AccountId: 011433970860
ContactId: e68863dc-3ae9-4c52-9582-4fbdf8cc5f5c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 724340 ms
Total Talk Time (AGENT): 257599 ms
Total Talk Time (CUSTOMER): 331157 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/e68863dc-3ae9-4c52-9582-4fbdf8cc5f5c_20250513T15:30_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I have a question um pertaining to, um, I guess my, my, uh, recent claim, um, from a procedure that I had gotten done at the hospital.
[AGENT][NEUTRAL] OK, um, sure, I can assist you with claims. Let me have your name and a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Uh, again, the name is [PII] and the phone number is [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number, Ms. [PII]?
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Um, you know what, hold on, see policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think that's maybe what it is. There's a guarantee number.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I can try that. OK.
[CUSTOMER][NEUTRAL] Oh, hold on, let's see.
[CUSTOMER][POSITIVE] View balance details. Hold on, let me see, there's a bunch of stuff here outstanding.
[CUSTOMER][POSITIVE] So much information um.
[CUSTOMER][NEGATIVE] Breaks it down to the amount.
[CUSTOMER][NEUTRAL] Uh, there's pending insurance. I don't know what that is.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Hold on, I'm sorry. Let's see what this is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There's a statement. Maybe there's something on that hold on.
[CUSTOMER][NEUTRAL] Yeah it looks like the only thing they have listed on this is a guarantee or ID.
[AGENT][NEUTRAL] Let me try that and see if that's the policy or if it will help me find it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's uh 107432922.
[AGENT][NEUTRAL] Mm, yeah, too many numbers, um.
[CUSTOMER][NEUTRAL] How many, how many are you looking for? because.
[AGENT][NEUTRAL] It usually starts with a 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, let me see something.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What is this? I got something. Here's a policy. There's a check number a policy here's a policy number, although I don't.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Pertains to the most recent, uh, actually it might here, hold on, that'll help. I'm sorry, uh, policy number is 01797557.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that sounds like it. OK, let's see.
[AGENT][NEUTRAL] All right. Yes, Miss um [PII], for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Uh, [PII] and email is [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you. All right, let's see where we at with the claim.
[CUSTOMER][NEUTRAL] I'm a little confused how this works.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um, what is the date of service that we're looking at? Is it the the most recent claim, the one on [PII]?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, let me look at this.
[AGENT][NEUTRAL] Let me pull the documents of the claim. One moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Not now.
[AGENT][NEUTRAL] I'm still waiting on the documents. I do apologize it's taking a little bit to pull up, OK?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] detail
[AGENT][POSITIVE] Thank you for your patience.
[AGENT][NEUTRAL] OK, so this is the hospital charges.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] You know what? I'm so confused. I'm sorry. I'm looking. I had two procedures. One was done [PII], and then I had one that was done [PII]. I don't know, do you guys work like insurance where like you have a full January to January and then it'll start over the [PII]?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the plan you have with us is a calendar year plan meaning that it starts in January.
[AGENT][NEUTRAL] For the benefits and it will stop on the, the last of the year. Um, so basically any benefits that you have available to use is yearly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, the charges on, yeah, the charges on [PII], those are gonna be for the year of [PII].
[CUSTOMER][NEUTRAL] OK, OK, that makes sense.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Oh, let me check on this one.
[CUSTOMER][NEUTRAL] OK then I guess I have other questions.
[AGENT][NEUTRAL] OK, right.
[AGENT][NEUTRAL] Just bear with me.
[AGENT][NEUTRAL] 24. So on [PII], you spend $405.05.
[AGENT][NEUTRAL] And this is for the outpatient service.
[CUSTOMER][NEUTRAL] 4 you said you said 40405?
[AGENT][NEUTRAL] 40505.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] And you have to pay that.
[CUSTOMER][NEUTRAL] Yeah I guess I have questions about that. How, how much does this? I thought it covered $3000 for, for the full. It does so I guess, I guess my, I guess, OK, so let me start with that question. So if I have $3000 available for an outpatient, does that cover everything and anything because like I had like I had a procedure done on [PII] like I said and.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The insurance covered $13,000 the bill was $17,000 so there was a balance of $4900 but if I had $3000 I'm wondering why that $3000 didn't go towards the, um, the first procedure on the [PII].
[CUSTOMER][NEUTRAL] If that makes any sense.
[AGENT][NEUTRAL] OK. So based on what you're telling me and what I'm looking at, OK, it doesn't look like we received the bill from the facility. What we received was the small bills from the physician, which that's what we paid. That's where the $405.05 went to.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] So it seems that you still have a bill for the hospital or for the facility, and we have not received that bill. So, um, that you just need to get in contact with them and see if they can send in the claim for you so we can go ahead and take care of that because you still have that um the remaining of the 3000 available for you to use for [PII].
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] OK, so claim for the procedure done on the [PII], correct?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Uh, I mean, of, of um, of last year. OK, alright, great, so let me write that down.
[AGENT][NEUTRAL] [PII]. Mhm. Yes.
[CUSTOMER][NEUTRAL] OK and then OK great so that answers that question so that was one procedure and then this, this most current procedure was done on [PII] and again it was the same type of service procedure, um, so I'm wondering if that full 3000 was used towards this procedure for April or did you guys not receive that claim either?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We did. So you did exhausted your benefits for [PII] because we are sending, um, let me give you this amount.
[AGENT][NEUTRAL] We're sending $2,604.87 to Herman Hospital. Again, that's $2,604.87 and this is for the hospital, the facility. And then we have sent a check um for the same date of service, [PII], and this was sent to the physician of $395.13. So that completes your $3000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] For 2025.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] Position, OK, so 2025 good solid we're good with that. So then I just need, I need for them to send them to send you guys the claim for the one for December.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, it's just because what happens with the hospital and that's why I'm a little confused I guess they, um, it looks like they're combining everything from both procedures, so I'm pretty sure that I don't owe this. I probably owe like not even half of this because they didn't send the claim to you guys, um, so what information do they need to give you?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] From that from December so I can let them know for sure just the claim or?
[AGENT][NEUTRAL] Yes. Just the regular claim information plus the copy of the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Copy of explanation, OK.
[AGENT][NEUTRAL] So basically a full claim. We need a full claim to be sent to us.
[CUSTOMER][NEGATIVE] Alrighty, OK, yeah, I knew that like dollar amount was not correct.
[CUSTOMER][NEUTRAL] Um, OK, so full claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright awesome OK great alright perfect well I think that answers all of my questions and I did receive this explanation of the benefits for that 395 13 to the physician so that's what I'm seeing in front of me so perfect just so I know what that is right, so we're up to date awesome. I.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. And we're getting ready to send that. OK. Mhm.
[CUSTOMER][POSITIVE] Beautiful. Well, I appreciate your help.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Uh, no, but thank you.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. And for the future, you can always go and register through our website at [PII] if you want to create an account and follow along with the history, OK?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Alright awesome thank you.
[AGENT][POSITIVE] You're welcome. Have a good day and thank you for calling ATL. Bye bye [PII].
[CUSTOMER][NEUTRAL] Yes. All right, bye bye.