AccountId: 011433970860
ContactId: e82ae1a6-7567-427f-a6c5-378d92e5378e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 533650 ms
Total Talk Time (AGENT): 279441 ms
Total Talk Time (CUSTOMER): 279243 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/e82ae1a6-7567-427f-a6c5-378d92e5378e_20250210T14:42_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] Um, can you give me your name again?
[AGENT][NEUTRAL] Sure. My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Yes, that's initial [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, uh, this is [PII], and I had, um, my supplemental insurance with you all, um, I've just received a bill in the mail today from.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, Athens orthopedic.
[CUSTOMER][NEUTRAL] And um they're saying that I have a balance of 527 17 from a surgery that I had um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's the first time I've received the bill.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, my, uh, health insurance did pay on this, and it's my understanding that and the way APL had always worked with me in the past is if my health insurance, uh United Healthcare paid whatever the balance was, APL being in my supplemental.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would then pick up is that not correct?
[AGENT][NEUTRAL] Um, it really depends the place of service, the service render. It has a lot of things, um, that we need to check on to determine or we need to know if we received the claim. So, um, if you have the policy number, let me have that policy number so I can search and see if we got the claim if we already received the claim in process, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm, I'm hoping this is it because I have been retired for 1 year and 3 months now. I verified all my claims were paid before I left my employer, so all I have is my booklet. I don't, I don't have my APL card anymore, but I do still have my APL booklet, and I hope this is the right number. The group number is P13333.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then there's an there's a number also on there uh 0163.
[CUSTOMER][NEUTRAL] 6028
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does that sound, does that sound like what you need?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah, the last number sounds like a policy number, so let me pull that one.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Praise the Lord. I'm, I'm telling you, I'm just, I'm retired and I just
[AGENT][NEUTRAL] Mm. Mhm.
[CUSTOMER][NEUTRAL] I'm grasping for straws here.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] It's OK, I understand Ms. [PII]. Uh, may I have, um, a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] OK, um, my home phone is [PII].
[CUSTOMER][NEUTRAL] 285.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you. And I need to verify the mailing address, email address, and the date of birth, your date of birth. Mhm.
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And I'm not real sure what email address y'all would have. I guess if I can even remember my Will's Memorial, I think it was [PII].
[AGENT][NEUTRAL] It's a [PII], it's your personal [PII].
[CUSTOMER][NEUTRAL] Oh, OK, it's uh [PII].
[CUSTOMER][NEUTRAL] Oh, no, [PII]. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. And what is the mailing address just to make sure we have the correct mailing address?
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] Danberg Road, Tignall, Georgia.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I'm sorry if you hear a lot of noise in the background. I'm babysitting my grandson.
[AGENT][NEUTRAL] OK. I understand. It's fine. Uh, let's see. So it was on [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm. Yeah.
[CUSTOMER][NEGATIVE] Like I said, this is the first time I know anything of this bill. It's the first time they sent it to me. I'm sure by now I would have been turned over to a collection agency had I been getting it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, um, yeah, it looks like, um, we have not received anything for that date of service. Um, the last one we received, yeah, the last one we received.
[CUSTOMER][NEUTRAL] Uh huh, that's what I thought.
[CUSTOMER][NEGATIVE] They told me that it was, they told me that it was applied to my deductible which did not make any sense to me that's what ALC just told me.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Mhm. Yeah.
[CUSTOMER][NEUTRAL] Will y'all still consider this bill, please?
[AGENT][NEUTRAL] Oh, yeah, we don't have timely filing limits. We just need to receive the claim. So if you can either send the claim or have them to send us the claim, we'll go ahead and process for you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, when you say claim, send you this bill.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, it may be a little bit more than just, just the deal. Um, it's easier if they send it directly from the provider of service, but if they say they can't because it's too late or any, any other reasons that they say they can, um, what you can do is ask them for an itemized bill, itemized bill with the diagnosis codes.
[CUSTOMER][NEUTRAL] Or that you've got to
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And then we're gonna need 2 more documents together with that. Um, the first one is going to be a copy of the explanation of benefits from the primary insurance for that date of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] It it's a what? It's a what?
[AGENT][NEUTRAL] The explanation of benefits from the primary insurance, the one that says that they applied it towards the deductible, yeah, the ELB for, for that date of service and then the third document is a claim form. Uh, the claim form you can find it in our website at [PII].
[CUSTOMER][NEUTRAL] OK, yeah, the EOB, OK, OK, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, trying to write all this down because my memory ain't what it used to be.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yeah, it's OK. I understand if I don't write stuff down it's like I, I forget to so it's fine.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh well, sweetheart, you have been a wealth of information. I can tell you I got this bill and I, I, I'm just stressing over it so much cause I, like I said, I've already thrown my APL card away. I just felt like I was grasping at straws and I called a friend of mine that's still at the employer and she said, [PII], if you still have your booklet, your, your number should be on the front of the book and praise [PII], I still had my booklet.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And she but she gave me y'all's phone number off of the back of her card so there is no reason that you can see why y'all wouldn't pay this entire amount, the 527 as far as they can get you everything you need.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, as long as it's applied towards the deductible co-payment co-insurance, and it was a service render in a covered place of service, then um it looks like you had at that time, let's see, let me go back to the benefits, and this is not a guarantee of payment, just a verification of coverage based on the benefits. The outpatient maximum you had at that time was 1500 per day.
[AGENT][NEUTRAL] Um, so yeah, it seems like it may cover the whole amount, but we cannot guarantee anything over the phone, but yeah.
[CUSTOMER][NEUTRAL] what was that that you said now about the, um, you said something about a deductible. What was that?
[AGENT][NEUTRAL] Oh, no, there's no deductibles. We cover the deductible. As long as it's applied towards the deductible co-payment and co-insurance from your major medical, then that's when we take place.
[CUSTOMER][NEGATIVE] OK, OK, well, if, if my insurance, if my, if this bill is showing my insurance payment of 20108, then that shouldn't not tell me that everything is squared away that you just talked about?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, sometimes it is, sometimes it's just letting you know that they pay that and that you owe an amount, but it doesn't really specify if it was applied towards the deductible co-payment and coinsurance in order for us to determine that's why we need the EOB. The EOB will show if it was applied towards the deductible. That's, that's why we need the EOB. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, but, but they're telling me that they have filed the claim, but you're telling me that they have not.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] No, we have not received a claim, uh, from the month of [PII], uh, the last, the next or the last claim we received was for August. So there is nothing in between, um, April and August for claims. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, thank you so much so I appreciate all your assistance.
[AGENT][POSITIVE] Mm. You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] I don't think so. Just say a prayer for me if you're a believer in God, say prayer for me.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][POSITIVE] Thank you. Mm bye-bye. You too, bye.
[AGENT][POSITIVE] Ms. [PII], you're welcome. Have a good day. Yes. Bye-bye. Thank you.