AccountId: 011433970860
ContactId: 1a1913ba-bfb6-46dc-8eb4-3014c3676fde
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 462359 ms
Total Talk Time (AGENT): 99428 ms
Total Talk Time (CUSTOMER): 312324 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/1a1913ba-bfb6-46dc-8eb4-3014c3676fde_20250522T15:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes. Hello, [PII]. Uh, my name is [PII]. And um I'm, I'm calling cause, um, in regards to a payment that was made, and I was wondering if I could get a copy of an EOB.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I can help you with the EOB [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Please?
[CUSTOMER][NEUTRAL] Thank you. Yes, my direct phone number is [PII].
[AGENT][NEUTRAL] And are you with the provider's office?
[CUSTOMER][NEUTRAL] Yes, Miami-Dade County Fire Rescue.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes. Uh, let's see. Uh, policy ID number 60801.
[AGENT][NEUTRAL] Um, that's our electronic payer ID. Um, is there a member ID or?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Um, let me see. I have a group number. Uh, I'm not sure. Let me see. Uh, there's a group number 24351.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Thank you. Let me check the
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] The patient's first and last name?
[CUSTOMER][NEUTRAL] Yes, my patient is [PII].
[CUSTOMER][NEUTRAL] Hold on. [PII] is the last. [PII] first name, [PII] Last name [PII]
[CUSTOMER][NEUTRAL] Let me get your information.
[AGENT][NEUTRAL] Uh, do you have the date of birth?
[CUSTOMER][NEUTRAL] Yes, uh, the birthday is.
[CUSTOMER][POSITIVE] Oh, I'm so sorry. I thought I was prepared here. I got so many windows open. [PII].
[CUSTOMER][NEUTRAL] That's the uh patient.
[AGENT][NEUTRAL] And you show an insured possibly because I'm not, I don't see that name listed.
[CUSTOMER][NEUTRAL] And uh let me see.
[CUSTOMER][NEUTRAL] Yes, yes. I'm, yes, yes. I'm gonna tell you the insurer is [PII]. Uh it's one name, [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's a subscriber.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. And apparently what happened is, um there's a coordination of benefits here. And, and, and the insurer has, um, well, American Public Life is the supplemental. And they, and she has Florida Blue. So Florida Blue uh wasn't built as primary. They are the primary insurance.
[CUSTOMER][NEUTRAL] So they told me if you go ahead and get an EOB from American Public Life showing a pay, I will have to submit the claim to Ford or Blue, um, and, and so they could further review and see what happens.
[AGENT][NEUTRAL] What was the date of service?
[CUSTOMER][NEUTRAL] Uh, this was, let me see here, [PII].
[CUSTOMER][NEUTRAL] Yeah, American Public Life was billed for, let me see, $170 even. And then there was a payment.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 48.
[CUSTOMER][NEUTRAL] Yeah, I'm, I've been requesting the EOB from co-workers, but to no avail, and I, um, I need to, I was hoping to
[AGENT][POSITIVE] Thank
[CUSTOMER][NEUTRAL] To file a claim electronically and.
[CUSTOMER][NEUTRAL] And provide the EOB today if I may, or when I am able.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah. So this, and you know, uh, this was the insurance that was on file, the American Public Life. But now, two years after,
[CUSTOMER][NEUTRAL] Um, uh, the, the, this members and the, the balance went to a, um, like a third party, um.
[CUSTOMER][NEUTRAL] Collection agency.
[CUSTOMER][NEUTRAL] And I'm, I'm trying to build it so I could uh see if it could get resolved. And insurance uh for we said we'll reconsider, you know.
[AGENT][NEUTRAL] Um, well, we showed that Florida Blue did process the claim. Um, they have, they have applied 41294 towards the deductible.
[AGENT][POSITIVE] And then 45706 exceeded reasonable and customary.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] Oh, OK, that's strange. I call for a, they say there, um, oh, was, uh, OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Like
[CUSTOMER][NEUTRAL] I didn't see there's no uh claim on file. They told me uh to go ahead and build this difference, the 45706.
[AGENT][NEUTRAL] Yeah, so I show we received the claim, um, and like I said, we, we received the explanation of benefits from Florida Blue.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So yeah, I can send you the explanation of benefits, but we've we've paid what was applied to the deductible.
[CUSTOMER][NEUTRAL] Oh, can you please, uh,
[CUSTOMER][NEUTRAL] Yeah, there's a total payment here 412.94. Is that the American Public Life payment?
[AGENT][NEUTRAL] Yes, because Florida Blue applied that towards the deductible and then the balance exceeded reasonable and customary determination, so we only pay on what they consider so since they, yeah, since they charged above.
[CUSTOMER][NEUTRAL] That's uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Correct. Right. What was allowed?
[CUSTOMER][NEUTRAL] Yeah, so the uh balance due 45706, that was the deductible amount.
[AGENT][NEUTRAL] No, that was the amount that exceeded reasonable and customary.
[CUSTOMER][NEUTRAL] Yeah, I mean the.
[CUSTOMER][POSITIVE] Exceeded.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK. Thank you so much. All right. Yeah, if you could please send me that, um, I don't know if if you may send that to me, I guess, by fax.
[AGENT][NEUTRAL] Yeah, what's your fax number?
[CUSTOMER][NEUTRAL] If it's possible.
[CUSTOMER][NEUTRAL] Uh, let me give you the [PII].
[CUSTOMER][NEUTRAL] 4, wait, I was giving you my number [PII].
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] [PII]. Yes. And my name is [PII]. It's [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'll fax over our explanation of benefits, um, just give it about 2 minutes, OK?
[CUSTOMER][NEUTRAL] The only [PII] here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Oh, thank you so much, Ms. [PII]. I appreciate it. OK. Thank you. Have a great day.
[AGENT][POSITIVE] OK. Thanks for calling. You too. Bye.
[CUSTOMER][NEUTRAL] Bye-bye now.