AccountId: 011433970860
ContactId: fcea5e10-b31c-43a7-9bf7-ecb9d864afdb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 618070 ms
Total Talk Time (AGENT): 286110 ms
Total Talk Time (CUSTOMER): 246548 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/fcea5e10-b31c-43a7-9bf7-ecb9d864afdb_20250604T14:03_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi yes, I received um two notices about claims that I tried to submit and they say they need um.
[CUSTOMER][NEUTRAL] I guess additional information.
[AGENT][NEUTRAL] I have a policy number?
[CUSTOMER][NEUTRAL] And that's wearing the final
[CUSTOMER][NEUTRAL] Yes, the policy number is 025.
[CUSTOMER][NEUTRAL] 99
[CUSTOMER][NEUTRAL] 306
[AGENT][NEUTRAL] And can I, are you the patient or the patient or the provider?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm the patient.
[AGENT][NEUTRAL] Can I have your name, date of birth, mailing address?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], and my date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Can I have a callback number for you just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Yes [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is the email address that we have on file for you?
[CUSTOMER][NEUTRAL] I don't know if it's [PII] or [PII].
[AGENT][NEUTRAL] We have the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, that's good.
[AGENT][NEUTRAL] And do you have the data service or the claim numbers that you're calling in reference to today?
[CUSTOMER][NEUTRAL] Yes, so the first one is, uh the reference number 02.
[CUSTOMER][NEUTRAL] Hold on, I have the claim number 360.
[CUSTOMER][NEUTRAL] 273 7.
[AGENT][NEUTRAL] Is this for American Public Life?
[CUSTOMER][NEUTRAL] Yes, the gap at the same.
[AGENT][NEUTRAL] Mhm. So it should, it's no letters in the claim number.
[AGENT][NEUTRAL] Are you looking at the claim now?
[CUSTOMER][NEUTRAL] Yeah, it's no letters, it's just numbers.
[AGENT][NEUTRAL] Well, it sounds like you said something else, so what could you repeat the claim number?
[CUSTOMER][NEUTRAL] Yes, 3602737.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So looks like we're requesting the additional information like the diagnosis, so we need an itemized bill listing the diagnosis.
[CUSTOMER][NEUTRAL] So the explanation of benefits.
[AGENT][NEUTRAL] What
[CUSTOMER][NEGATIVE] Does not suffice.
[AGENT][NEUTRAL] No, the estimate the explanation of benefits only provides us with the information that the primary made payment on the claim. However, we need the diagnosis from the like such as the itemized bill.
[AGENT][NEUTRAL] From the facility that you received the services from?
[CUSTOMER][NEUTRAL] OK, so the hospital.
[AGENT][NEUTRAL] Mhm. And let them know that you need the um the diagnosis codes.
[CUSTOMER][NEUTRAL] OK, just to idolize them.
[CUSTOMER][NEUTRAL] I just had a baby, so that's what it was, so you need that.
[CUSTOMER][NEUTRAL] The ICD code.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The diagnosis codes. Mhm.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for the second claim.
[AGENT][NEUTRAL] It looks like we're requesting the EOB.
[CUSTOMER][NEUTRAL] Yeah, the.
[AGENT][NEUTRAL] And the primary insurance company.
[CUSTOMER][MIXED] That was so funny. So the second claim they want the EOB, but the first thing they don't want the EOB.
[AGENT][NEUTRAL] No, because you submitted the EOB for the first one.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] But you didn't submit the ELB for the physician fees, professional fees.
[CUSTOMER][NEUTRAL] Would that be the same EOB?
[AGENT][NEGATIVE] The first one is for the facility is still no.
[AGENT][NEUTRAL] Let me look and see what you submitted.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, cause I just submitted the whole EOB from Blue Cross and Blue Shield.
[CUSTOMER][NEUTRAL] So I don't think they, they, they, I don't think they um they divvy up between the position and
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] a little bit.
[AGENT][NEUTRAL] So for the first, the one for the um the physicians, well, the anesthesia charges, there was only a UB.
[AGENT][NEUTRAL] The claim itself, it was sent with the the um ICD codes, however, there was no EOB attached to it.
[AGENT][NEUTRAL] Did you submit the same day?
[CUSTOMER][NEUTRAL] Wait, what?
[AGENT][NEUTRAL] This is for the phys the physician submitted this and they didn't attach the EOB to it. Mhm. So the first one that you're calling about the facility charge, you submitted that one, but the physician itself submitted the other claim that you're calling about that we're requesting the EOB we sent that request to them but it went to you as well.
[CUSTOMER][NEUTRAL] Oh, they submitted it.
[CUSTOMER][POSITIVE] Oh, they're good on their own.
[CUSTOMER][NEUTRAL] OK, so they will probably provide that. The second one that I just asked you about.
[AGENT][NEUTRAL] Mhm, but it looked like.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] The so the one that we're requesting information from you, it looks like the um provider submitted their their claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we paid the provider for that claim that you're calling about that we're requesting the diagnosis codes.
[AGENT][NEUTRAL] They submitted a claim on your behalf.
[CUSTOMER][NEUTRAL] Oh, so it was already paid.
[AGENT][NEUTRAL] Mhm it it was pay after you submitted yours and we requested information from you.
[CUSTOMER][NEUTRAL] Oh, do you, do you know how much they pay towards that?
[AGENT][NEUTRAL] Yeah, it looked like they paid $5000.
[AGENT][NEUTRAL] Which maxed out your benefits.
[CUSTOMER][NEUTRAL] OK, cause what I was trying to.
[CUSTOMER][NEUTRAL] OK, so I will have to pay the additional $783.
[AGENT][POSITIVE] And 17 cents, yes, that's correct.
[CUSTOMER][NEUTRAL] Oh, look at God.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] He's definitely good, man.
[CUSTOMER][NEUTRAL] OK, so the other one about the EOB, the physician's gonna send all that information to you guys.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But we're assuming.
[AGENT][NEUTRAL] Because they submitted the claim.
[CUSTOMER][NEUTRAL] OK, so that claim was for like $5000 also, right?
[CUSTOMER][NEUTRAL] $5,236.
[AGENT][NEUTRAL] Mm, it was for, yes, that is how much it was for the anesthesia charges.
[CUSTOMER][NEUTRAL] I say total bill charges.
[AGENT][NEUTRAL] But your benefits were maxed out, so you have uh you have um per calendar year you have $5000 per calendar year for inpatient services.
[CUSTOMER][NEUTRAL] OK, y'all
[AGENT][NEUTRAL] And it makes out.
[CUSTOMER][NEUTRAL] I wonder why they, why they trying to say this. What?
[CUSTOMER][NEUTRAL] Sharing the health card.
[AGENT][NEUTRAL] How much is
[CUSTOMER][NEUTRAL] Like why are they sending that?
[AGENT][NEUTRAL] Mm, they do you want, so with the facility when you go into a facility, there's professional fees that comes with it like we, we be like, OK, so this is the facility charge and we think that's it, but.
[AGENT][NEUTRAL] Everybody wants them, everybody wanna get some in, right? That's the um it's for the anesthesia charges.
[CUSTOMER][NEUTRAL] Yeah, what is position come from?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] But they better find out another day.
[CUSTOMER][NEUTRAL] Cause I was
[CUSTOMER][NEGATIVE] Cause I'm trying to, OK, I know it's 5000, but my insurance should have covered some of this.
[AGENT][NEUTRAL] Um, so it depends on if your deductible and out of pocket was met.
[CUSTOMER][NEGATIVE] they, they, they're doing too much.
[CUSTOMER][POSITIVE] It definitely was met with this $19,000 bill I received.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You probably need to go on the website to see which claims was processed first just like say if the um.
[CUSTOMER][NEUTRAL] Definitely, cause they said.
[AGENT][NEUTRAL] Say if anesthesia sent the bill to your primary first before the facility did, then they just, they process them as they come like first come, first served.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because my out of my out of pocket max is 7200, so it definitely should have been met and then everything else will be covered for the rest of the year.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because I know you deduct you have out of pocket expense, so the deductible be amount once amount and then out of pocket be a different amount where you pay only 20% towards your services once your deductible has been paid in full, met in full.
[CUSTOMER][NEUTRAL] Yeah, no, I'm probably in the car though.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I probably have to just wait and see and but y'all did pay the first bill that I was trying to submit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The itemized bill. OK, so I should receive a bill from the hospital saying this is the remaining balance?
[AGENT][NEUTRAL] Um, I, I assume you would. Mhm.
[CUSTOMER][NEUTRAL] Because y'all cover the $5000.
[CUSTOMER][NEUTRAL] Oh yeah, me too, because I keep going online to wait for the bill, but I haven't received it yet so I'm just gonna, I guess I'll wait for like another month or two.
[AGENT][NEGATIVE] You gotta stop looking for them bills.
[CUSTOMER][NEUTRAL] I know, but I just don't wanna be hit over the head and they send me all these.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] All the bills at once.
[CUSTOMER][NEUTRAL] Trying to get a house. I don't need no more bills coming.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, and you definitely don't need anything on your credit when you're trying to get a house because they're gonna be like, well, you gotta pay, you could have a house and your credit credit score whatever have you where you don't have to pay a clo closing costs. But then when this gets attached to your credit file, then they'll be like, well, you have to pay this certain amount of money before you get approved for the home. Oh yeah, I do understand.
[CUSTOMER][NEUTRAL] OK, but like you said,
[CUSTOMER][NEUTRAL] Exactly. So I'm, I'm trying to catch up with it first and then you do like a payment plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And go from there, OK, but it's good that I know that you said that $5000 down to $783.17.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] So I just gotta figure out what this other 52306 for this position. I need to go sit down somewhere.
[CUSTOMER][POSITIVE] So I need to figure out them. OK. So you've been a big help. Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] That'll be all.
[AGENT][POSITIVE] Well thanks for calling APL. Have a great day, Ms. [PII].
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thanks. Goodbye.