AccountId: 011433970860
ContactId: f219391e-8764-46be-a064-46e26671ffb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519460 ms
Total Talk Time (AGENT): 201336 ms
Total Talk Time (CUSTOMER): 214344 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/f219391e-8764-46be-a064-46e26671ffb9_20250502T16:58_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII].
[AGENT][NEUTRAL] May I help you?
[CUSTOMER][NEUTRAL] H
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and um.
[CUSTOMER][NEGATIVE] My last EOB I got for my huge hospital claim, uh, it's like you guys only paid $600 and it looks like my max has been met, which
[CUSTOMER][NEGATIVE] I find kind of ridiculous as much as paying so much every month for my premium, but um I, I just recently got another bill from my emergency room physician and I want to double check to make sure I am maxed out um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll have to call them and make a payment. It's a large bill, so.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, [PII] Ms. [PII], I can help you with your claim and um your benefits to see if you're maxed out for the calendar year. Can I please get your call back number ma'am, just in case the call is disconnected I can call you right back.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your policy number, please?
[CUSTOMER][NEUTRAL] It's 02435427.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] I just couldn't imagine you got.
[AGENT][NEUTRAL] OK, miss
[CUSTOMER][NEUTRAL] Oh, go ahead.
[AGENT][NEUTRAL] Yes, ma'am. Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Well, my, my phone number again that I gave you is [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my email [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you, ma'am. I appreciate you verifying that information for me. OK, so let me look at the claim real quick. I do show that um the $600 was paid.
[AGENT][NEUTRAL] Um, as you stated,
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, the calendar year.
[CUSTOMER][NEUTRAL] And it says max.
[AGENT][NEUTRAL] Right. Let me see.
[CUSTOMER][NEUTRAL] Where was it?
[CUSTOMER][NEUTRAL] What's the calendar year map.
[AGENT][NEUTRAL] Let me check for you real quick.
[CUSTOMER][NEUTRAL] But that
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the um.
[AGENT][NEUTRAL] Let me give you the codes.
[AGENT][POSITIVE] Real quick.
[CUSTOMER][NEUTRAL] But I'm the one that mailed the UBs in and everything.
[AGENT][NEUTRAL] Yes, ma'am, I unders
[CUSTOMER][NEUTRAL] And then I had to go had to make an extra trip. I mean, I pay claims myself for another insurance company, but I made.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] I even had to go get you the um admin times and discharge times because that wasn't on my itemized bill or my UV.
[AGENT][NEUTRAL] OK, so I do see that um your hospital benefit for the the procedure code for hospital.
[AGENT][NEUTRAL] Was paid $500 and it matched the calendar year benefit with the $500 which was the allowable amount on according to your policy and then um.
[AGENT][NEUTRAL] For procedure RB.
[AGENT][NEUTRAL] And that's the procedure code that I'm getting is RB the charge was 6000 and.
[AGENT][NEUTRAL] $85.42. It paid $100 which was the maximum.
[AGENT][NEUTRAL] For that benefit for that date of service.
[CUSTOMER][NEUTRAL] OK, that's just not much at all, but OK. Anyways, um.
[CUSTOMER][NEUTRAL] So I have another question. So I guess I'll have to provider out of pocket if you've never received it. Did you ever receive a bill from Metro Emergency physicians for [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] For a total amount of $1,513.
[AGENT][NEUTRAL] Let me look real quick.
[AGENT][NEUTRAL] No, ma'am. The only um
[AGENT][NEUTRAL] The only claim that we have received.
[AGENT][NEUTRAL] Was the one that was reported on [PII] and prior to that we had a claim reported on [PII].
[AGENT][NEUTRAL] That was paid
[AGENT][NEUTRAL] $100 and it was to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah I know that so um but if I was able to get an itemized bill for this and send it to you, would it be paid or would it say I'm maxed out?
[AGENT][NEUTRAL] And this is for the ambience ride? Is that what you're stating?
[CUSTOMER][NEUTRAL] No, I
[CUSTOMER][NEUTRAL] I was not in an ambulance. This is the emergency physician that um did my emergency room exam and repaired my fracture to my knee.
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] OK. Let me see if you have emergency room benefits and how much they pay.
[AGENT][NEUTRAL] You have an outpatient.
[AGENT][NEUTRAL] Accident and sickness treatment benefit, and this is just to verify your benefits. It's not a guarantee of payment for the emergency room that pays $100.
[CUSTOMER][NEUTRAL] So I guess I can get an itemized bill from them and then send it to you.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Should I have them fax it or mail it? I mean, they'll send it to me. Should I fax it where I've faxed before, or?
[AGENT][POSITIVE] Either way is fine, whichever is most convenient for you if you wanted to fax it in, you can do that. I can give you the fax number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] What that
[CUSTOMER][NEUTRAL] Yeah, I know I have it from the other, but then when I fax for it was like uh it should go somewhere else. So alright, fax numbers what?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 1877
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Wait 1, 1877.
[CUSTOMER][NEUTRAL] 365.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] Yes. 9423.
[CUSTOMER][NEUTRAL] 942 3.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And and attention claims.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Alright, I'll see if they'll fax that over. If not, I'll have them send me an itemized bill and send it to you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK. So your name is [PII]?
[AGENT][NEUTRAL] Ms. [PII], is there anything else?
[AGENT][NEUTRAL] It is.
[CUSTOMER][POSITIVE] No, OK, alright, [PII], I appreciate your help and you have a great day.
[AGENT][POSITIVE] Well, you have a wonderful day too, and we thank you for calling APL. Have a great weekend.
[CUSTOMER][NEUTRAL] Uh-huh, you too. Mm bye.
[AGENT][NEUTRAL] Bye-bye, Ms. [PII].