AccountId: 011433970860
ContactId: e1717edf-3fd2-46e4-bd30-471b709f0147
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1690660 ms
Total Talk Time (AGENT): 431787 ms
Total Talk Time (CUSTOMER): 921744 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/e1717edf-3fd2-46e4-bd30-471b709f0147_20250224T14:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Uh, good morning [PII]. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] I'm good, I'm good. I was calling about, um,
[CUSTOMER][NEUTRAL] Uh, some claims that I submitted this morning, uh, there, there was someone else helping me a couple weeks ago, um.
[CUSTOMER][NEUTRAL] I forgot her name, but uh.
[CUSTOMER][NEUTRAL] So, so my son had a couple claims with Children's, um, I submitted those, but then they wanted like the detail, uh, diagnostics code, so, um, I, it took 3 weeks for me to request that information so I finally get that information and I uploaded that, um, this morning and just kinda wanted to discuss that because this would be the 3rd time I'm submitting this, and I just wanna make sure you guys get all the information that you need.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, for this.
[CUSTOMER][NEUTRAL] And then also there was one claim that I submitted, but uh, I accidentally selected my son's name and it was for my daughter.
[AGENT][NEUTRAL] OK, well give me your name.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Spell your first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what's the what's your policy number?
[CUSTOMER][NEUTRAL] Uh, my policy number is 253-775-2.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me pull up your policy, give me one moment.
[AGENT][NEUTRAL] And can you verify your date of birth and your mailing address?
[CUSTOMER][NEUTRAL] Uh, my date of birth is [PII]. My mailing address is [PII].
[AGENT][NEUTRAL] And your email address.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that for me. You kind of go in and out a little bit. Your voice gets a little faint sometimes and you said that you're call that's OK. You're calling on a claim that was sent in for your son or yourself.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] It's, it's, it's for my son we could just focus on my son for right now so what I did was I submitted, um, I submitted uh documentation and then uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me verify the son's name and date of birth that way I'll know which one to look at.
[CUSTOMER][NEUTRAL] His name is [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, his date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so I see several documents uploaded like you said today.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So the one the last claim that I submitted, I accidentally selected my son [PII] versus my daughter [PII] so I can give you that that um is there a way to change the name for who it was submitted for or?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, or you can just submit it under the correct dependent.
[CUSTOMER][NEUTRAL] Resubmit it, OK, OK, well we could talk about the, the first two that I submitted, um, those dates of service was for.
[CUSTOMER][NEUTRAL] Alright, give me one second, it was for.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] What year?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, if we kind of just go through the history of this, right, so, um, let me.
[CUSTOMER][NEUTRAL] Take a look at the one that I submitted.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So I submitted his, his, his medical bill and then what they did was, uh.
[CUSTOMER][NEUTRAL] They wanted the explanation of benefit so so I submitted that and the explanation of benefits and they came back and they said that they wanted the diagnostics code, so.
[CUSTOMER][NEUTRAL] Um, I had to call the hospital and request that, so, so I, I get that and I submitted that.
[CUSTOMER][NEUTRAL] This morning
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] For the claim number, let me see what he did give me a claim number? No, he gave me a confirmation number, so the confirmation number is.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Ends in 27 and 28, those two confirmation numbers.
[CUSTOMER][NEUTRAL] I submitted the charges and the explanation of benefits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I just wanna make sure that you know.
[CUSTOMER][NEUTRAL] This claim gets processed the proper way because it I owe the hospital quite a bit of money and.
[CUSTOMER][NEUTRAL] You know, every time I submit it, you know, I, I, I'm just trying to make sure that.
[CUSTOMER][NEUTRAL] Um, APL has everything that they need to process the claim properly.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] And when you so I see the primary explanation of benefits that you submit the itemized bill under a separate entry when you uploaded it?
[CUSTOMER][NEUTRAL] Uh, for which claim number are you talking about ending in 27 or or confirmation number?
[AGENT][NEUTRAL] Yeah, so this is gonna be related to data service 827 and 118.
[CUSTOMER][NEUTRAL] Yep, so I submitted, I submitted that breakdown there, right, um, which.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Just 3 weeks to get right, so it gives a complete detail and then there's the explanation of benefits.
[CUSTOMER][NEUTRAL] Um, that show, that shows what my balances are and then.
[CUSTOMER][NEUTRAL] Uh, if you, if you scroll down to the other claim number as well, um.
[CUSTOMER][NEUTRAL] That that there shows what the hospital billed me.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] There's the hospital bill, there's the explanation of benefits, and then there's the itemized diagnostics code.
[CUSTOMER][NEUTRAL] That they sent me and it also shows the bill as well of of what they what they bill.
[AGENT][NEUTRAL] OK, so now I don't see any itemized bills for your son. I see the primary explanation of benefits.
[CUSTOMER][NEUTRAL] Uh, that, that one document that says charges 2024-0827 charges.
[CUSTOMER][NEUTRAL] So that that's a breakdown so the the.
[AGENT][NEUTRAL] Is that the explanation of benefits?
[CUSTOMER][NEUTRAL] Those are the charges that the hospital charged.
[AGENT][NEUTRAL] I know it, but is it the hospital bill or is that on the the primary EOB?
[CUSTOMER][NEUTRAL] Uh, the EOB is the other document, um, the, uh, I just put [PII]'s EOB.
[CUSTOMER][NEUTRAL] So that EOB is a breakdown of of what they charge and what insurance paid.
[CUSTOMER][NEUTRAL] And then what my balance is.
[AGENT][NEUTRAL] OK, got that.
[CUSTOMER][NEUTRAL] So it shows I have about
[AGENT][NEUTRAL] Mhm. And I do see the hospital bill for 59,000 or 5,962.75.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh yep.
[AGENT][NEUTRAL] OK, and I see the diagnosis code is on that one. OK, so you're good. That's for date of service [PII].
[AGENT][NEUTRAL] And did you send one for data service 118?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] I did, I did, yep, and it's the it's the same thing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] So then you should be good.
[CUSTOMER][NEUTRAL] So that one shows.
[CUSTOMER][NEUTRAL] OK, and then the other claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The last one,
[CUSTOMER][NEUTRAL] I guess that one was for my daughter and that's the total charges of 606.79.
[AGENT][NEUTRAL] Mhm, I see that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And and the insurance just just process that straight through. They didn't actually selected my son, but this is for my daughter, um, so is it.
[AGENT][NEUTRAL] Did you send an explanation of benefits with that charge for your daughter or just the itemized bill?
[CUSTOMER][NEGATIVE] Uh, the itemized bill, there's no explanation of benefits because what they just, they just processed it. They, they didn't process anything because it's high deductible plans, so they just applied that balance towards my deductible. There's nothing online that that shows um.
[CUSTOMER][NEUTRAL] Uh, that shows that they processed this claim because it's, it's a high deductible plan.
[AGENT][NEUTRAL] OK, so we're gonna need the primary ELB before we can continue that claim.
[AGENT][NEUTRAL] Um, for your daughter.
[CUSTOMER][NEUTRAL] Yeah, I, I, I, I do.
[AGENT][NEUTRAL] It'll deny
[CUSTOMER][NEUTRAL] Um, I, I.
[AGENT][NEUTRAL] It, it'll deny for a copy of the major medical explanation of benefits.
[CUSTOMER][NEUTRAL] OK, um, I tried.
[CUSTOMER][NEUTRAL] I called, I called the thing is they don't have anything online. I, uh.
[AGENT][NEUTRAL] Maybe they have not processed it yet.
[CUSTOMER][NEUTRAL] They, they did. I called the hospital and I talked to the hospital and I was like, hey, you know, like where is this?
[CUSTOMER][NEUTRAL] Explanation of benefits and the hospital said yeah they processed it because uh they they showed that they have it.
[AGENT][NEUTRAL] They have the explanation of benefits?
[CUSTOMER][NEUTRAL] No, no, the hospital showed that it processed through insurance and then, uh, because I contacted insurance and I asked them for the explanation benefits they said that, uh.
[CUSTOMER][NEGATIVE] They don't see anything so then I contacted the hospital and the hospital said that they processed it. So then I called the insurance back again and insurance told me that they just applied it towards the deductible. There's nothing to process.
[AGENT][NEUTRAL] Yeah, but we still need the ELB showing that it was applied towards deductible so if.
[CUSTOMER][NEUTRAL] I was like, well, I still need that.
[CUSTOMER][NEUTRAL] Yeah, I know, I know.
[AGENT][NEUTRAL] Yeah, and um you should be able to go on their website to download the explanation of benefits or they, you can request that they mail it to you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, they, they, they don't have it. That, that's the thing. I'm on the website. I'm on United's website. I could see everything. I even see the Walgreens pharmacy.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Dallas process.
[AGENT][NEUTRAL] Now you may wanna reach out to the primary for assistance because if they applied it towards deductible, it still will be it'll reflect that on the explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um.
[CUSTOMER][NEUTRAL] So I have another claim as well, um, how do I
[CUSTOMER][NEUTRAL] Submit
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Do I have to submit the bill from the hospital as well, or can I just submit uh explanation of benefits? Uh, this is for my wife. I have a different claim.
[AGENT][NEUTRAL] Yeah, so any time you submit a claim to APL, there's 3 documents that are required, the APL claim form, so you'll need to complete that and listing your spouse as the patient.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we'll need the itemized bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like that UVL4 form? Was she in a hospital? Was it just a doctor's visit?
[CUSTOMER][NEUTRAL] This was a CT scan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you would request the um did, where did she have it done?
[CUSTOMER][NEUTRAL] This was a CT scan.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I think one of the hospitals maybe like could she she went to the doctor and then the doctor referred her.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, there, so, so, so, you know, we ended up paying like $300 something dollars for the office visit and then they, they prescribed her a CT scan so she went and did a CT scan and what's crazy is this is that, you know, um, she said what is the out of pocket expense they said $400 and then uh.
[CUSTOMER][NEGATIVE] Uh, when she gets there they're like, oh, we're gonna process this through insurance, and they processed it through insurance and told her that she had to pay $811 and then she's just like, well, I wanted to self pay like, well, it's already processed through insurance, um, this is what your balance is and I was just like, oh my [PII], you know this, I don't, I don't know.
[CUSTOMER][NEUTRAL] You know it's, it's crazy.
[AGENT][NEUTRAL] Did you, did, did she present the major medical ID card and the APL Metlink ID card?
[CUSTOMER][NEUTRAL] Well, nobody takes it. I mean like the the uh.
[CUSTOMER][NEUTRAL] The, the APL card nobody takes it, so we, we, we have to pay out of pocket and then submit the claim afterwards so they, they wouldn't run the CT scan, um, but yeah, even when we're at the hospital, my son was there we tried to submit the APL card they, they wouldn't take it, um.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And that's not a problem because you are sending them in yourself, but we do require 3 documents to consider a benefit regardless of what they say. Uh, if, if, if the claim is sent to your major medical carrier and even though it's applied towards deductible, we still need a copy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of the explanation of benefits from your primary.
[AGENT][NEUTRAL] Showing that showing the amount that was applied towards the deductible.
[CUSTOMER][NEUTRAL] OK, so, so
[CUSTOMER][NEUTRAL] OK, so the explanation of benefits and then the bill from the provider are the two things that you need, correct?
[AGENT][NEUTRAL] Mhm. Like that UBO form, that hospital bill that you sent, it has to be an itemized bill like that. And I was trying to determine the location. If she had it done like in a hospital, it would be the same type of form that you sent for your son.
[CUSTOMER][NEUTRAL] Uh, give me one second. I'm, I'm trying it when I, when I click on this and it's like view details, um.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] It doesn't give me.
[CUSTOMER][NEUTRAL] The explanation of benefits it shows like.
[CUSTOMER][NEUTRAL] I got, I got like a summary, but when I click on explanation of benefits, it doesn't, it, I guess it's not ready. It says one available you can view your explanation of benefits, so it's, it's, it's not available right now, but um.
[CUSTOMER][NEUTRAL] Can I take a screenshot of this?
[CUSTOMER][POSITIVE] It shows what it applied it's pretty much essentially.
[CUSTOMER][NEUTRAL] Breakdown of it, so maybe if I take a screenshot of this.
[AGENT][NEUTRAL] What's on the document that you're looking at now?
[CUSTOMER][NEUTRAL] No, I'm on the website.
[AGENT][NEUTRAL] Mhm. And what's on the document?
[CUSTOMER][NEUTRAL] I'm on the website.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It shows um claim payment breakdown plan discount uh total amount.
[CUSTOMER][NEUTRAL] Old
[CUSTOMER][NEUTRAL] Um, it it is pretty much the same thing of an explanation breakdown. It just gives me the claim breakdown and what.
[AGENT][NEUTRAL] Is there a column?
[AGENT][NEUTRAL] Is there a column that says deductible? Another column that says co-insurance copay?
[CUSTOMER][NEUTRAL] No, no, no, this one is, is different, uh, yeah, plan amount bill discount plan paid copay, co-insurance deductible.
[CUSTOMER][NEUTRAL] Um, not covered, so it, it shows this here.
[CUSTOMER][NEUTRAL] Here, let me
[AGENT][NEUTRAL] So you do, you do see those three columns?
[CUSTOMER][NEUTRAL] Let me try to see
[CUSTOMER][NEUTRAL] I do, I do.
[AGENT][NEUTRAL] Is there anything in the columns, uh, any dollar amounts, or does it say 0?
[CUSTOMER][NEUTRAL] No, no, it shows the dollar amounts.
[AGENT][NEUTRAL] OK, so that sounds like the explanation of benefits.
[CUSTOMER][NEUTRAL] It's just different um it it's the website version of it, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Versus the actual, you know, like the blue header column and stuff.
[AGENT][NEUTRAL] Mhm. Does it have the insurance company name at the top of that document?
[CUSTOMER][NEUTRAL] It does.
[AGENT][NEUTRAL] OK, so that may be sufficient, you know, if it has, you know, like you said, the total bill amount, you know, it'll probably list, you know, like you said, the discounts that were given, uh, the deductible column, co-insurance, co-pay columns, and it has money in those three categories, you could send that over to us.
[CUSTOMER][NEUTRAL] It does.
[AGENT][NEGATIVE] And it needs to match the itemized bill.
[CUSTOMER][NEUTRAL] OK, and then
[CUSTOMER][NEUTRAL] The item
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So I got to request an itemized bill from the hospital, or can I just provide my receipt?
[AGENT][NEUTRAL] Mm, we can't process from a receipt. Any time you send us a claim, we'll need these three documents the itemized bill, the primary explanation of benefits, and an APL claim form, 3 documents.
[CUSTOMER][NEUTRAL] Of what I paid
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] Yeah, we can't use a receipt.
[CUSTOMER][NEUTRAL] OK, so let me, let me go with my wife and get that sent over and maybe I can process this, this, this next claim for her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you can just upload those 3 documents under her name. What's your spouse's name and date of birth?
[CUSTOMER][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] OK, yeah, so when you upload that information just select her name.
[AGENT][NEUTRAL] And then we can take a look at that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you do know that the office visit fee is not covered under your policy, right?
[CUSTOMER][NEUTRAL] Yeah, we pay for that out of pocket, so it was like 300 and then uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You know, I'll call her and get her to apply that towards deductible or or towards insurance. I, I don't know. You know the thing is is that it's so stupid because I didn't, I'm, I'm sorry for for getting worked up. I have like I have, I have like 12 to $13,000 worth of medical bills and, and I'm paying almost $2000 a month for medical insurance and it's a high deductible plan. I don't understand this and.
[AGENT][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] What blows my mind is, is that I didn't have insurance before. If my son went to the hospital and, and he was sick and I get a, a $15,000 medical bill or like a $5000 medical bill, I would call them and they would reduce it down by 60 to 75% and, and it'd be a one time payment, but now I can't even.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Talk to them about these bills because you go through insurance, insurance sets the price and then that's what I'm stuck with, and it's ridiculous prices.
[AGENT][NEUTRAL] So when you, so when they, when they, when your health care providers submit the claim to your major medical insurance company.
[AGENT][NEUTRAL] Um, there's usually an adjustment made or a discount given.
[AGENT][NEUTRAL] So are, are they doing that or are they saying we can reduce your benefit and they're not sending it to your major medical carrier?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, they're sending it to my major medical carrier. They're sending it to [PII] and, and, uh, and, OK, for example, let's take this one bill, right? It's like for this year, right on the [PII], it's 90 59 62 75, right? So they sent that to the ins.
[AGENT][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] OK, are you looking at your son's bill?
[CUSTOMER][NEUTRAL] I'm looking at my son's business. I'm, I'm, I'm using this as an example.
[AGENT][NEUTRAL] OK, let me, let me pull that back up so I can follow you. Give me a second.
[AGENT][NEUTRAL] And you're looking at data service [PII], right?
[CUSTOMER][NEUTRAL] Yep, [PII], right? So.
[AGENT][NEUTRAL] OK, give me a second.
[AGENT][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] All right. So the total charge is $5,419.
[CUSTOMER][NEUTRAL] No, no, no, it is, uh, $5,962.75.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] I'm looking at the the itemized bill from Arthur and blank.
[AGENT][NEUTRAL] Hospital?
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] On the document that you sent, it says 5419.00.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So are you looking at the bill or are you now looking at the ELB from the primary from United?
[CUSTOMER][NEUTRAL] No, no, I'm, I'm, I'm, I'm looking at the bill, the itemized bill that I sent this morning. It shows $5,962.75 is the charges.
[CUSTOMER][NEUTRAL] The total charges for 827.
[CUSTOMER][NEUTRAL] So if you click on that one claim.
[AGENT][NEUTRAL] Oh, I'm looking at 11 8. I'm sorry. OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] So, so if, if you take a look at the total charges, it's $5,962.75 right?
[CUSTOMER][NEUTRAL] They they sent that in insurance.
[CUSTOMER][NEUTRAL] And insurance applied an adjustment of 21,000.
[CUSTOMER][NEUTRAL] 2150 35, right? So my remainder balance is.
[CUSTOMER][NEUTRAL] 381,240.
[CUSTOMER][NEUTRAL] Right, so that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] And of the amount that they say you owe, what columns are those in? Deductible co-insurance, co-pay?
[CUSTOMER][NEUTRAL] Uh, yes, yes, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So historically, without me having insurance at all, right? Like if, if, if, if I didn't have medical insurance and I didn't have any of this, and my son went to the doc to the hospital for the same visit.
[CUSTOMER][NEUTRAL] Right, and I get billed 59,006275, right, almost $6000 worth of medical bills. They would send, send that to me.
[CUSTOMER][NEGATIVE] I don't have health insurance at this point. I don't have any coverage or anything. I'll call the hospital and I'll say, hey, you know, I got this bill. I'm trying to settle this bill, where can we come to terms on this?
[CUSTOMER][NEUTRAL] The hospital will reduce this by almost 60%.
[CUSTOMER][NEGATIVE] And I would have a 40% balance because I don't have health insurance, but for the fact that I do have health insurance, they bill this to the to the insurance company. The insurance company then gives me a small discount or payments adjustments, and then I'm stuck with a large bill.
[CUSTOMER][NEUTRAL] Does that make sense?
[AGENT][NEUTRAL] Mm I understand what you're saying.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] So for me this this this is just it's mind blowing that I'm paying $2000 a month for medical insurance and then I have all these bills and I'm still paying an outrageous amount.
[CUSTOMER][NEUTRAL] So this this is this isn't.
[AGENT][NEUTRAL] So I mean that's a decision you're gonna have to make if, if you're allowing the hospital to negotiate a rate for you versus them sending it to united.
[CUSTOMER][NEUTRAL] It's, it's not
[AGENT][NEUTRAL] Then
[CUSTOMER][NEGATIVE] Yeah, I, I mean at this point I, there's nothing I can do because all of the, all of this has already been processed through insurance, so there's nothing I can do at the at this moment. I'm just stuck with.
[AGENT][NEUTRAL] Right, right. Mhm.
[CUSTOMER][NEGATIVE] All of these bills, but I, I just was venting, expressing my frustration on on this matter.
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, uh
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] You know, thank God, at least I have this gap that that helps with.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] With something right so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, your maximum outpatient benefit is up to $750 per calendar day and so when I look at the United Healthcare ELB for the $5,962.75 charge, I see the deductible amount was like 3476, a co-pay of $300.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And then co-insurance was 3597, so your, your responsibility is the 38, 1240.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And of this amount, your policy will only cover up to 750.
[AGENT][NEUTRAL] So you're saying
[CUSTOMER][NEUTRAL] For just a
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, I'm sorry, go ahead.
[AGENT][NEUTRAL] Yeah, which means that you know $3,812.40 minus $750 you're saying you would be still left with a pretty large balance.
[CUSTOMER][NEUTRAL] I'm sorry, ma'am.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm still left with $3,0062.40 right? is is what I'm left with for this data service and then.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, but if my son went to the hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And, and, and, and historically, um, when, when, when this has happened.
[CUSTOMER][NEUTRAL] You know, a bill of this caliber 50 to $6000 even $7000 is, is a normal bill but uh they they would reduce it down to me paying about $1500 to $2000 making a one time payment in that amount.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] But you know it is what it is.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] But uh we got a couple other charges as well so um you know.
[CUSTOMER][POSITIVE] And any any bit will help.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Any other claims you wanna go over?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think there was.
[CUSTOMER][NEUTRAL] Bear with me, let me close this out.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, so there was a claim that I received, um, they didn't pay the full 7 750 for for me that day, but let me, let me review this and then get back. How soon will these two, these claims process?
[AGENT][NEUTRAL] Yeah, our standard processing time is 7 to 10 days from the date that we receive it.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Um, I just wasn't sure if you were gonna go ahead and process it yourself since we already spoke or.
[AGENT][NEUTRAL] Oh, no, no, no. Yeah, it'll go to the area. Uh yeah, it's in the area that will be processing the clay.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you know each claim is is processed based on when we receive it to give everybody, you know, everything is processed and they receipt order.
[CUSTOMER][POSITIVE] OK, no worries, thank you so much.
[AGENT][POSITIVE] Alrighty, any other questions I can assist with today?
[CUSTOMER][NEUTRAL] Uh, no, ma'am.
[AGENT][POSITIVE] Alright, hold on, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Alright bye.