AccountId: 011433970860
ContactId: fda7fc37-0a30-4413-b021-dc8fa7480248
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426290 ms
Total Talk Time (AGENT): 173516 ms
Total Talk Time (CUSTOMER): 255254 ms
Interruptions: 6
Overall Sentiment: AGENT=0.8, CUSTOMER=-2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/fda7fc37-0a30-4413-b021-dc8fa7480248_20250421T22:26_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] over in customer care. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] Hey, I'm good. um, I have an insured on the line and she has a question about a claim. I was trying to explain to her that we need an explanation of benefits from her primary, and she's kind of arguing back with me as far as why, and I tried to explain it, but I may not be doing a good job, so could you maybe help her.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] 1,462,920 for [PII] and then I have the claim number too.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] Claim number is 359-0532.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright you can send her on over.
[CUSTOMER][POSITIVE] Thank you. Here she comes one moment.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I just need to know why my my claim was not paid.
[AGENT][NEUTRAL] OK, and that's the claim for uh.
[AGENT][NEUTRAL] Data service uh 520 and 514, is that correct?
[CUSTOMER][NEUTRAL] It was the 5:14 MRI that I paid for, yes, not, not the office visit, it was all on the same bill and I paid for the MRI so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what I'm questioning.
[AGENT][NEUTRAL] OK, alright, so with your policy we do pick up the amount that was applied to your deductible copay or co-insurance from your major medical.
[AGENT][NEUTRAL] So it looks like we were needing a copy of the explanation of benefits from your major medical.
[AGENT][NEUTRAL] So that we can see the amount that was applied.
[CUSTOMER][NEUTRAL] That it
[CUSTOMER][NEGATIVE] It does show it on there but what I faxed you guys shows all of that, so I'm not sure why. I thought you were supposed to pay the 1st $1000 out of pocket.
[CUSTOMER][NEUTRAL] Towards the deductible, so that uh that 500 and something I paid for my MRI should be.
[CUSTOMER][NEGATIVE] I shouldn't have to be calling on that.
[AGENT][NEUTRAL] OK. Um, as I stated,
[AGENT][NEUTRAL] We pick up your deductible, co-pays or co-insurance from your major medical. So the only way that we will know the amount they applied to your deductible copay or co-insurance is if you will send in the explanation of benefits from them and so that's what we're needing and once we get that information, we can finish processing your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what number do I fax this information, the same fax as before?
[AGENT][POSITIVE] Yes ma'am, that's correct.
[CUSTOMER][NEUTRAL] Do I do attention to anybody?
[CUSTOMER][NEUTRAL] So I need EOB again for the last 5 1424 EOB for my MRI and
[AGENT][NEUTRAL] No ma'am, you don't have to.
[AGENT][NEUTRAL] I'm sorry, I, I didn't understand you.
[CUSTOMER][NEUTRAL] What's the fax number again?
[CUSTOMER][NEUTRAL] What's the fax number again?
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, and, and is it possible for me to go paperless?
[AGENT][NEUTRAL] Uh, what do you mean paperless?
[CUSTOMER][NEUTRAL] I don't want uh a letter in the mail every time it says we have received a claim we are working on your claim and then I get updates through the mail. Is there any way I can just go paperless and just you send me emails, or does it all have to be through the mail, regular mail?
[AGENT][NEUTRAL] It doesn't have to be you are able to uh create an account on our online service center.
[AGENT][NEUTRAL] And then that way you can upload claims and you can also review your claims on the online service center and you there's also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Will you still mail me, will you still mail me one because I did all of that and I still got mailed stuff so I was wondering if there's any way I could go paperless.
[AGENT][NEUTRAL] Did you opt out?
[AGENT][NEUTRAL] Where did you opt out on the online service?
[CUSTOMER][NEUTRAL] Yes, and I
[CUSTOMER][NEGATIVE] Yeah, and I even sent a fax saying please make me paperwork. I don't know why I, I keep getting tons of mail and I don't really need all of this.
[CUSTOMER][NEGATIVE] It's just a lot of waste on paper and mailing for you guys especially.
[AGENT][NEUTRAL] OK, yeah, but that's usually a a way that you can opt out of um.
[AGENT][NEUTRAL] Have to look see if we can.
[CUSTOMER][NEUTRAL] So I guess I'll just go in there again and try it again.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEGATIVE] I've just been really frustrated with the APL. It's like the first year we had it, it claims were really easy and now it's just makes it's just on purpose really hard to get all of this stuff to you guys. It's just very frustrating and and people providers.
[AGENT][NEUTRAL] Uh, but I mean it's, it's been that way, especially with the meddling policy.
[CUSTOMER][NEGATIVE] And providers do not want to do any of it they just act like they don't know what it is but if providers actually do it for you then we get some some action but when we have to do it all ourselves we don't ever get paid so it's very frustrating.
[AGENT][NEUTRAL] The providers have to submit the same information that you have to submit the itemized bill with the, with the diagnosis code, yeah.
[CUSTOMER][NEGATIVE] They won't, yeah, they won't, but they won't do it. They won't they won't do it anything for APO. We have to do it on our own now. They used to be able to do that, but now nobody will do it for us and then when we do it, that you guys don't pay because it's just an endless cycle.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I mean if we, if we have everything that we that we're requiring then we will pay um but as I stated, you know, we don't know how much we have to pay on this MRI uh unless we know what they applied to your deductible and so the only way we'll know that is if you submit the EOB.
[CUSTOMER][NEGATIVE] I don't understand. I, it should be the 1st $1000 out of pocket, and it shows how much I paid out of pocket for my MRI.
[AGENT][NEUTRAL] We, we don't pay the amount.
[CUSTOMER][NEGATIVE] And they don't approve it unless it's.
[AGENT][NEUTRAL] We don't pay the amount that we don't pay the amount that you paid it it doesn't, if we don't go off the receipt.
[CUSTOMER][NEUTRAL] You don't pay the amount what?
[CUSTOMER][NEGATIVE] Why would, why would you not do that? You're supposed to pay the 1st $1000 out of, out of what I'm supposed to be paying, so I don't understand that.
[AGENT][NEUTRAL] OK, so if you send us a receipt saying that you paid $492 and you could if the exponential benefits says that they applied more than $492 that's the amount that we're gonna pay that's on the exponential benefits.
[CUSTOMER][NEUTRAL] No, it shows on that sheet it shows on that sheet that I faxed you how much they paid on my insurance, so.
[AGENT][NEUTRAL] But this is not the explanation of benefits. This is just the patient transaction report. Yes, I'm sorry, and we can't use it because this comes from the this comes from the doctor. It doesn't come from your major member.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What's the difference?
[CUSTOMER][NEGATIVE] That's ridiculous. Yeah, well, tell your upper management that it's very frustrating. I'm gonna let HR know that too because this policy is just not worth our hospital having because lots of people are having issues with ATL so let your upper people know that it's very frustrating and a lot of employees are getting fed up. OK, thank you.
[AGENT][NEUTRAL] OK, well, I'm sorry.
[AGENT][NEUTRAL] I will, I will.
[AGENT][POSITIVE] That's I'm sorry thank you have a great day.
[CUSTOMER][POSITIVE] That's all right. Uh-huh. You too, bye.