so I actually have to go back. I have to call Cigna, reference the date that I was at the hospital, have them send me the explanation of benefits. Then in turn when Cigna sends that to me, so effectively then you would con this is after I pay the bill. So then effectively what happens is, is then you and Cigna talk to one another and then figure out who's gonna reimburse me if it's reimbursable.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] So then if you're sending the claim to us, you would send us a copy of sickness explanation of benefits and the itemized bill that you'll get from the hospital.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] APL will receive those two documents and on Cigna's explanation of benefits it tells us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What you owe, which is the amounts in the deductible column, co-insurance and co-pay column, that's how we know so we don't call Cigna, it's on their EOB, their explanation.
[CUSTOMER][NEUTRAL] Understood.
[AGENT][POSITIVE] The benefits.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] You said it's on their ELB?
[AGENT][NEUTRAL] Uh, EOB, which stands for explanation of benefits.
[CUSTOMER][POSITIVE] Understood. All right, I'm on your, OK. All right. I just need a little more paperwork. I may, I may buzz you back, but you've been very helpful. I appreciate it, OK.
[AGENT][NEUTRAL] Alrighty. Anything else, [PII]?
[CUSTOMER][POSITIVE] That's it. Have a great day. Thank you.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] You too, thanks for calling APL have a great day.
[CUSTOMER][NEUTRAL] I know.