AccountId: 011433970860
ContactId: 0caa11fc-ffea-4515-a37a-c1cc29d5f753
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 939979 ms
Total Talk Time (AGENT): 457429 ms
Total Talk Time (CUSTOMER): 387489 ms
Interruptions: 17
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/0caa11fc-ffea-4515-a37a-c1cc29d5f753_20250625T17:41_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL, my name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], how are you?
[AGENT][NEUTRAL] I'm fine, how are you?
[CUSTOMER][NEUTRAL] Good. I wanted to get an update on my claim.
[CUSTOMER][NEUTRAL] To make sure everything was uploaded and everything is there.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Sure, I'll be glad to. What's your policy number, please?
[CUSTOMER][NEUTRAL] 0181
[CUSTOMER][NEUTRAL] 684.
[CUSTOMER][NEUTRAL] 5 ML 7 or ML 8.
[AGENT][POSITIVE] I appreciate that. If I could verify your name, uh date of birth, and a phone number, please, sir.
[CUSTOMER][NEUTRAL] Here is the call.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Hi yeah, [PII].
[AGENT][POSITIVE] OK, I do appreciate that. Thank you. Let me just see what we've got here. It looks like you just said something, so let's see what we've got.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You said something on the [PII].
[CUSTOMER][NEUTRAL] I think it's a UBO4.
[AGENT][NEUTRAL] Right, right.
[AGENT][POSITIVE] It's very good.
[AGENT][NEUTRAL] And I apologize my computer is just a little bit slow, but what I am pulling up now to see what we've got.
[CUSTOMER][NEUTRAL] It's OK. I just wanna make sure you guys got it because the hospital told me they were gonna send it themselves.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Because they were able to link it to the, to like the, that, that number I just gave you.
[AGENT][NEUTRAL] Yes they did. So what I have.
[CUSTOMER][NEUTRAL] But they they linked it to that patient.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And this is Baptist Health South Florida, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes, we do have that, um, now we are processing the claims that we received on the [PII] and [PII], uh, we received yours on the [PII], so you should be hearing something from us at any time.
[CUSTOMER][NEUTRAL] On the [PII] and [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But OK, so we've got the hospital bill.
[CUSTOMER][NEUTRAL] That's if you got the.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, yes, it looks like everything came up.
[CUSTOMER][POSITIVE] I just wanna make sure everything you need is there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Yeah, I'm just looking now. I'm sorry, I'm just looking.
[AGENT][NEUTRAL] So I've got all the hospital bills.
[CUSTOMER][NEUTRAL] again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like I got the hospital bill. Do you have your explanation of benefits from your primary insurance? um.
[AGENT][NEUTRAL] Did you bring out?
[CUSTOMER][NEUTRAL] My primary insurance?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Let's see, yes, sir. Uh, now you have this through your
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] But you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Uh, I'm not sure, I'm not sure.
[AGENT][NEUTRAL] OK, so what we have is a hospital bill. Yeah.
[CUSTOMER][NEUTRAL] Why do you
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] So, I'm just gonna check here. Excuse me just a moment please. I just
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because we're your secondary insurance, um, we, uh.
[AGENT][NEUTRAL] You usually get the explanation benefits from your major medical. In this case, it looks like uh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't know, is it Cigna? Do you have Cigna as well?
[CUSTOMER][NEUTRAL] Cigna or Edna?
[AGENT][NEUTRAL] Aetna. OK, that's fine. Um, so what I have is your hospital bill. It looks like there were 9 pages of the of the hospital bill, um, and it looks like you, you had charges beginning [PII]. What we need is the, uh, diagnosis code and your explanation of benefits from your primary insurance, and the reason that we need that is because we need to.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Well, that's what I just asked you, cause, cause they were supposed to upload the diagnostic code with the UVO4.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's why I asked you was did they upload it and I think you told me yes.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah, well, I'm sorry, sorry, I meant that I'm sorry. What I meant was they uploaded what have been uploaded is the hospital bill itself, so no, the, the UB form and the.
[CUSTOMER][NEUTRAL] OK, so you don't have the UBO4. OK, I have the form in my email right now.
[AGENT][NEUTRAL] No, sir, I don't.
[AGENT][NEUTRAL] Right. I'm just checking again because I don't see it.
[CUSTOMER][NEUTRAL] I just gotta upload it, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because I'm not seeing it, sir.
[CUSTOMER][NEUTRAL] Well, they said they were gonna upload it themselves.
[AGENT][NEUTRAL] Oh, I see.
[CUSTOMER][POSITIVE] But it's OK. I can upload it myself.
[AGENT][NEUTRAL] OK, yes, you'll
[CUSTOMER][NEUTRAL] So besides the diagnostic code, what else do you need?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Your explanation of benefits from your primary insurance, please, so that we can, we'll know what the deductible, co-payment or co-insurance is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] From your major medical.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] What is that exactly? Let me look at my application and see if I can find with the.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Let's see what selection they have.
[CUSTOMER][NEUTRAL] Alright, what I so it says benefits and plans documents.
[AGENT][NEUTRAL] When you went to the hospital, did you give them, uh, what insurance card besides ours did you give them?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I didn't give him years. I, I, I did it after the fact.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Yeah, cause there's a lady that helped me last year when I did this, and she says it's better doing it that way.
[AGENT][NEUTRAL] OK, and, and what?
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] OK, that's great.
[CUSTOMER][NEUTRAL] So I, I kept doing it the way she advised. I'm sorry?
[AGENT][NEUTRAL] Of course. And no, no, that's fine, that's fine. Um, did, uh, do you have your major medical, have you, have you, uh, turned this in to your major medical yet?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like from E
[AGENT][NEUTRAL] To your
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What do you mean like my plan documents or?
[AGENT][NEUTRAL] Well, the, did you, uh, is, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This is your uh primary insurance, Aetna, do they know that you've been to the hospital? Have they, have they processed the claim yet?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh yeah, it's completely processed, correct, yeah, yeah, yeah, I already met my out of pocket.
[AGENT][POSITIVE] Oh great. OK, well then if I can.
[AGENT][NEUTRAL] Great, OK, well then I just need the explanation of benefits that that will generate and it shows the deductible, co-payment or co-insurance that we need to pay. And if, if we could have that along with the, with the, but the, but the UV form, sir, I'm, I'm looking again and I, I've got the, I've got the bill from the hospital, but I don't have the UB form or that um explanation of benefits from from Aetna so those is.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's OK. I, I'll I'll upload that one myself. So from Aetna, what do you need exactly?
[AGENT][POSITIVE] Great.
[AGENT][NEUTRAL] Your explanation of benefits for this data service showing the deductible, co-payment or co-insurance that we need to pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Well, that's the thing, you're gonna pay me this. You're not gonna pay my insurance.
[AGENT][NEUTRAL] No, no, of course not, but I need to know what the, what I'm supposed to pay you the amount that I'm supposed to pay you, and what they will do is they will process it and then they will tell it on that explanation of benefit it will tell us the amount of the charges that they put towards your deductible so that I'll know what to pay you.
[CUSTOMER][NEUTRAL] Well, I don't know. I did this last year and they just paid me the $2000 and that's it.
[AGENT][NEUTRAL] And that
[AGENT][NEUTRAL] OK, so last year, let's go over the documents that you, OK, let's go over the documents that you turned in, uh, in July of last year. Let's do that and then, um, that might be easier. OK, so let's just.
[CUSTOMER][NEGATIVE] I don't, I don't get any.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, cause I don't think I went through all this.
[AGENT][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] I know I had to get an itemized bill and diagnostic code. I know I had to get that. But besides that, I didn't have to do anything else.
[AGENT][NEUTRAL] OK, well, let me
[AGENT][NEUTRAL] OK, well, let me go ahead and tell you the documents that were turned in and this is on [PII].
[AGENT][NEUTRAL] And so let me tell you everything that was turned in.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] For you to get that payment, OK? So the and this is for um Mercy Hospital and it looks like there were a couple of doctors, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So what we had
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I can find it here.
[AGENT][NEUTRAL] I apologize. I'm just waiting for this to follow up.
[CUSTOMER][NEUTRAL] No, I I don't remember having to get my insurance thing and all that stuff. I remember getting the itemized bill, the diagnostic from the hospital. Besides that, I didn't get anything else that I remember.
[AGENT][NEUTRAL] We'll give it
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me just check and I'll be right back. Excuse me just one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so there were multiple things that were turned in. Um, there was the, uh, the, uh, documentation, um, from the, the hospital, from the doctor's visit.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And then we also had an explanation benefits that you submitted to us from Aetna, and on it it said explanation of benefits EOB. This is not a bill, and this is something that you had submitted to us there last year and on it, uh, what we were.
[CUSTOMER][NEUTRAL] So I did get some of the, what's it called, the EOB?
[AGENT][NEUTRAL] Yes, sir. And on it it says your claims up close.
[CUSTOMER][POSITIVE] It seems like a fine man.
[AGENT][NEUTRAL] It says your claims up close and it says claims for [PII] and it says uh for example, uh provider uh with Quest Diagnostics. This is from [PII]. Um there was another one that said uh for a doctor, uh [PII] um that was [PII] and what this does is it.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The one, yeah.
[AGENT][NEUTRAL] And on there it says, it says the amount, uh, billed, the member rate, that's how much you know, they, they have a discount for you and applied to your deductible, your co-payment, or your co-insurance.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Now this is all from Aetna and this is what you submitted to us.
[CUSTOMER][NEUTRAL] Alright, so
[CUSTOMER][NEUTRAL] What's the name of the thing again?
[AGENT][NEUTRAL] An explanation of benefits.
[CUSTOMER][NEUTRAL] No, but the document.
[AGENT][NEUTRAL] The document is called an ex.
[CUSTOMER][NEUTRAL] You said it had like uh
[AGENT][NEUTRAL] It's called an explanation of the.
[CUSTOMER][NEUTRAL] A what?
[AGENT][NEUTRAL] It's called an explanation of benefits or an EOD.
[CUSTOMER][NEUTRAL] Um, it's.
[CUSTOMER][NEUTRAL] For an EOB?
[AGENT][NEUTRAL] Yes, sir, and you submitted it to us from, uh, from your primary insurance and that.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] At that time was Aetna. I guess it's still Aetna, but that is not.
[CUSTOMER][NEUTRAL] Yeah, no, I have the same one. I have the same one.
[AGENT][NEUTRAL] And that's how we knew how much to pay.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] was because you provided us with this document.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Documentation. So what we would need, uh, I guess the hospital is going to sit.
[CUSTOMER][NEUTRAL] You just
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Where?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It's going to send a UB form.
[CUSTOMER][NEUTRAL] It's trying to do.
[AGENT][NEUTRAL] But you would need to send your explanation of benefits, your EOB from Aetna in order for us to process this because otherwise we have no idea how much to pay you.
[CUSTOMER][POSITIVE] Oh, I got it right here. EOB statement. I got it right here.
[AGENT][NEUTRAL] Yes, if you could submit that to us, sir, and then that and then when the hospital will send the the UB form then we would be we would be able to finish.
[CUSTOMER][NEUTRAL] I got
[CUSTOMER][NEUTRAL] Oh my God.
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] Processing.
[CUSTOMER][NEUTRAL] Let me see if there's a way for me to like download this.
[CUSTOMER][NEUTRAL] No, I just, oh.
[AGENT][POSITIVE] But yes sir we always need that because that's.
[CUSTOMER][NEUTRAL] Download PDF.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It lets me do it. I mean, it says EOB expiration benefits a breakdown for 6 claims.
[AGENT][POSITIVE] That's right. That's it.
[AGENT][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Uh, yeah, I think I when I download the most recent statement, correct? Not all of them.
[AGENT][NEUTRAL] Well, what you
[AGENT][NEUTRAL] What you'll do is you'll download the statement for that for that service, um, for the hospital.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, OK, perfect.
[AGENT][NEUTRAL] Yeah, I, yeah, I don't need the ones from all of your other, you know, if we're just looking at the hospital, that's the only one that we need to look at.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Download PBS.
[CUSTOMER][NEUTRAL] Let's see what, let me see what it says. It says [PII] statement. Let me see if it's still the surgery so.
[AGENT][NEUTRAL] Yeah, it should have the hospital in it.
[CUSTOMER][NEUTRAL] So if this one shows the surgery.
[AGENT][NEUTRAL] It should
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't see yeah.
[CUSTOMER][NEUTRAL] Yeah I don't see anything on it.
[CUSTOMER][NEUTRAL] Yeah, I don't think it's there. I got stronger there.
[CUSTOMER][NEGATIVE] It's like I've already met my deductible and everything but it's just not showing the.
[CUSTOMER][NEUTRAL] The, the surgery on the EOB so I have to wait till that document gets there.
[AGENT][NEUTRAL] Yeah, that's, that's what
[AGENT][NEUTRAL] Right, that's right. And then, and then we'd need that from the hospital we need that UV form or at least the, the diagnosis code and uh then, then we can um we can finish processing. But all the other documents, the um the hospital bill did come in. We, we did receive that the documents that you submitted, the hospital bill did come in. We just need the other two documents and then we'll be fine.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] This.
[AGENT][NEUTRAL] Is there any other data service sir that we need to look at or?
[CUSTOMER][NEUTRAL] No, no, no, I'm having another knee surgery, but I can only use this one, so it doesn't really matter.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, cause you're only allowed to use the gap thing once a year, so.
[AGENT][NEUTRAL] OK, well, uh,
[AGENT][NEUTRAL] Yeah, well, you have up to $2500 per year um for the outpatient surgery.
[CUSTOMER][NEGATIVE] Yeah, I'm gonna eat up the $2500 on this story.
[AGENT][NEUTRAL] Oh, OK. OK.
[CUSTOMER][NEUTRAL] Yeah, I ate up the whole thing last year, one surgery, and this was bigger surgery, so.
[AGENT][NEUTRAL] Well yeah
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Oh no, that's, yeah.
[CUSTOMER][POSITIVE] Yeah, I'm gonna get it in just one surgery. Yeah, doesn't matter. Alright, thank you so much. I'll make sure I upload those documents and I'll give you guys a call back once they do.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well thank you very much for contacting APO. You have a good day.
[CUSTOMER][POSITIVE] Thank you so much.