AccountId: 011433970860
ContactId: 183fc0ff-9f70-4fa8-ba37-d07481535e09
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 255570 ms
Total Talk Time (AGENT): 96158 ms
Total Talk Time (CUSTOMER): 118055 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/183fc0ff-9f70-4fa8-ba37-d07481535e09_20250122T18:37_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, sir, I'm getting, I, I had coverage with you all back I guess in [PII].
[CUSTOMER][NEUTRAL] And my eye doctor said that they had a mess up in billing, blah blah blah.
[CUSTOMER][NEGATIVE] So they're resubmitting everything and I'm getting all kinds of stuff from y'all now. I, I don't understand if stuff's getting paid or not paid. Can you help me with that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, let's take a look. Do you have the policy number?
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh huh it's 01.
[CUSTOMER][NEUTRAL] 836-355
[AGENT][NEUTRAL] OK, let me pull this up here.
[CUSTOMER][NEUTRAL] And everything submitted is probably gonna be from Doctor [PII], but they're submitting like 56, and $400 charges.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And my Blue Cross should have paid some I think so I, I'm just trying to make sure what they're doing is correct.
[AGENT][NEUTRAL] No, I gotcha. OK. Let me just verify please your name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then what would have been the address we would have had on file?
[CUSTOMER][NEUTRAL] And in little
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you. OK.
[AGENT][NEUTRAL] So there was a claim since um on the [PII] of this month. It was for a date of service of [PII].
[AGENT][NEUTRAL] It's provider says [PII].
[CUSTOMER][NEUTRAL] Massingale.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And so that claim was paid to them, the full amount.
[CUSTOMER][NEUTRAL] Of was it the 32547?
[AGENT][NEUTRAL] Mhm, yep, the full amount was paid to them, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that's from [PII]. They were supposed to submit one from [PII] as well. Did they not cover that one?
[AGENT][NEUTRAL] Let's see what this one says from [PII].
[AGENT][NEUTRAL] So [PII] it looks like was applied towards the deductible so there was a $1000 a year deductible on the plan, so there was nothing as far as an amount sent to them, no.
[CUSTOMER][NEUTRAL] OK, so are you saying that that's what it took to get to the completed amount?
[AGENT][NEUTRAL] Yeah, I would have to go back.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] I, I mean it was just like one was the [PII] and one was the [PII] and they didn't pay one they did pay the other so you're saying that one was to get to the deductible.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then what about the $98.40 I don't know they're submitting higher amounts, so I'm trying to figure out.
[CUSTOMER][NEUTRAL] What they're doing because everything is like.
[CUSTOMER][NEUTRAL] They also submitted one from [PII].
[CUSTOMER][NEUTRAL] And it says
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] These services were rendered covered after coverage was terminated.
[AGENT][NEUTRAL] Right, OK, that makes.
[CUSTOMER][NEUTRAL] Which I don't even know what that means.
[AGENT][NEUTRAL] That just means that you were seen after the plan was no longer active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the data service when you were seen by the provider you weren't active with us um as far as coverage so we didn't cover anything that's what that one means.
[CUSTOMER][NEUTRAL] Because, OK, yeah, I'm gonna have to ask them on that because that should have been submitted to a different secondary because I think they just switched the secondary coverage. OK, so I paid one didn't pay the other one. OK, that's what I'm trying to figure out. Thank you so much.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, not a problem, [PII]. Is there anything else?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] No, that'll do it thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye.