AccountId: 011433970860
ContactId: 229a9480-e4d4-4610-b67d-eb75af756e8f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401500 ms
Total Talk Time (AGENT): 220295 ms
Total Talk Time (CUSTOMER): 145599 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/229a9480-e4d4-4610-b67d-eb75af756e8f_20250326T13:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh my name is. My name is [PII], and uh I am uh a claimant, I guess, uh, [PII]. Anyways, uh, and can you call my claim number, uh, is, um.
[CUSTOMER][NEUTRAL] I got you guys send me one check, right? That was what was sent uh one check I believe what was sent uh to my address and I just wanna verify that.
[AGENT][POSITIVE] It would be my pleasure to assist you, Mr. [PII]. What is the callback number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And do you have that claim number or the policy number for you?
[CUSTOMER][NEUTRAL] Yes, I have the claim number. It is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, 357-527-1.
[AGENT][NEUTRAL] And Mr. [PII], do you mind verifying your date of birth and current mailing address?
[CUSTOMER][NEUTRAL] Yes, uh, [PII], and it's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then finally, if you don't mind, can we verify your Gmail address?
[CUSTOMER][NEUTRAL] My email, yes it is uh [PII].
[CUSTOMER][NEUTRAL] At [PII].
[AGENT][NEUTRAL] All right, thank you. I appreciate that. Yes, sir, um, now on this claim, it was processed on the [PII], so the
[AGENT][NEUTRAL] It's coming to you by check, and it would have been mailed out on the [PII].
[AGENT][NEUTRAL] To the address
[CUSTOMER][NEUTRAL] OK and and what was the amount? It's one of our uh that.
[AGENT][NEUTRAL] 5 $5,825.
[CUSTOMER][NEUTRAL] OK, now what about on this claim? Yeah, I, I got different paperwork. OK, this is my wife that asks a question you can let let my wife ask you a couple questions?
[AGENT][NEUTRAL] Sure, as long as you give me permission to speak with her.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, I, I'm doing that she's sitting right here.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] Thank, thank you, thank you.
[AGENT][POSITIVE] My pleasure.
[CUSTOMER][NEUTRAL] Hi, good morning. Um, how many checks?
[AGENT][NEUTRAL] Good morning, Ms. [PII]. How are you?
[CUSTOMER][NEUTRAL] Good, how many checks have you gotten?
[AGENT][POSITIVE] Good
[CUSTOMER][NEUTRAL] Uh, from you guys.
[AGENT][NEUTRAL] So on this accident policy, it would be um only one claim that we have on file, and that's for that [PII] data service.
[CUSTOMER][NEUTRAL] Since it started.
[AGENT][NEUTRAL] That's on his accident policy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so, but there's a check on uh [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] For the [PII] OK and then I have another piece of paper more recent when I opened yesterday or the day before and um it says uh check date [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am, I was looking up his gap policy as well and I do see that one, we are now on this Medlink gap policy and this is for um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What is that?
[AGENT][NEUTRAL] 11525 also. But with the gap policy, we will need the primary EOB from your major medical insurance, because your gap policy is a secondary policy to your primary insurance.
[AGENT][NEUTRAL] So we are actually it that claim is still pending for that EOB or explanation of benefits. It's also called from your primary.
[CUSTOMER][POSITIVE] Well, my husband, my hus my husband got that all squared away in the primary care has signed off on it.
[AGENT][NEUTRAL] So this would be from Florida Blue is what we're needing.
[CUSTOMER][NEUTRAL] OK, um, and what amount would that check be?
[AGENT][NEUTRAL] Well, I'm, let's see. I cannot give the amount of the check cause it's not processed yet, but I can give you the benefit amount on the policy.
[CUSTOMER][NEUTRAL] Cause it says
[CUSTOMER][NEUTRAL] OK, because it says bill uh billed the charges was 46,000.
[AGENT][NEUTRAL] Right. And that's from the hospital and it looks like maybe some um doctors. Now, for inpatient coverage.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, that's, that's what they are that's the claim that was sent in, the claim information. Now, on the gap policy, Mr. [PII] does have a calendar year benefit of $3000. The on the gap policy, we pay to whatever Florida Blue applies to the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Up to $3000 per year.
[CUSTOMER][NEUTRAL] So what
[CUSTOMER][NEUTRAL] Oh, OK, but it's, but since it's work comp we don't, um.
[CUSTOMER][NEUTRAL] They, they cover it so there isn't the gap, is that correct?
[AGENT][NEUTRAL] So when have you seen how Florida Blue processes the claim?
[CUSTOMER][NEUTRAL] No, I haven't.
[AGENT][NEUTRAL] So once Florida Blue processes that claim for that data service, if there is a deductible or co-pay or co-insurance, you can submit that Florida Blue explanation of benefits or health statement from Florida Blue.
[AGENT][NEUTRAL] And that can be submitted on his gap policy, and we can consider it for benefits. It all depends on how Florida Blue processes the claim and what they apply to deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but y'all cover that too?
[AGENT][NEUTRAL] We do.
[AGENT][NEUTRAL] That's under his medley gap policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All righty.
[AGENT][NEUTRAL] But it's just pending for that additional information.
[CUSTOMER][POSITIVE] And OK, let me tell him that and then um he can move forward with that. Alrighty, thank you very much.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you can, he can go to the Florida Blue uh website and see if that.
[AGENT][NEUTRAL] Claims detail or EOB we need something saying what was applied to the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty thank you.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Well, thank you for calling APL. It's been a pleasure to assist you and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] All right, bye bye.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.