AccountId: 011433970860
ContactId: eb651fc4-9c22-4733-883b-b130cec24e76
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 956159 ms
Total Talk Time (AGENT): 401849 ms
Total Talk Time (CUSTOMER): 439360 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/eb651fc4-9c22-4733-883b-b130cec24e76_20250226T21:06_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] Yeah, good afternoon. My name is [PII].
[CUSTOMER][NEUTRAL] I have, um, I received a letter from you, um.
[CUSTOMER][NEUTRAL] Uh, you need all my information before to tell you what is going on?
[AGENT][NEUTRAL] Um, yes, ma'am. May I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] 305
[CUSTOMER][NEUTRAL] 965
[CUSTOMER][NEUTRAL] 77
[CUSTOMER][NEUTRAL] 0.6
[AGENT][POSITIVE] Thank you. And the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And, the one you say is the one that that one?
[AGENT][NEGATIVE] Say that one more time, the phone was breaking up.
[CUSTOMER][NEUTRAL] The one is
[CUSTOMER][NEUTRAL] The one you say is the one you say group?
[AGENT][NEUTRAL] It says policy um certification number.
[AGENT][NEUTRAL] It should start with a 01 or 02.
[CUSTOMER][NEUTRAL] Oh yeah, yeah, yeah. OK, I got it. It's that 02?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 08
[CUSTOMER][NEUTRAL] 82
[CUSTOMER][NEUTRAL] 41
[CUSTOMER][NEUTRAL] M as in mom,
[CUSTOMER][NEUTRAL] L as in Lauda 7.
[CUSTOMER][NEUTRAL] And the same number, there's another one, and the same number, uh, at the end is it 8 instead of 7.
[AGENT][NEUTRAL] All right, thank you for that. And can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and the address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and then just your email address.
[CUSTOMER][NEUTRAL] OK. It's a, uh, I don't know if you have a, a moon, it's a
[CUSTOMER][NEUTRAL] You know
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, you got it or no?
[AGENT][NEUTRAL] No, it, the phone went completely out. Can you repeat your email address for me?
[CUSTOMER][NEUTRAL] OK, is that.
[CUSTOMER][NEUTRAL] OK, alright. [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], that's the zip code.
[AGENT][NEUTRAL] OK, and your email address is [PII]?
[CUSTOMER][NEUTRAL] I, oh yeah, it's [PII].
[CUSTOMER][NEUTRAL] Oh, I don't use that not too much. Let me check the food already.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let me see. [PII] [PII], uh.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] It's a year.
[CUSTOMER][NEUTRAL] Yeah, it's a yes, I, I, it's I think [PII] [PII]. I think that that's the.
[CUSTOMER][NEUTRAL] Yeah, yeah, no, no, 2220 it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. And how may I assist you today?
[CUSTOMER][NEUTRAL] OK, I'm calling regarding to, I, I, I received a letter from you that I just wanna, I just wanna know first, I have a claim here, uh, from, from [PII].
[CUSTOMER][NEUTRAL] Uh, of the year, the [PII].
[CUSTOMER][NEUTRAL] And that I see here that the, the, the, the, the hospital, the one that sent the, the bill to you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Here you guys say in the letter like the, the above reference claim appeared to be duplicate of privilege submit expenses.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I wanna know.
[CUSTOMER][NEUTRAL] On what day you gonna have that claim, because
[CUSTOMER][NEGATIVE] The, the, I received uh an a, and a, and a bill from the hospital that you guys paid didn't, didn't pay nothing. And now I received this letter that you guys, they say basically the hospital sent like a double, a double claim, you know what I mean?
[AGENT][NEUTRAL] Mhm. I see it here. So, um, hold on, I'm just getting all the claim numbers. So we received the claim 3 times. So the first time we received it, hold on, let me get the 17.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] So we originally received it back in [PII] and when we received it, we um requested the detailed explanation of benefits from the provider and we let them know this. So they sent the explanation of benefits, but it doesn't show any, it doesn't show any of
[AGENT][NEUTRAL] The amounts applied to the charges from primary. So since we're 2, we have to see what primary applies so we know what's left over, if we have to reimburse you or send it to the provider or both. So we ask them for an detailed explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Explain most.
[AGENT][NEUTRAL] And then they sent it, looks like they sent it again.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] What's the second one? Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the second one they sent.
[AGENT][NEUTRAL] 94.
[AGENT][NEUTRAL] Oh wait, so I said it backwards. So they sent the first one in January, the second one in March, and
[AGENT][NEUTRAL] The 2nd 1 in February and then there's also one in March. So they sent it 3 times.
[CUSTOMER][NEUTRAL] So that was on what? OK, that, that was on what, on what year?
[AGENT][NEUTRAL] So they sent it [PII] and then they sent it [PII] and [PII]. When they sent it.
[CUSTOMER][NEUTRAL] On, on [PII], right?
[CUSTOMER][NEUTRAL] OK, let, let me put.
[CUSTOMER][NEUTRAL] Mhm let me put those back here because.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If you want, if it's something I have to call them and tell them everything. So the first one was January, yeah January, uh.
[AGENT][NEUTRAL] Oh, sure.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEUTRAL] [PII], you say, right?
[AGENT][NEUTRAL] Well, the very first time was, let me get the, hold on, one second, was [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] That was the first one.
[AGENT][NEUTRAL] That was the first one.
[CUSTOMER][NEUTRAL] [PII], OK. 24, uh-huh, the first one.
[AGENT][NEUTRAL] So that one we process on [PII] and that's when we asked them, when we send it back, we asked them for the more detailed explanation of benefits.
[CUSTOMER][NEUTRAL] Then now you proceed, OK. Uh-huh.
[AGENT][NEUTRAL] And then they sent it again on [PII].
[CUSTOMER][NEUTRAL] Uh-huh
[AGENT][NEUTRAL] And then on [PII], we sent them the same explanation asking for the detailed explanation of benefits.
[AGENT][NEGATIVE] And then when they sent it again on [PII], that's the one that that um was denied as a duplicate from the one sent in January.
[CUSTOMER][NEGATIVE] OK, so basically they didn't give you any explanation why they charged it for, right?
[AGENT][NEUTRAL] Right, we don't, we need a um detailed explanation of benefits from your primary insurance. They show, it shows the charges there, we need to know what was paid for those charges, so we know what's left over.
[CUSTOMER][NEUTRAL] Oh, OK, because here on the, uh, I'm here on the, in my chart, my, my from the hospital, the details that I see here is the United Healthcare say $86,822.80. That, that was my insurance, the primary insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So and the American public life, it says 0. So, and on the battle say HP saying assist contract to I don't, so I think that that was from then it say $3,522 with 4 cents.
[CUSTOMER][NEUTRAL] So and they send me here an uh an a invoice that it said that I I own a.
[CUSTOMER][NEGATIVE] $826 with 6060 cents, and I asked him, I asked them why you guys charged me this? What happened with this? And that was from that day, that [PII] on the [PII], and they say no, because the, the second insurer, the one that you have, they didn't want to pay or they didn't pay nothing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So now what what I should tell them or what I do or what you guys can do because basically I don't have the money to pay all this amount and if they didn't give you any explanation why they didn't give you the explanation you guys have to pay for the month, you know, the, the rest of the of the month exactly. So basically the, the, the, the amount.
[AGENT][NEUTRAL] Right, the rest of it. Mhm.
[CUSTOMER][NEUTRAL] On the without the discount, it was 4000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The remaining, uh-huh, it was 4000.
[CUSTOMER][NEGATIVE] $348 with 20 cents. Basically you guys were supposed to put, you guys were supposed to pay that amount.
[CUSTOMER][NEGATIVE] And they say that they give me a discount from that amount, and now I have to pay $800 almost $900.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what they told me.
[AGENT][NEUTRAL] See, I looked up, so I just um pulled up the documents so I could see what they were sending in. So, basically this is like a
[AGENT][NEUTRAL] This isn't the explanation of benefits. It's, it's a remittance. It's kind of like a summary of the explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We need the actual explanation of benefits, like it shows the total charges and what was allowed, but it doesn't show what was paid, you know, like what co-pay right here says 0. So like those are the things that we need to know, so we know to.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because if you've paid that to them, like, for example, this deductible, $3,944.05. Let's just say you paid that, you know, once you had the er to get the service, that could possibly be reimbursed to you, but it doesn't show what what was paid.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It just shows charges.
[CUSTOMER][NEUTRAL] Yeah, but on this
[CUSTOMER][NEUTRAL] So in this case, you guys, you guys wanna call them when I have to call them and to them to call you? What, what can I do in this case because
[AGENT][NEUTRAL] So we can't, we as an APL can't call them because we're a third party, but we did notify them in writing like, um, you know how you receive that letter, we sent it to them too.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So every time you receive something from us, they receive it too.
[CUSTOMER][NEUTRAL] So they, they
[AGENT][NEUTRAL] Unless you're the, unless you're the only one to file, then it just goes to you.
[CUSTOMER][NEUTRAL] Yeah, but.
[CUSTOMER][NEUTRAL] So, not so, and, and the person who had to call them to, to let them to let them know they have to send an explanation why you guys have to pay for it, right?
[AGENT][NEUTRAL] Right, just let them know that you've called your insurance company and I can give you the claim numbers if you need them, um, but let them know that you called the insurance company and they they've asked twice for a detailed explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] So in this case, that in this case that I have this bill here, the almost 900, I mean, uh-huh, 900.
[CUSTOMER][NEUTRAL] It's gonna be a standby until until you get a solution or or.
[CUSTOMER][NEUTRAL] What is, what is going on with this?
[AGENT][NEUTRAL] Now, that depends on the provider. I don't, because each provider has like their own rules, so I don't know like how long they keep bills there. Usually it's about a year, it could be a few months, so it depends.
[AGENT][NEUTRAL] Um, you also, I don't know if you have access to your insurance, your primary insurances like portal to where they have like the explanation of benefits listed because if you have a copy of of the explanation of benefits, you can send it in to us also that that's another option.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what they cover from that pro uh procedure or that's what you mean.
[AGENT][NEUTRAL] Wait, say that one more time?
[CUSTOMER][NEUTRAL] So you wanna see what they, what they cover about that procedure, what about that that day, no? That's what you mean?
[AGENT][NEUTRAL] Right. Mhm. So for everything that was charged, we, we need to know what they paid and what you paid.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Because here, like I say, in the computer show me that they pay 80 almost 87,000.
[AGENT][NEGATIVE] Yeah, see that number isn't even anywhere on this what they sent to us.
[AGENT][NEUTRAL] It, it looks like a, like a summary, like you know how the explanation of benefits from your insurance has like the coding and like, you know, whatever was done and then it shows all the charges and all of that, that's not there.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh, OK, so, basically they, they need to, oh Lord, so that's, that's the, that's too much. So I have to call the insurance, my, my, my primary insurance, and ask them what they cover from this, and then they're gonna send it to you or they're gonna send it to them?
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] So you could do 2 things. You could do 2 things. You can call your, you can either call your insurance company or access your insurance company's online portal and just print off the explanation of benefits for each of these dates of service for the for the claim.
[CUSTOMER][NEUTRAL] I think to you, right?
[AGENT][NEUTRAL] And then you can submit that to us or you can call the provider, the um Memorial Regional, you can call them.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And let them know that your insurance company has sent 2 notices to them requesting a detailed explanation of benefits. And if they need to call us, you know, if they have any questions that are unsure of what we're asking for, I mean, they can definitely call and we'll be more than happy to help them too.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] There's any way um.
[CUSTOMER][NEUTRAL] Like a phone number so I can give it to the hospital and to see if they call, if they can call you and you guys explain to them all these details you gave me right now.
[AGENT][NEUTRAL] Mhm. Um, so it'll be, it'll be this phone number [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, the same phone number.
[AGENT][NEUTRAL] Yes, ma'am, and any one of us will be able to assist and I'm going to put notes on your policy also, so if it's, you know, if you get someone else, they'll still know what's going on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome. Well, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it, thank you. It was helpful.
[AGENT][POSITIVE] All right, well, thank you so much for calling APL Elena, I hope you have a great day.
[CUSTOMER][POSITIVE] You too. Thank you, bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.