AccountId: 011433970860
ContactId: f63d5a3b-4628-4e77-8e8b-35499ff927fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2011160 ms
Total Talk Time (AGENT): 711976 ms
Total Talk Time (CUSTOMER): 1023493 ms
Interruptions: 5
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/f63d5a3b-4628-4e77-8e8b-35499ff927fc_20250414T22:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Go ahead. Go ahead. Hey [PII], um, I am calling. I'm, uh, I have a couple questions about some claims, some of the checks that I've received, and, uh, it's my husband's policy, so he will have to give you permission to speak to me.
[AGENT][NEUTRAL] Yes, ma'am. I can check claim status for you guys. Um, can I please get your name and your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Good because the last time just did get disconnected. I, my name is [PII].
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII].
[AGENT][NEUTRAL] OK, and then what is the policy number?
[CUSTOMER][NEUTRAL] The policy number is, well, I, I can I go ahead and give you permission to talk to her so I got work to do.
[AGENT][NEUTRAL] Yes, sir, um, I will need for you to verify your policy, uh, as soon as I get it pulled up if you guys.
[CUSTOMER][NEUTRAL] I did that right quick. I don't know why he.
[CUSTOMER][NEUTRAL] Jumping the gun, it is 01973079.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK [PII].
[AGENT][NEUTRAL] OK, [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then I'll also need your address, phone number and email address that we have on the policy for you, sir.
[CUSTOMER][NEUTRAL] OK, [PII], phone number [PII].
[CUSTOMER][NEUTRAL] And if you have email it'll be my work [PII].
[AGENT][POSITIVE] OK, thank you, Mr. [PII]. I appreciate that and I appreciate you giving me consent to speak um to Ms. [PII] about your policy. Thank you.
[CUSTOMER][NEUTRAL] I may not.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][POSITIVE] Alright, great. Now if uh if I have to call you after today we gotta do this step every time, right?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yes ma'am, uh, um, the verification lasts for a day unless you want to go to our website and download the third party authorization form and fill that out and send it in, then we can put you on file. He'll have to fill it out, send it in, we could put you on file that you don't have to go through the verification process that he's given consent for you to be able to discuss anything on the policy.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, hopefully.
[CUSTOMER][POSITIVE] Well, I'm hoping what I've done is kind of uh I had to play catch up with my like wellness uh visits. So I have checks coming in and I'm kind of waiting for them to all come in so I can check them all because
[CUSTOMER][NEUTRAL] When I send y'all a claim, it's, well, it's what y'all do, it's complicated for me.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Like I'll send in uh EOBs and I'll send in like the doctors, well, I send in the EOBs. They've been and I put all the diagnostic codes and yes they send in and want different stuff that they're picking.
[CUSTOMER][NEUTRAL] Like all the EOBs, they're just picking out random dates and stuff that I'm like, well I don't even like have that information. So anyway, we've had to kind of go back and forth with some different claims here. So kind of catching up. So looking back at [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think, is it [PII] or [PII], maybe it was [PII]. Um, on our [PII] policy, and I put the, the actual like the policy number that went with that plan on there and it came back and they only want, they only wanted to pay 4 visits for [PII].
[CUSTOMER][NEUTRAL] But in in that year we should have, we had the the older policy that had 5.
[CUSTOMER][NEUTRAL] Visits. So I feel like I'm still should be reimbursed for one for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And I have that policy number.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what is that policy number?
[AGENT][NEUTRAL] So I can look at
[CUSTOMER][NEUTRAL] That policy number is 12 yeah it's 126.
[CUSTOMER][NEUTRAL] 2877
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, so looking at the old policy, uh, you have, it doesn't go by visits, it goes by the amount.
[AGENT][NEUTRAL] Let's see. I'm gonna, I'm gonna double check myself here real quick before I go and tell you that. You got a benefit amount of $5000.
[CUSTOMER][NEUTRAL] Yeah. It's usually 5 it was.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEGATIVE] And once that $5000 is exhausted, then the policy won't pay.
[CUSTOMER][NEUTRAL] OK, well you
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, but for that one I'm just claiming like the 5 office visits. It stopped me at 4 and said I had used my maximum benefit.
[AGENT][NEUTRAL] OK, let me see if it has specified office visits.
[AGENT][NEUTRAL] I'm pulling up your old policy real quick to see what it says.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're so welcome.
[CUSTOMER][NEUTRAL] Yeah, when you play catch up, you get a little bit uh like everything it gets confused and.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, I, I don't know what happened with COVID, but I did not keep up with stuff. I don't even know.
[AGENT][NEUTRAL] OK, I see the inpatient. Let me look for the outpatient.
[AGENT][NEUTRAL] We're still inpatient. I'm scrolling to see what it says for your outpatient coverage.
[CUSTOMER][NEUTRAL] That's fine, and I had the policy in there. I feel like it was towards the back somewhere, but I can't remember now. I would have to go actually pull it out of the envelope, but it might be a bad.
[AGENT][NEUTRAL] Yeah, they
[AGENT][NEUTRAL] They are pretty long.
[CUSTOMER][NEUTRAL] Let me get my while you're uh also doing that because I know when I called in and spoke to somebody about filing these, I know our new plan like starting on [PII] went to where you got 4 a piece for the maximum of 8 per family.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, so you, this is what on your old policy, this is what your outpatient benefit is treatment in a hospital emergency room, outpatient surgery in a hospital outpatient facility, diagnostic testing in a hospital outpatient facility or MRI facility.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Up to $200 for treatment of the same or related conditions unless separated by a period of 90 consecutive days.
[AGENT][NEUTRAL] Then a new outpatient benefit will be payable.
[CUSTOMER][NEUTRAL] Yes, what I'm looking for is the wellness visit.
[AGENT][NEUTRAL] The wellness, OK.
[CUSTOMER][NEUTRAL] I'm looking for the wellness business. I'm sorry, maybe I should clarify that.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][POSITIVE] Yes, that's where it's um I'm sorry uh.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] And I feel like that lady made directed me to the back of this thing. I'm just trying to remember which page she told me to go on originally, but.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Be between me and you, we ought to be able to figure this out somewhere.
[AGENT][POSITIVE] Yes ma'am, we should. I'm, I'm gonna start at the back and move forward. How about that?
[CUSTOMER][POSITIVE] That's what I'm doing as well.
[AGENT][NEUTRAL] We'll do that.
[CUSTOMER][NEUTRAL] Because I feel like it was towards the back.
[CUSTOMER][NEUTRAL] I didn't think it was this far in the middle so I don't know where I'm missing it. OK, it looks like it's on.
[CUSTOMER][NEUTRAL] Hang on, I'm gonna tell you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It's not on that page. Hang on, that's the wrong thing.
[CUSTOMER][NEUTRAL] That was for medical.
[CUSTOMER][NEUTRAL] Alright, where's the wellness coverage, my word.
[CUSTOMER][NEUTRAL] It's not this hard.
[AGENT][NEUTRAL] And and it's probably staring us right in the face and if it was a snake, he'd bite us.
[CUSTOMER][NEUTRAL] Yeah, I looked at page 8, but that was kind of what you were reading, and that's not what we're needing.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So, OK, it is actually on page 3.
[AGENT][NEUTRAL] Page 3. OK, so it's at the beginning. Let's go up there.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] So you see at the bottom where it says the physician outpatient treatment benefit and it says 25 per treatment for 125 maximum per family per calendar year.
[AGENT][NEUTRAL] Yes, $25 per treatment, $125 maximum.
[AGENT][NEUTRAL] Per calendar, yes, I do see that.
[CUSTOMER][NEUTRAL] So it looks like what they pay me the, by my records is they only gave me 4.
[AGENT][NEGATIVE] OK, so once you reach the way that it reads to me is once you reach the $125 then it stops paying.
[CUSTOMER][NEUTRAL] Yes, and they only gave me 100 because they only paid 4. So the new policies read different. The new policy says 4, you can have 4 per person up to 8 per family. So like I could get 100, my husband can get 100, but this old plan said 125 per family. So they only paid me.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, $100 so they still owe me one of those visits and I feel like I filed all my claims for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, um,
[AGENT][NEUTRAL] What I can do is have somebody call you back on that claim. It's specifically that claim. Is it the one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause I do see where it says calendar year policy maximum for 4 doctor visits per person has been met. I do see that. So let's make sure, and that was for
[AGENT][NEUTRAL] Reported on [PII] and it's claim number 3577524 and that was on [PII]'s claim.
[CUSTOMER][NEUTRAL] Yes, I don't have actually have that at like the check number in front of me. I mean, I can come up with with it pretty quickly. It's just that I know in the back of my mind they still owe me one but I knew they were going based on like the updated because it then it updated on [PII] and it went to another claim number which is what we gave to you the first time in the beginning.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] But so they're looking at the new number and that's why on that claim when I send it in and faxed it with that paper on the top, I put in the old claim number at the top so they would know to look back at the old claims.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so what I'll do is I'm gonna send in a request to have somebody call you back within 24 hours so that they can go over how they process that claim for you on that one,
[CUSTOMER][NEUTRAL] Benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] That would be perfect. OK, now, now let me ask you if.
[AGENT][NEUTRAL] Is
[AGENT][NEUTRAL] Is that the only one you had questions about?
[CUSTOMER][NEUTRAL] No, I, uh, I have another question, but let me ask you this question while I have you on the phone. I don't know if you can go back. I was looking through my records. I know I had some uh surgery back in.
[CUSTOMER][NEUTRAL] Like the end of
[CUSTOMER][NEGATIVE] Of [PII] and I feel like y'all would have paid for that. I can't find any kind of receipt for that. Do you have a way to look back in [PII] just out of curiosity, early [PII] and see if you paid something that would have been a couple $1000.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Are you able to see a check or or?
[AGENT][NEUTRAL] Right, so on your first policy, the effective date was [PII]. So it wasn't effective in [PII].
[CUSTOMER][NEUTRAL] OK, bye.
[CUSTOMER][NEUTRAL] Oh, that's right. It was the American public life, you can't see those, that's for somebody else, right?
[AGENT][NEUTRAL] Right, that's probably with somebody else because the, the first policy that you had started on [PII].
[CUSTOMER][NEUTRAL] OK, this other one we have with American, I'm sorry, it was an American Fidelity Insurance Company that one we had then it turned over to y'all, so I guess I would have to call those people.
[AGENT][NEUTRAL] Right. Yes, ma'am.
[CUSTOMER][NEUTRAL] And that a sister of y'all, but you can't see that one right?
[AGENT][NEUTRAL] No, I can't see that one. I can only see APL.
[CUSTOMER][NEUTRAL] OK, so that one started. OK, yeah, somewhere along the way this changed from this company to y'all. So, OK, that would make sense. I'm sure I would have got paid for it, but I maybe I can reach out to them another day. OK, so now we're, what made me wanna call you is for [PII].
[CUSTOMER][NEUTRAL] I sent in a bunch of information and I got something today in the mail and it's saying that I am.
[CUSTOMER][NEUTRAL] With this check, the policy maximum for this benefit has been met, but I'm not counting enough, uh, checks for that to have met.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 8 visits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see. And that was the most recent one for dermatology associates for [PII]?
[CUSTOMER][NEUTRAL] So yes, today I got him a dermatology once so I checked that off his list.
[CUSTOMER][NEUTRAL] Um, so I got that one.
[CUSTOMER][NEUTRAL] Then I got myself who came in today for sound neurology, but it's on the back of mine that says that the maximum has been met with the.
[CUSTOMER][NEUTRAL] With this benefit and I'm like, but I don't know how because they're not paid my for. I filed [PII] 2 different times.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And unless I've got more cakes coming for 21, I feel like somewhere there's a
[CUSTOMER][NEUTRAL] Maybe a miscommunication unless I've got checks that still are arriving for 21.
[AGENT][NEUTRAL] OK, is there a claim number on that letter that you received?
[CUSTOMER][NEUTRAL] So on mine from on the back of mine, so it's under me, so the claim number.
[CUSTOMER][NEUTRAL] I hang on, I gotta find it claim number, OK, so the check I got is 35.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] 86668
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 866 8. Let me look.
[AGENT][NEUTRAL] OK, that
[AGENT][NEUTRAL] Claim was processed and paid on [PII].
[AGENT][NEUTRAL] There's another payment.
[CUSTOMER][POSITIVE] Yes, I got it in the mail today.
[AGENT][NEUTRAL] OK, there's another payment coming by check that was processed and paid on [PII].
[AGENT][NEUTRAL] For Nova Health.
[AGENT][NEUTRAL] And it's gonna be
[AGENT][NEUTRAL] Let me make sure that they didn't file that or if it was you.
[CUSTOMER][NEUTRAL] Yeah, I'm just looking for the [PII]. I've got some coming from the like a in, in hospital. That's a whole different like benefit.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, these are my wellness, or not, I call them wellness, they're not actually wellness. They're office visits where you can't be well. So that's why you have to send all the codes in. But I'm looking for like another $25 check for [PII]. Not, not the 200 ones, but the $25 ones.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that one was a $200 payment and it was released on [PII].
[CUSTOMER][NEUTRAL] Yeah, that's a different that's different.
[AGENT][NEUTRAL] That's a different one, OK.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] Yeah, that's a different kind of thing.
[AGENT][NEUTRAL] So I'm showing that on [PII].
[AGENT][NEUTRAL] We have check number 20 no that's $200.01 too hold on let me keep let me keep looking.
[CUSTOMER][NEGATIVE] Yeah, I've gone through all my 21s. I've got check numbers that are lying in front of me that would pertain to 21. I don't know if that would make it easier for you.
[CUSTOMER][NEUTRAL] But I should have 8, I should have.
[AGENT][NEUTRAL] No, I'm
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] $200 separately but for uh separate office visits.
[AGENT][NEUTRAL] OK, because I'm showing on the [PII] there was 3 checks that went out.
[AGENT][NEUTRAL] One was for.
[CUSTOMER][NEUTRAL] Is that what I what you're talking about for me?
[AGENT][NEUTRAL] One was for $50.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yes, that one's mine. That's the check number I just gave you the claim number.
[AGENT][NEUTRAL] And it's
[AGENT][NEUTRAL] OK, the 2037 for the claim number that you just gave me, OK, yeah, 66. No, this claim number is 3586668.
[CUSTOMER][NEUTRAL] 358-666 that's what I just gave you [PII]. That's what I just gave you for $50.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's the one that says that my policy has been met, my maximum has been met is what's on the back of it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so what we're gonna do is we're gonna have claims call you about this one also.
[AGENT][POSITIVE] That way they can go through step by get a claim specialist to call that way they can go step by step with it through you on how they paid and we can see if that other bit uh $25 is still.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or that other visit, I should say.
[CUSTOMER][NEUTRAL] So how about you do me this favor? If I, if you still got checks coming to me, um.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Why don't I not make this? Can we not make the phone call tomorrow? Am I allowed to call like let me allow, if you, do you just say one more check coming to me or a couple of checks coming to me?
[AGENT][NEUTRAL] Well, you said that you've received how many that were issued on the [PII]?
[CUSTOMER][NEUTRAL] Issued on the [PII]. OK, so I have 12.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], so I have 5 that came in from the [PII]. Let me check those dates again.
[AGENT][NEUTRAL] OK. And the, and those are for both?
[CUSTOMER][NEUTRAL] 12345. Yes, I have 5.
[AGENT][NEUTRAL] Those are for both you and [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We've got another payment that was issued for [PII].
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] And that's gonna be check number 2038006 and it's going to be for $25.
[CUSTOMER][NEUTRAL] For which uh date?
[AGENT][NEUTRAL] Data services [PII].
[AGENT][NEUTRAL] Dermatology associates.
[CUSTOMER][NEUTRAL] OK, well there's a 21 still coming. OK, so there's a 21 coming, maybe that's what they, maybe it's not it's showing the maximum, but I maybe haven't received all the checks yet.
[AGENT][NEUTRAL] Right. That could be very possible.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Less let's wait for, let me wait then if that's the case because that might keep me from having to really call y'all except for that one year. But let me um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] How about I get everything. That's why I haven't, I haven't cashed them is because I'm trying to check them off when they get in because I've got like 90 days or 120 days to do this. So I'm kind of checking them off as I get them and then that way I know if I need to do follow up with information. So let's let them come, they should be starting to wrap up.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let them come and then if I, I keep my notes and then that way I'll be able to ask it all at one time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I may probably still will have to call about the [PII] because for that particular year with that benefit, um, number that I gave you a minute ago, I should be getting 5 then it changed the following year for 4 and 4 so.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Let's just let them roll in and then that way I can keep my notes and ask at one time. I think that's gonna be the best.
[AGENT][NEUTRAL] So at this time, so at this time you do not want me to have anybody call you on any of the claims at this time you wanna go ahead and wait and see what we have coming into you and then check them off of your list before we do that.
[CUSTOMER][NEUTRAL] Yeah, that would be good. Now, can you just repeat to me real quick that one that said for uh [PII] you said that was for $25 and what was that date again?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, that was [PII], let me look him up, um.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] The [PII], no, that's [PII]. Let me go back. I had him. It was for [PII] and it was for dermatology.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Another dermatology one.
[AGENT][NEUTRAL] It was dermatology associates, the.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, date of service was [PII].
[AGENT][NEUTRAL] It's gonna be in the amount of $25.
[CUSTOMER][NEUTRAL] The [PII], OK.
[CUSTOMER][NEUTRAL] All right, that might be, I still feel like they owe me one but let's uh kind of wait and see what.
[AGENT][NEUTRAL] And then the
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, you don't see anything for [PII] like a different [PII] that to be generated because I feel like they owe me one.
[AGENT][NEUTRAL] Let me look on you again and see that I'll start from the nearest and go down.
[CUSTOMER][POSITIVE] So fine
[CUSTOMER][NEUTRAL] Yeah, [PII] has 3.
[CUSTOMER][NEUTRAL] Yeah, he'll have 3 coming in and then [PII] had 1, so that should give that 14 and then I have 4 claims I sent to you. I actually have 5 sent to y'all for me, but they're only trying to pay for 3.
[CUSTOMER][NEUTRAL] So I just
[CUSTOMER][NEUTRAL] I didn't know if you see another one coming for [PII] for me.
[AGENT][NEUTRAL] I'll look for [PII], um, the last one was [PII]. Let me go down and see if I can find a [PII].
[AGENT][NEUTRAL] Um, we've got Salem Neurological Center.
[AGENT][NEUTRAL] Data service is
[CUSTOMER][NEUTRAL] Yeah, I got those today for 50.
[AGENT][NEUTRAL] Yes, that's 50 and then let's keep looking.
[CUSTOMER][NEUTRAL] And then I received one for our being that was [PII] and that's all I see for myself.
[AGENT][NEUTRAL] OK, there's one for $200 for Nova Health.
[AGENT][NEUTRAL] And that's for data service [PII] that's [PII]. I need to look at your dates, Tory, you want [PII].
[CUSTOMER][NEUTRAL] Yeah, that's something different.
[CUSTOMER][NEUTRAL] Yeah, and not the [PII], those are different.
[AGENT][NEUTRAL] Uh, OK, here's the [PII].
[AGENT][NEUTRAL] OK, yeah, I've got a $200.01 on data service of [PII].
[CUSTOMER][NEUTRAL] Yeah, that's a different one. I'm just trying to figure if I need to send resend it because it's 2 times I sent 21 in and I don't know why that one has fallen through the cracks, but there should be for me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which I know you can't answer it, but I filed one for me for 12121 and 2 121. So there should be out of those 21 of those should be eligible for me to have a 4th 1. So I don't know why they're saying um right max that benefit because there's not 8 payments there for the family. So, um.
[AGENT][NEUTRAL] Right. So you said the data service for you was um.
[AGENT][NEUTRAL] And this is gonna be for you. Let me look at you, yeah, can you give me the data service and I'll pull up by data service to see what we have.
[CUSTOMER][NEUTRAL] That I'm waiting on
[CUSTOMER][NEUTRAL] OK, so the two days of service that I should feel like I should get one, only one of these, but there are two dates that could be picked from. One is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look on that one first.
[CUSTOMER][NEUTRAL] And the other one is too
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I don't show any claims for [PII] for you.
[AGENT][NEUTRAL] For that data service and then
[CUSTOMER][NEUTRAL] It was [PII]. It was [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, looking at data service of [PII], I don't find a claim on file for [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For you.
[CUSTOMER][NEUTRAL] OK, well, so I faxed it, but that just means they didn't like accept it as part of going towards the payment, is that what you're saying?
[AGENT][NEUTRAL] I'm just showing that it hasn't been completed yet. Um, there's, there's.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's not there um now what's the other data service that we could look at?
[CUSTOMER][NEUTRAL] OK, and then
[CUSTOMER][NEUTRAL] The other day service is [PII].
[AGENT][NEUTRAL] OK, let me look up that data service.
[AGENT][NEUTRAL] And I'm not showing [PII] for you either those two dates aren't showing up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah, somehow they've missed one for me. I don't know why because they paid me for 1 121 and they paid me for 1 1421 and they paid me for 1 1121, but I still have these other two that I've resent like twice, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So maybe, I don't know how y'all get these and how they look at them. I thought about, do I refax it and say, hey, I'm still do one for myself for this date.
[AGENT][NEUTRAL] You can do that yes ma'am. Do you have the fax number?
[CUSTOMER][NEUTRAL] Yeah, I packed all of these. So I'm just trying to figure out, so for me, they, they've only paid 3. For [PII], if they've got a check coming with you, they've only paid 3 on [PII], the ones coming would be 3.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And then [PII], I had a kid at that time, they paid 1 on his, but we should have 8 total amongst the whole family. And I'm only counting 7.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEGATIVE] I've gotta figure out where that's messed up at.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Because they sent her I'm let me tell you this real quick. No, I'm on the phone with the insurance company.
[CUSTOMER][NEGATIVE] They sent a random weird payment on, on online on [PII], which doesn't even make any sense why they sent that one.
[AGENT][NEUTRAL] On [PII]
[CUSTOMER][NEUTRAL] [PII], 3121.
[AGENT][NEUTRAL] Um, [PII]. OK. Let me look and see.
[CUSTOMER][NEUTRAL] But regardless, it still doesn't equal up to the 8 visits. I don't know.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's like a random one for $11.18.
[AGENT][NEUTRAL] And that was for [PII], and what was that date again? [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me keep looking.
[CUSTOMER][NEGATIVE] Because if that's messing up and not kicking, if it's kicking mine out then we need to, I don't know what we need to do with that one because I don't even know why they paid for that one at $11.
[AGENT][NEUTRAL] Because this policy helps with deductible, co-pay or co-insurance. So if you sent in information that the deductible co-pay or co-insurance could go towards, then they'll pay for it if it's covered procedure.
[CUSTOMER][NEUTRAL] Well, that's a shot for, uh, that's a shock cause he's allergic to bees and they're the, they kind of pick up on those. I, I'm not sure why they picked that one but I have other ones that would have equal $25. So I'm not sure why they wanted that one to be one that they chose to pay on.
[AGENT][NEUTRAL] Right, I
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] So I guess maybe when I talk to the person about [PII], I'm gonna say, why did y'all pick that one at $11.18 to pay when I've got 4, that's well over $25 that y'all could have paid instead of his at $11. And that, because I have the other claims for that same company that says we don't pay for uh medication. Well, that what they gave him, I guess is considered a medication. It's a shot, it's an allergy shot.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So I guess I'll uh I'll hold off and.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I'll get that other one for [PII] because I feel like they shouldn't have paid for that one and they should have picked up one of mine. It's what I feel like should have happened.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Well, if, um if you decide you want to talk to them, you can ask them about that.
[AGENT][NEUTRAL] It it
[AGENT][NEUTRAL] During the time that you decide to talk to them and see um why they paid that one rather than the other one it might be that that one they got it first and processed it first. I'm not sure um I'm not in that department.
[AGENT][NEUTRAL] But I could
[CUSTOMER][NEUTRAL] OK. I.
[AGENT][POSITIVE] If you do need um me to have them call you or if you wanna wait like you said and call back later and let your checks come through either way is fine whichever you would like for me to do to help you.
[CUSTOMER][NEUTRAL] Alright, so when I call when I call back when I get all my checks and and I figure it all out, so when I call in and it's asking me to speak to claims, who am I needing to speak to? Do I ask for a different department?
[AGENT][NEUTRAL] Uh, you'll always have to go through my department first because we have to verify your policy before we can transfer you and then once we verify the policy then we would transfer you to the claims specialist and it'll be anybody that picks up the phone but all of them are trained in processing claims, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, well I'll try to see. I will go through all of these dates.
[AGENT][POSITIVE] But anybody you get should be able to help you. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I'll just try to go through my date so I can ask all my questions at one time, but I know when I send in EOBs, what I'm sending in like I'll have a date specific. And let's just say [PII]. On [PII], I'm sending in, you know, it's a long EOB that's kind of got, they, they send it in for like the month. So I put in there like.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I went to my neurologist on that day and I put it in my code. And there's other stuff on there and then they'll respond to me and be like, well, we need the we need your information for this other date. I'm like, well, why are you picking the other date? I've, I outlined to you the 4 dates that should be counting because that's the information that I've gotten myself.
[CUSTOMER][NEGATIVE] No, you're making me do extra work for claims that to me should have been like I'm numbering them, I'm underlining them, I'm putting codes by them. So why they randomly pick dates and tell me that they need me to send stuff on it.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] I don't understand it. So anyhow, I don't know why they randomly picked up that one because there's tons of them $11.18 throughout the whole time cause my husband gets allergy shots regularly.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] And some of them will say that's not covered because it's medication. So I don't know why they chose to pick that one to pay for. Anyway, it's messing up a 2021. I think that's what's messing up 21. And I'm gonna make the people fix it and say, well, I don't care if you have to add the difference to make it $25 for me.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But let's get rid of the 11 and 18 because that's odd when you could be paying my plan for 25, you know what I'm saying?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, yes, I understand.
[AGENT][NEUTRAL] I understand. OK.
[CUSTOMER][NEUTRAL] OK, well, I, I don't need you to do anything at this point. I will wait on my checks to come in and then I'll make all my questions so we can handle it all at one time.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, sounds good.
[CUSTOMER][POSITIVE] OK. Well, thank you very much.
[AGENT][NEUTRAL] OK. All right.
[AGENT][POSITIVE] You're welcome, Miss [PII]. I hope you guys have a wonderful night. Thanks for calling APL.
[CUSTOMER][POSITIVE] You have a great day.
[CUSTOMER][POSITIVE] OK you too.
[AGENT][NEUTRAL] Um, bye-bye.
[CUSTOMER][POSITIVE] OK thanks alright bye bye.
[CUSTOMER][NEUTRAL] Bye.