AccountId: 011433970860
ContactId: 13998034-eadb-4989-86b0-ed2b28a10f3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 870750 ms
Total Talk Time (AGENT): 335090 ms
Total Talk Time (CUSTOMER): 385326 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/13998034-eadb-4989-86b0-ed2b28a10f3f_20250127T21:05_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, um,
[CUSTOMER][NEGATIVE] I need to find out. I know on one of um there's the um the doctor's office that billed you, and I know that you did pay them some money, but they keep charging me, so I need to know exactly how much you paid them.
[AGENT][POSITIVE] OK, yeah, I can definitely help you with that today. Do you mind if I have your name and policy number, please?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] Um, the policy is under my husband's name, [PII], and same last name.
[CUSTOMER][NEUTRAL] Um, the group number, is that the one you want?
[AGENT][NEUTRAL] It may say member ID or policy certificate number.
[CUSTOMER][NEUTRAL] Mm, it says group number.
[AGENT][NEUTRAL] OK, I can look it up with the group number.
[CUSTOMER][NEUTRAL] This is group number.
[CUSTOMER][NEUTRAL] 2607 I'm sorry 26087.
[AGENT][NEUTRAL] 87. OK, give me one second.
[AGENT][NEUTRAL] All right, and I was able to find that policy for you. Do you want me to give you the policy number for your records?
[CUSTOMER][POSITIVE] Oh OK perfect.
[AGENT][NEUTRAL] All right, and I have, do you have a pen and paper handy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, 241526-2.
[CUSTOMER][NEUTRAL] 241
[CUSTOMER][NEUTRAL] OK, 241-5262.
[AGENT][NEUTRAL] Mhm and Miss [PII], would you mind verifying some information with me, please?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right. I need to verify your date of birth if we can.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful and can you verify for me the mailing address on file?
[CUSTOMER][NEUTRAL] [PII]. That's [PII].
[AGENT][POSITIVE] Perfect
[AGENT][NEUTRAL] Thank you. And then there's just 2 more things if you can, the email on file and the phone number on file.
[CUSTOMER][NEUTRAL] OK, um, I'm not sure if it's my husband, but mine is [PII].
[AGENT][NEUTRAL] I think it's under your husband's.
[CUSTOMER][NEUTRAL] OK, so it would be [PII].
[AGENT][POSITIVE] Wonderful thank you and then uh just that phone number if you can.
[CUSTOMER][NEUTRAL] OK, I'll give you his first in case it's his [PII].
[AGENT][POSITIVE] That was wonderful. Thank you so much and let's take a look at some of your recent claims, Miss [PII], and see what we can do to help you out here.
[CUSTOMER][NEUTRAL] Well, this is an old claim. This is from [PII].
[AGENT][NEUTRAL] Old, you know.
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect. That's what I was gonna ask if you knew the data service, so let me look it up [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] To
[AGENT][NEUTRAL] Looks like there's a couple claims in here I'm gonna check out what is the name of the provider's office that um.
[CUSTOMER][NEUTRAL] OK. The actual, it's the biller is A M R Y W L I N and Associates PA.
[AGENT][NEUTRAL] All right, so that does not match that.
[AGENT][NEUTRAL] Let's move on.
[AGENT][NEUTRAL] OK, my friend. OK, so I think I figured out.
[AGENT][NEUTRAL] Some of it. Hang tight. I feel so close to your answers that you need.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I am seeing that we received 3 different claims for that day.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm showing that the first one we received.
[AGENT][NEUTRAL] was for
[AGENT][NEUTRAL] Make sure
[AGENT][NEUTRAL] The first one we received was for the physician's practices um uh the medical center and we paid them $100 is what they charged and we covered that. The next one that came.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you paid them 100. OK, let me see.
[AGENT][NEUTRAL] Mhm and that was for physician services, so it was a different um like they bill out through different things, so that one was under physicians. The next one that came through was your anesthesiologist bill, and that one we paid $150 on um for that data service and that was for your anesthesiologist and then.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, uh-huh.
[AGENT][NEUTRAL] Finally, a little bit later we received the claim from the group you're talking about. They sent it like 6 months later, um, and that one was denied as a claim because your max benefit per calendar day is $250 and it had already been met with from the other two claims that had been paid the $100 to the physician service and the $150 to the anesthesiologist. So then this one got.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] OK, so you did not pay. No wonder that's why they're charging me for the whole thing, OK.
[AGENT][NEUTRAL] Yes, and it's just if they had submitted their claim first it would have gone to them, but it goes out in order where what comes in first.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] Is there anything else I can help you with, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK, that's
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEGATIVE] I wish I had better news for you. I'm sorry.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, yes, I do, um, I need your help with something. In the past I've tried, OK, I get an infusion every month, OK, which is not a doctor's visit, it's just I go there at the doctor's office, but they put in, you know, any intravenous um infusion and um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, Florida Blue does cover part of it. I have to pay $55.
[CUSTOMER][NEGATIVE] Every, you know, it's 55 every time I go every month. Now I did try to send in the past, but you denied it.
[CUSTOMER][NEGATIVE] Um, I have, I need to get this. I'm not working. I, I need to get this paid because, you know, it's very difficult, you know, to get anything, you know, I'm like.
[CUSTOMER][NEUTRAL] I'm squeezing my my husband for his all his money, you know, with all the medical bills and things, so, um.
[CUSTOMER][NEUTRAL] What do I need to do?
[CUSTOMER][NEUTRAL] In order to get these covered.
[AGENT][NEUTRAL] Yeah, so, um, you said you've submitted them in the past do you remember, um.
[AGENT][NEUTRAL] Let me take a look and see if I can find information on one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, sometimes I notice that sometimes they pay a little more. Like I see one of these here they pay, you know, Florida Blu paid like $80 something dollars but usually how much they pay, yeah, just because you said so maybe they're they're starting to, I know that they've been.
[CUSTOMER][NEUTRAL] Let me take a look at these here, um.
[AGENT][NEUTRAL] Do you happen to have like one of the dates of services from one you might have submitted to us so I can take a look into it for you?
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You know what, I wanna, I would have to probably go take a look and see the papers, but um.
[CUSTOMER][NEUTRAL] Yeah, because the.
[CUSTOMER][NEGATIVE] I tell you the truth, the doctor's office won't do it for me. They say that um.
[CUSTOMER][NEUTRAL] This is their words not mine. They say that you never want to pay the claim.
[CUSTOMER][NEUTRAL] That's what they tell me. So they said they didn't wanna do it. So, um,
[CUSTOMER][NEUTRAL] They said, you know, I have to submit the claim, so I'm trying to figure out.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] So it looks like I see that we have some uploaded. It looks like [PII] you uploaded some from Miami Shores Medical Group.
[CUSTOMER][NEUTRAL] That's how, OK. Uh-huh.
[AGENT][NEUTRAL] So for these ones they were denied but they're requesting the explanation of benefits from your primary insurance carrier um so you're, you'd be able to resubmit or just you wouldn't even have to resubmit the claims just the explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what do I have to, I have to send like what I printed out from Florida Blue?
[AGENT][NEUTRAL] Yeah, so just your Florida blue explanation of benefits and you can even like download them to your computer and upload them to the online service center, um, but the reason for that is because we follow major medical so a lot of how we determine what we're gonna pay is based on how major medical applies charges to your copay, your co-insurance and your deductible, and because we are secondary to them, we have to have their paperwork to process.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright, OK, so I'm gonna, I'm, I'm gonna get this up and and done, um, I'm gonna take care of this, uh.
[CUSTOMER][POSITIVE] Within the next, uh, you know, today and tomorrow I'm gonna have it all um done OK.
[AGENT][POSITIVE] Perfect, yeah, send that all in. We don't have a time limit on our side, so you're good to submit that and once they have that information, they'll be able to.
[CUSTOMER][NEUTRAL] OK. Yeah, but I wanna just get it done, so I'm gonna, anyway, I'm gonna ask the girl at the doctor's office to make sure that she gives me, they give me like um like something, you know, that comes like it's a bill. It's on a like a red and white thing. I don't know how well it looks on the other, you know, for you, but she gives me the information and the codes and everything, you know, of what was done.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Yeah, because I only see the doctor once every, the ones where I see the doctor, when I see him, they do both things they do, I see him and I do the infusion, but those, since the bill says that it's, you know, for a doctor's visit, you know, it says it includes the infusion, but there's no separation of infusion and doctor's bill, so it's only one flat $55.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You know, for that, so that I'm not including, I only want the ones where I go for the infusion by itself.
[CUSTOMER][NEUTRAL] You know that I have that information there.
[CUSTOMER][NEUTRAL] Which, you know, specifies it's for the infusion. And I only see him like every 4 months or so.
[AGENT][NEUTRAL] For the infusion.
[AGENT][POSITIVE] Yeah, definitely send us the information from those and we'll be able to process them out for you um and then any time you wanna submit something new just make sure you have that explanation of benefits from your major medical and that will just smooth the process along on our side so that we don't have to like send in a request saying we need that for you.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK, so that's great so I'll be able to um send you all this information and uh oh, I noticed that you have when I put in my bank information that it shows a different bank, like a real old one.
[AGENT][NEUTRAL] Is it just the name of the bank or is it the?
[CUSTOMER][NEUTRAL] That used to be, you know.
[CUSTOMER][NEUTRAL] Yeah, the name of the bank was like, you know, from 20 years ago.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, I mean the
[CUSTOMER][NEUTRAL] You know, the, the actual, I think bank has changed like twice 3 times, you know, names, so, um.
[AGENT][NEUTRAL] If the account number and routing number are right on that online service center, then the name of the bank won't impact where it goes, but if you see that the account number or the routing number are incorrect, um, we can absolutely work on getting that updated for you.
[CUSTOMER][NEUTRAL] OK, but if the, if, if the um account numbers are fine but the name is not, is OK?
[AGENT][NEUTRAL] It's OK, yeah, sometimes our system just won't update the names of the bank, uh, but the account number and the routing number what we wanna make sure are correct so as long as.
[CUSTOMER][POSITIVE] Yeah, that I verified, yeah, mhm, that is correct.
[AGENT][POSITIVE] Yes, perfect, and your money will go right where you want it to go.
[CUSTOMER][POSITIVE] Oh, OK, perfect. OK. All right, well thank you very much.
[AGENT][POSITIVE] Hey, it's my pleasure and if there's anything else you need or you have any other questions just give us a call and we'll do our best to take care of you.
[CUSTOMER][POSITIVE] OK. All right, thank you. Bye bye.
[AGENT][POSITIVE] My pleasure you take care bye bye.