AccountId: 011433970860
ContactId: f33a6de4-9dd5-4a68-9c1a-375c7561d50f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1085079 ms
Total Talk Time (AGENT): 321901 ms
Total Talk Time (CUSTOMER): 262822 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/f33a6de4-9dd5-4a68-9c1a-375c7561d50f_20250227T21:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I had a question about a claim that was processed.
[AGENT][NEUTRAL] OK, and your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], what's your policy number?
[CUSTOMER][NEUTRAL] It is see if it's on the bill here, um, yeah, 018741117.
[AGENT][NEUTRAL] OK, you're the policy holder, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, can I get a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And if I can get you to verify your date of birth, your mailing address and email, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The address is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the email is [PII].
[AGENT][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] And do you have a claim number, [PII] that I can look at?
[CUSTOMER][NEUTRAL] I do. It's 355-722-5.
[AGENT][NEUTRAL] OK, this is for you, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me pull that up and then I can help you with the.
[AGENT][NEUTRAL] With how it was processed and so what's your question regarding this claim?
[CUSTOMER][NEUTRAL] Well, it's I thought it was the APO was my deductible coverage and the deductible on this claim was $878.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But there's the APL only covered $45.
[AGENT][NEUTRAL] OK, so let me take a look at who is your primary insurance?
[CUSTOMER][NEUTRAL] Blue Cross Blue Shield.
[AGENT][NEUTRAL] Let me take a look at their explanation and see what it says.
[AGENT][NEUTRAL] And is this for the bill from heart of the Rockies?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] So when I look at the explanation of benefits from Blue Cross, it shows under the deductible column $45.
[CUSTOMER][NEUTRAL] See, the one I have is $878.75 and I'm.
[AGENT][NEUTRAL] What's the pay date on the one that you have? They may have gone back in and reprocessed it. There should be a pay date at the top.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Top right.
[CUSTOMER][NEUTRAL] Let's see the date processed, so this was [PII].
[AGENT][NEUTRAL] OK, so the one I'm looking at says [PII], so it looks like they may have gone in and reprocessed the claim maybe so.
[CUSTOMER][NEGATIVE] Hey, I don't know because I'm still, I'm, I'm still getting a bill from the hospital for $833 and I just got that yesterday. Yeah.
[AGENT][NEUTRAL] From Hearts of the Rockies.
[AGENT][NEUTRAL] Yeah, so that's what I'm saying we may not have received the updated uh or or corrected ELB. Let me check real quick. This was the date of service in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yeah, I don't show that we've received the corrected explanation of benefits if that's what it is, does it say corrected on there anywhere?
[CUSTOMER][NEUTRAL] I'm trying to find the new one. You said the Blue Cross one was in [PII].
[AGENT][NEUTRAL] The one that we received under the pay date it says [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm, OK, so I've got one that says where did it go?
[CUSTOMER][NEUTRAL] Yeah, this one's like um.
[CUSTOMER][NEUTRAL] I lost it. Hang on, bear with me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the one I got.
[CUSTOMER][NEUTRAL] [PII], so it'd be a newer one than the one you're looking at.
[AGENT][NEUTRAL] But is it for the same hospital charge? What's the total charge on the one you're looking at?
[CUSTOMER][NEUTRAL] $925 is what the hospital bill.
[AGENT][NEUTRAL] OK, that's what it says online. So they may have, them being your primary may have reprocessed it.
[CUSTOMER][NEUTRAL] OK, and then it's
[AGENT][NEUTRAL] And so if that be the case, we need a copy of the updated or corrected EOB for review.
[CUSTOMER][NEUTRAL] I can I'm looking at it right now. Can I just send this to you?
[AGENT][NEUTRAL] Right, so of the $925.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see. Oh, you know what? What we have, it says that the total charge was 286.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] But the, but the
[AGENT][NEUTRAL] But the itemized bill says.
[AGENT][NEUTRAL] 9:25. Hold on a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, send us a copy of the explanation of benefits that you have and at the top I'm gonna give you a claim number to reference because the itemized bill that matches the total charge that you gave me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be under the claim number that I give you, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Well, you actually have a copy of the EOB don't you?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] So you can actually send a copy of the EOB.
[AGENT][NEGATIVE] Well, no, because that's not gonna work because on the ELB what is the total bill charge?
[CUSTOMER][NEUTRAL] Um, after they processed it or from the hospital?
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] For so on on the ELB that you received from American Public Life.
[CUSTOMER][NEUTRAL] Oh, from American Public Life, it says total bill charged 925 and you guys paid 45.
[AGENT][NEUTRAL] Oh, it says 9, it says 9.
[CUSTOMER][NEUTRAL] Yeah, the, the EOB I got from American Public Life, that's dated, um, see is there a date on this anywhere.
[AGENT][NEUTRAL] Should be
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, that's what mine says. It says check date [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and it's, yeah, it's got um total bill charges is 925 paid to providers 45.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that, OK. Yeah, it does say 9:25.
[AGENT][NEUTRAL] But on the, OK.
[AGENT][NEUTRAL] Give me a second, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, the explanation that we received shows a total charge of 286. So on the primary ELB that you have, does it show the total charges as 925?
[CUSTOMER][NEUTRAL] Yeah, from the one I have from Blue Cross.
[CUSTOMER][NEUTRAL] The claim total from the hospital was 925 and then Blue Cross Blue Cross paid.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] 40, well, no, that's their discounts. They didn't pay anything. They discounted it and then left the deductible of $878.75.
[AGENT][NEUTRAL] Is there an allowed amount on there?
[CUSTOMER][NEUTRAL] A loud amount, yes, was 87875.
[AGENT][NEUTRAL] Is that what that they they went they that's what will apply towards deductible?
[CUSTOMER][NEUTRAL] So they didn't pay, yeah, that was the allowed amount.
[CUSTOMER][NEUTRAL] They applied that whole amount towards the deductible, yes.
[AGENT][NEUTRAL] OK, so send us a copy of that explanation of benefits, [PII], and put this claim number on it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me write it down. Can I just can I email it? I have it a PDF of it here.
[AGENT][NEUTRAL] Well, email is not a secure way to send it um you can fax it if you want to or you can upload it online if you have, you know, you can create an account and upload it.
[CUSTOMER][NEUTRAL] Can we do that?
[AGENT][NEUTRAL] Uh-huh. I can show you how to do that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, yeah, that'd be great.
[AGENT][NEUTRAL] And so you're gonna go to [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Well let me know when you're at a computer.
[CUSTOMER][NEUTRAL] OK, I am hang on let me get up here.
[CUSTOMER][POSITIVE] OK, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] it's in there, OK.
[CUSTOMER][NEUTRAL] Oh, OK, um, yeah, I'm logged in here.
[CUSTOMER][NEUTRAL] Already
[CUSTOMER][NEUTRAL] I see where it says claims upload documents is that where I need to go?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so upload files.
[CUSTOMER][NEUTRAL] And then let's see in claim details I guess that's me, [PII] documents.
[CUSTOMER][NEUTRAL] Policy coverage. OK, so I have the lapsed coverage on this one.
[AGENT][NEUTRAL] Yeah, so what policy number are you selecting?
[CUSTOMER][NEUTRAL] 187411117
[AGENT][NEUTRAL] Let me see.
[AGENT][POSITIVE] Which is what you gave me, so that's right.
[CUSTOMER][NEUTRAL] OK, so next.
[CUSTOMER][POSITIVE] It's all good select files here we go.
[CUSTOMER][NEUTRAL] Let me get out of this.
[AGENT][NEUTRAL] And I, have you done it already?
[CUSTOMER][NEUTRAL] Not yet.
[AGENT][NEUTRAL] Cause I want you to put the policy number.
[AGENT][NEUTRAL] On theirs, I mean the claim number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let me get to my file and then I will do that.
[CUSTOMER][NEUTRAL] Do I need to name the file anything in particular as far as the PDF I upload?
[AGENT][NEGATIVE] No, you don't.
[CUSTOMER][NEUTRAL] OK, I'm just gonna call it EOB Blue Cross.
[AGENT][NEUTRAL] And you may want to put 9 the date of service 9.
[AGENT][NEUTRAL] Um, 9 27 23.
[CUSTOMER][NEUTRAL] 927 23 got it.
[CUSTOMER][NEUTRAL] OK, I'm uploading that.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And then when you get a confirmation number, be sure to write that down.
[AGENT][NEUTRAL] And then I can see it. I'm gonna give it a few seconds.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I can go ahead and just submit submit this now.
[AGENT][NEUTRAL] And then I should
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK, I'm gonna click submit.
[AGENT][NEUTRAL] And then you'll get a confirmation number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I'm gonna wait a minute because I could see it here in a few seconds since you did it online that's how quick it is when you uploaded it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Awesome, yeah, I got
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] I got a compromise. That's cool.
[AGENT][NEUTRAL] So let me refresh.
[CUSTOMER][NEUTRAL] And then they come through.
[CUSTOMER][NEUTRAL] Any luck?
[CUSTOMER][NEUTRAL] Are you still there?
[AGENT][NEUTRAL] [PII], I'm sorry. I made it myself cause I was coughing and then forgot to take myself off of mute. I'm just talking.
[CUSTOMER][NEUTRAL] Oh, I thought I lost you.
[AGENT][NEUTRAL] OK, no, I'm sorry. Yeah, we did. I see it. I think what happened before the hospital sent the correct itemized bill showing a charge of 925, but the ELB that was attached didn't match the total charge.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, anyway, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I see it
[AGENT][NEUTRAL] OK, so it's in your file now it's in line for processing.
[CUSTOMER][NEUTRAL] OK, so that is reprocessed that.
[AGENT][NEUTRAL] Yeah, we'll go in and, and take a look at it and, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So I am going to make a note here.
[AGENT][NEUTRAL] OK, I wanted to put a note in the system.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, and so they'll take a look at that?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so you're, you're set. We have the information here and so allow at least 5 to 7 or 7 to 10 days, uh, could be before then, but just allow that amount of time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right, thank you for your help.
[AGENT][POSITIVE] Oh, you're welcome and thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.