AccountId: 011433970860
ContactId: 077655a3-7707-4485-9af9-21f6627e2e8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 512359 ms
Total Talk Time (AGENT): 224257 ms
Total Talk Time (CUSTOMER): 217458 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/077655a3-7707-4485-9af9-21f6627e2e8b_20250110T16:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, I, uh, got a bit from, uh, the hospital.
[CUSTOMER][NEUTRAL] And it was back uh from service I had in September and I talked to them and they said that that that particular uh claim or whatever it was then I by you know so I'm just checking on that.
[AGENT][NEUTRAL] What is your policy number?
[CUSTOMER][NEUTRAL] The policy is 02566464.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And may I have your name and date of birth, please?
[CUSTOMER][NEUTRAL] This is uh [PII] and the uh [PII] is the date of birth.
[AGENT][NEUTRAL] OK, thank you, Mr. [PII]. May I have your call back number if we are disconnected please sir?
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[AGENT][NEUTRAL] OK, thank you and verify your complete mailing address.
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] OK, thank you, thank you for the verification process, Mr. [PII]. Now what, what date was the
[AGENT][NEUTRAL] Visit 4.
[CUSTOMER][NEUTRAL] It was uh [PII].
[AGENT][NEUTRAL] [PII]. OK, give me one moment.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Mm thank you for your patience. Bear with me please.
[CUSTOMER][NEUTRAL] Oh it's OK. They give me the claim uh number too if you need that.
[AGENT][NEUTRAL] OK, I was about to say that the policy number that you provided me is a current policy number which does not start until [PII] of this year. So let me just check here just to go back to the last year, um, what is
[CUSTOMER][NEUTRAL] Yeah, they gave us a new card, so I just grab that one out of my wallet. Sorry, should I go get the other one?
[AGENT][POSITIVE] No problem, no problem.
[AGENT][NEUTRAL] No, sir, I have it. I have it. What is that claim number? Thank you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. It's uh 202-427-050 V as in Victor 12620X00.
[AGENT][NEUTRAL] OK, so that is not one of our claim numbers. That must be a claim number for your major medical, but no worries. You said that was [PII]. Give me one second.
[CUSTOMER][NEGATIVE] I tried to tell them that and they, they just weren't for me that just was irritating. I said, did you run it through AL uh, well, uh, our major no, I'm not, I'm saying ATL.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] anyway.
[AGENT][NEUTRAL] OK, no problem, let's see.
[AGENT][NEUTRAL] 01 moment. [PII], OK.
[CUSTOMER][POSITIVE] And, and I gotta say you speak perfect English, so this is very refreshing, so.
[AGENT][POSITIVE] Thank you, I appreciate that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm sorry. Um, is it from a facility or was it um professional fees?
[CUSTOMER][NEUTRAL] It was from a physician service at the uh Christopher Lynch and it was uh prior to my uh stomach surgery and stuff.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and y'all paid all that for the surgery and the hospital stay and, and, uh, you know, so.
[AGENT][NEUTRAL] 528. OK.
[CUSTOMER][NEUTRAL] I'm just curious about that.
[AGENT][NEUTRAL] OK, let's go back here.
[AGENT][NEUTRAL] And what is the total amount of the bill, please, Mr. [PII]?
[CUSTOMER][NEUTRAL] The one they sent me today by the the my chart thing is uh $214.62.
[CUSTOMER][NEUTRAL] And it shows for Blue Cross Blue Shield that it was an 18 $816 bill and Blue Cross Blue Shield paid $601 so.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, that's why I was wanted to know the total price. OK, so I show that we did receive the claim from the provider, however, they did not send us the explanation of benefits. So if you have the explanation of benefits from Blue Cross Blue Shield, you can send it to us and we can continue processing the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, hang on just a second now. Blue Cross should have sent you all that.
[AGENT][NEGATIVE] No, so the provider who sent us the claim should have sent that to us, but they did not. They only sent the claim to us.
[CUSTOMER][NEUTRAL] OK, so would I require what you need?
[AGENT][NEUTRAL] You can reach out to Blue Cross Blue Shield to let them know that you need the explanation of benefits for [PII].
[AGENT][NEUTRAL] And again, like you said, the total price was $816.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or you can reach out to the provider who submitted the claim to us which shows AHS Oklahoma physician group. They can send us the explanation of benefits from Blue Cross Blue Shield and then we will continue to process the claim.
[CUSTOMER][NEUTRAL] OK, uh, now number I called, uh, about this bill, I guess it was, uh, the res hot people. Can I call them back and say that y'all need the explanation of benefits.
[AGENT][NEUTRAL] Yes sir, you can call the
[CUSTOMER][NEUTRAL] And I can add that because they're all under the, huh.
[AGENT][NEUTRAL] Yes, sir. You can call them to let them know that we are needing the explanation of benefits from your major medical.
[CUSTOMER][NEUTRAL] OK, from Blue Cross Blue Shield, OK, or would it, would it be, uh, quicker if I just call Blue Cross Blue Shield?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] It may be quicker if you call Blue Cross Blue Shield or if they have a website that you can obtain the explanation of benefits for this particular procedure.
[AGENT][NEUTRAL] No, maybe faster or quicker.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I'll try that. OK, um, is, uh, can, will I get a different person when I call back if that's wondering because you kind of know what I'm doing here.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Or we go do this again.
[AGENT][NEUTRAL] It it's possible, but I will make a um a note and of course that I talked to you in regards to claim number 352-0528.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] 352-05 what?
[AGENT][NEUTRAL] 28
[CUSTOMER][NEUTRAL] 28 OK.
[AGENT][NEUTRAL] Yes, and
[CUSTOMER][NEUTRAL] OK, 352-052-8.
[AGENT][NEUTRAL] Yes sir and that is your claim number with APL again the one that you provided me is obviously probably from Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is, yeah, so, OK, OK, uh, 353-052-8.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And that's y'all's claim number.
[AGENT][NEUTRAL] Yes. Yes, sir. 352-0528. Yes, sir.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, now when I go to the Blue Cross Blue Shield would I look for this date here and the particular doctor for the, uh, explanation of benefits?
[AGENT][NEUTRAL] Yes, or look for that particular procedure code. It shows 43239.
[CUSTOMER][NEUTRAL] 43, say again.
[AGENT][NEUTRAL] 43239.
[CUSTOMER][NEUTRAL] OK, and that's the uh.
[CUSTOMER][NEUTRAL] Uh, procedure code.
[AGENT][NEUTRAL] Yes sir, that's what was performed that biopsy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, good deal. OK, I'll, uh, see what I can do.
[AGENT][NEUTRAL] OK, now we if you do do it, um, if you do receive that EOB you can send it to us via fax or if you have an account created with us on our online service center you can upload it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, or you can mail it, but we, we're not able to take it over the phone, of course, or by email.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] See I'll need a hard copy.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Basically.
[CUSTOMER][NEUTRAL] OK, and that's what I told these uh Hilcrest people send me hard copies, don't email me stuff, so.
[CUSTOMER][MIXED] It's this has been ongoing. It's just been kind of irritating, but I'm all healthy now, so should be good for a little while.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] Alright, OK, I appreciate all your help.
[AGENT][POSITIVE] You're welcome, Mr. [PII]. Thank you, sir. You have a good day.
[CUSTOMER][POSITIVE] OK, have a good day uh huh bye bye.
[AGENT][POSITIVE] You too you too bye bye.