AccountId: 011433970860
ContactId: ea096bb4-90b2-47a5-8f0c-fca1419c38ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 810679 ms
Total Talk Time (AGENT): 245927 ms
Total Talk Time (CUSTOMER): 330515 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/ea096bb4-90b2-47a5-8f0c-fca1419c38ae_20250303T19:48_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I have a couple of questions about some um.
[CUSTOMER][NEUTRAL] I guess um
[CUSTOMER][NEUTRAL] Some claims that were put through to you. I wanted to know if you can tell me a little bit more about the the provider.
[CUSTOMER][NEUTRAL] What where can I start?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, well, 1st may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] And the contact number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] The policy number is, well, this was supposedly inpatient at the time so it would be uh 01842070 M as in Mary, L as in Larry 7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII] um my mailing address is [PII] and um my email address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And then what questions did you have?
[CUSTOMER][NEUTRAL] OK, so I was in the hospital and for the dates of the hospital, which I'm looking at them here, they're all pretty much in order I guess it was [PII], I mean, yeah, through the [PII] of this year.
[CUSTOMER][NEUTRAL] Of, of last year, sorry, last year, obviously, um, there's a chargeside hospitals list.
[CUSTOMER][NEUTRAL] What is that? I was in I.
[AGENT][NEUTRAL] You said there's a charge beside where?
[CUSTOMER][NEUTRAL] East Side Hospitalist, [PII]. Let's start with there. So there's 4 charges going through to you 1112, 13, and [PII].
[AGENT][NEUTRAL] OK, hold on one second, let me find the claims.
[CUSTOMER][NEUTRAL] Oh, the benefits were paid. I thought they weren't paid. That's why I was calling.
[AGENT][NEUTRAL] So, it's still
[CUSTOMER][NEUTRAL] It's probably a provider with a.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEGATIVE] No, you guys paid it.
[CUSTOMER][NEUTRAL] I guess I saw the name and I was like, oh my God, it's probably a provider within the hospital when I was in there the 4 days.
[CUSTOMER][NEUTRAL] Just didn't know what that is, East Side Hospitalist.
[AGENT][NEUTRAL] Hold on, here goes. There's several claims. Let me, I'm just gonna pick one because they all were paid. Hold on one second.
[CUSTOMER][POSITIVE] I can give you an amount, if that'll help.
[AGENT][NEUTRAL] OK. Yes, what's an amount.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] The the the amount you paid out was 20298.
[AGENT][NEUTRAL] Hope it is.
[AGENT][NEUTRAL] Oh, that's the one I picked, OK.
[AGENT][NEUTRAL] Hold on one second.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, so here it is.
[AGENT][NEUTRAL] So you're asking what East Side Hospital list is?
[CUSTOMER][NEUTRAL] Yeah, is that like a, does it say what kind of doctor, what kind of provider it was within the hospital?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] So for right here it just says Eastside Hospital Inc. Let me see if I can see a doctor's name or something. Hold on one second.
[CUSTOMER][NEUTRAL] Yeah, just wondering what kind of doctor it was.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So let me see, it's coming up now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh my goodness, it's written over. OK, so it looks like it's saying that.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, that's him? OK, yeah, OK, that makes sense now. OK, I know who it is.
[CUSTOMER][NEUTRAL] Because the guy that kept trying to do surgery on me, yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah, I'm like, I didn't come in for that. I didn't come in for. I did have a problem of my appendix, but he had to follow me, uh, throughout my hospital stay because, um, yeah, so.
[AGENT][POSITIVE] To make sure everything is good.
[CUSTOMER][NEUTRAL] I'm still here.
[CUSTOMER][NEUTRAL] Yeah, my, my brain can get interruption, but, um.
[AGENT][POSITIVE] Well, that's a blessing.
[CUSTOMER][NEUTRAL] Yes, ma'am. Alright, so that's out of the way. So my main concern was.
[CUSTOMER][NEUTRAL] I keep getting
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I keep getting charges, the $250 so I went to an outpatient procedure at the Western Outpatient surgical Center.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One of the procedures was on [PII]. The other one I believe was the beginning of December, and the other one was now at the, at the end of January.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And that was for Doctor [PII], but his, it was from West Western Outpatient Center, so I have a $250 that I have to pay to go into the surgical center, but American Public Life covers that for me, but they haven't, you guys have not paid 3 times the $250 the 3 different times I went in for the procedures.
[AGENT][NEUTRAL] So when they're submitting the claims, they're not submitting them with the explanation of benefits. So that's why this claim was denied, just asking for the explanation of benefits and as soon as we receive it, we'll continue processing um so that it can be paid or, you know, you just, you receive the decision, but that's why this [PII] from Western Outpatient and we sent them the request as well. So, so anytime we send
[AGENT][NEUTRAL] It to you like an explanation of benefits for the most part. Um, the only time we wouldn't send it to the providers if, if you filed the claim, then it's just your claim, but the provider filed this, so we send it to both. So, so we sent this out to them as well, um, letting them know that we need the explanation of benefits to continue processing.
[CUSTOMER][NEGATIVE] We're all three, we're all three, visits [PII], [PII], and [PII] something, um, we're all three of them not paid.
[AGENT][NEUTRAL] Um, let me check them. So you said [PII], OK, so that's the one we just did and then December, you said [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Let me check that one. Hold on one second.
[AGENT][NEUTRAL] [PII], there's no claim on file, so they didn't file for [PII].
[CUSTOMER][NEUTRAL] And then in January is there any claim on file for January?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] For the west.
[AGENT][NEUTRAL] Let me see if there's any January claims.
[AGENT][NEUTRAL] Mhm. Um, so after this, wait a minute.
[AGENT][NEUTRAL] January of this year or last year?
[CUSTOMER][NEUTRAL] No January of this year.
[AGENT][NEUTRAL] OK, wait, no, this is it. So I was I was looking for last year. OK, so there's
[AGENT][NEUTRAL] Let me get this claim number.
[AGENT][NEUTRAL] This was.
[CUSTOMER][NEGATIVE] Cause I just want to be able to tell them, look, on [PII], that first one, they told you they needed the explanation of benefits you didn't send it. [PII], you never put in a claim. I wanna tell them.
[AGENT][NEUTRAL] Right, and then
[CUSTOMER][NEUTRAL] And I wanted in January.
[AGENT][NEUTRAL] The third one now, so, so we do have a claim from [PII], but this is from cardiovascular specialist, so it looks like they haven't filed a claim. Now unless you can get the data service, I can check for sure to see if there's a claim on file, but this is the only one from January of this year.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure, let me look a minute, give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was about it was on a Wednesday, so it was the [PII].
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Yeah, there's no claim on file for [PII].
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] Incredible.
[CUSTOMER][NEUTRAL] OK, um, and my last question is I have 4 specialists I can see a year, so I'm assuming that that cardiovascular one that you just saw is one of them and they put in the claim for that. Did you pay them out?
[AGENT][NEUTRAL] Let me see, I believe it was, hold on, let me go back to it.
[CUSTOMER][NEUTRAL] I wanted to know for, for this, for this new year, how many have I put in already? How many have gone through?
[AGENT][NEUTRAL] OK, so yes, we did pay the $50 also, yes, that does go towards um your
[AGENT][NEUTRAL] Specialist office, um, coverage. Hold on one second, I'm going to your coverage now so I can look at everything.
[AGENT][NEGATIVE] Mm, I don't like the way that looks. Let me look over here. Hold on one second.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I'm looking for your um policy benefits, but this is broken down a little differently, so hold on one moment so that I can
[AGENT][NEUTRAL] Look at the fine print too.
[AGENT][NEUTRAL] OK, so yeah, it's 4 per year at 50 and this one used the first one. So you want to see for [PII] how many you've used so far?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, just the one for um January.
[CUSTOMER][NEUTRAL] Just the [PII], the cardio specialist?
[AGENT][NEUTRAL] Mhm. And it paid out $50.
[CUSTOMER][NEUTRAL] Was that for was that for a service date, um, [PII]?
[AGENT][NEUTRAL] Hold on one second, let me go back to.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK, um, just give me one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I thought I had gone to
[CUSTOMER][NEUTRAL] Did [PII]'s office put in um
[CUSTOMER][NEGATIVE] On I'm, I'm, I'm surprised that [PII] has office. He's a dermatologist that she didn't put in because they verified that you guys were gonna pay the $50 on [PII], and I'm surprised that they didn't put in a claim for it.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, it is [PII]. OK, hold on one second.
[AGENT][NEUTRAL] Yeah, there's no claim on file for [PII] yet.
[CUSTOMER][NEUTRAL] Let me put that here [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On [PII], they didn't, and I'm just keep looking because I felt I was like weight, I, I know I went to.
[CUSTOMER][NEUTRAL] 2 more people. I'm on the [PII] already.
[CUSTOMER][POSITIVE] Oh look at me, I'm doing better this year. I haven't gone to so many doctors.
[CUSTOMER][NEUTRAL] Oh my gosh, the story of my.
[CUSTOMER][NEUTRAL] OK, hold on, I'm working on the [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, we're good.
[CUSTOMER][NEUTRAL] Alright, so it's only been one paid out. [PII] hasn't filed yet. [PII]'s office, and uh, OK, well thank you so much. I'll let them know about putting the explanation of benefits through.
[AGENT][POSITIVE] Well, you're very welcome. Well, was there anything else I can assist you with today?
[CUSTOMER][NEGATIVE] No thank you that's it.
[AGENT][POSITIVE] All right. Well, thanks for calling [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] OK you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.