AccountId: 011433970860
ContactId: fc2cd9de-d051-47fe-a127-eacc57f3feec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 458790 ms
Total Talk Time (AGENT): 146543 ms
Total Talk Time (CUSTOMER): 177422 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/fc2cd9de-d051-47fe-a127-eacc57f3feec_20250616T20:08_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. I'm calling because
[CUSTOMER][NEUTRAL] I received a bill from one of my
[CUSTOMER][NEUTRAL] Um, doctors.
[CUSTOMER][NEUTRAL] And they, so I have Gap, which is the American Public Life, which is my secondary insurance with you guys.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] And usually everything gets, that doesn't get covered, um, gets charged there and I haven't had an issue.
[CUSTOMER][NEGATIVE] And then I received a bill from.
[CUSTOMER][NEGATIVE] The office saying that I owe $160 and they, it, there wasn't really a response as to why it was denied by my gap.
[AGENT][NEUTRAL] OK, do you have?
[CUSTOMER][NEUTRAL] So,
[AGENT][POSITIVE] A phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So, with this card, I have a payer ID.
[CUSTOMER][NEUTRAL] A group number.
[AGENT][NEUTRAL] Inpatient
[AGENT][NEUTRAL] Inpatient outpatient certificate number?
[CUSTOMER][NEUTRAL] Yes, yes, 0250.
[CUSTOMER][NEUTRAL] 8098.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, and then the number 8.
[AGENT][NEUTRAL] Thank you. Hold on one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify your uh address and email address, please?
[CUSTOMER][NEUTRAL] Um, [PII] I mean [PII]. Email address is [PII].
[AGENT][NEUTRAL] OK. Did your address change?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. It was [PII].
[CUSTOMER][NEUTRAL] Yes, [PII], yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can you give me the new one so I can get it changed for you again?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, I'll get that changed for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And you had a question about a claim that was denied?
[CUSTOMER][NEGATIVE] Correct, it was denied. I called.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] The, the, the number that they have for the bill to ask as to why it was denied. They said that the answer was very vague for me to call the insurance to ask as to why.
[AGENT][NEUTRAL] OK. uh, I can help you with that. What date of service was it for?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, date of service.
[CUSTOMER][NEUTRAL] It says [PII].
[AGENT][NEUTRAL] What was the total charge for it?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It says total balance.
[CUSTOMER][NEUTRAL] $240 insurance pending $160 and then amount due now is $80.
[AGENT][NEUTRAL] Does it have a procedure code on it? I have two claims for that data service. I have an office visit and then I have some diagnostic tests, so.
[AGENT][NEUTRAL] Was it for the office visit or?
[AGENT][NEUTRAL] What's the name of the facility?
[CUSTOMER][NEUTRAL] It says, it says, it says office visit.
[AGENT][NEUTRAL] OK. If it's an office visit, office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then which other one did you say you have?
[AGENT][NEUTRAL] Hold on, I'll tell you who it's from let's see.
[AGENT][NEUTRAL] Vital MD Group Holdings.
[AGENT][NEUTRAL] Let's see what it was for.
[AGENT][NEUTRAL] For an ultrasound.
[CUSTOMER][NEUTRAL] OK, and where is it from?
[AGENT][NEUTRAL] Vital MD Group Holdings.
[CUSTOMER][NEUTRAL] A vital O.
[AGENT][NEUTRAL] Did you have an ultrasound done?
[CUSTOMER][NEUTRAL] Yeah, but I don't know if it's from that place though. I only go to ultrasounds. It's in the association in advanced maternal fetal medicine is where I go to my ultrasounds.
[AGENT][NEUTRAL] OK. Hold on just a second. I'll tell you who the doctor is.
[AGENT][NEUTRAL] But that one was paid. The only one that was denied was that office visit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's because office visits are no this is for [PII].
[AGENT][NEUTRAL] The ultrasound.
[CUSTOMER][NEUTRAL] OK, yes.
[AGENT][NEUTRAL] No, that one was paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Yeah, but the only one that was denied was that office visits, and they're not covered under this policy.
[CUSTOMER][NEUTRAL] OK, so is my total for this $80 or is it $160?
[AGENT][NEUTRAL] That would be up to the provider's office because the total charge was 595.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It just depends on how much your um major medical pay because we didn't pay anything.
[CUSTOMER][POSITIVE] OK. That's fine. Thank you.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[AGENT][NEUTRAL] It was 565. I apologize. The total charge for that office visit was $565.
[CUSTOMER][NEUTRAL] No, ma'am, that's all.
[CUSTOMER][NEUTRAL] Yeah, it's OK.
[CUSTOMER][POSITIVE] Yeah, I saw it. Don't worry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, ma'am, that's all.
[AGENT][POSITIVE] Thank you, Ms. [PII] for calling APL. You have a good afternoon.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][POSITIVE] Thank you. Bye-bye.