AccountId: 011433970860
ContactId: 25daef9f-e11a-4afd-830d-7698670d14f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 495380 ms
Total Talk Time (AGENT): 218788 ms
Total Talk Time (CUSTOMER): 125770 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/25daef9f-e11a-4afd-830d-7698670d14f4_20250521T20:47_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, yeah, I wanna review with you a claim um that I had a while back.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] If possible.
[AGENT][NEUTRAL] Sure, we are we just needing clarification on that claim?
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] Yes, because um I received the bill for the other portion that wasn't paid by APL. I'd like to check with you if there's still something could be done in this regard.
[AGENT][NEUTRAL] OK, we can take a look at that claim um what was your name?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] I'm sorry, you said [PII]?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK, um, and then before we go any further, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and then uh do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, yes, I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just one second.
[CUSTOMER][NEUTRAL] Policy number 0.
[CUSTOMER][NEUTRAL] 236-590-8
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] I'm sorry, I think I must have misheard that policy number. Um, could you repeat that for me?
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] 23
[CUSTOMER][NEUTRAL] 639-08
[AGENT][NEUTRAL] OK, sorry about that, one moment.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And they're just gonna verify some information really quick. [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you. Looks like it is a Hotmail account.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright thank you so much for verifying all of that. OK, so the claim that we're looking at is this uh for you or was this for uh somebody else under your policy?
[CUSTOMER][NEUTRAL] My son, [PII].
[AGENT][NEUTRAL] [PII], OK, one moment, let me get that pulled up.
[AGENT][NEUTRAL] All right. Do you happen to have that claim number?
[CUSTOMER][NEUTRAL] Uh, no, I do not. I'm sorry.
[AGENT][NEUTRAL] OK, no, no, no, that's perfectly fine um I just wanna make sure I'm looking at the correct one. do you have the date of service that he receives treatment?
[CUSTOMER][NEUTRAL] Yeah, I turn.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it was [PII] or [PII], between
[CUSTOMER][NEUTRAL] I think [PII].
[AGENT][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] 0 [PII], OK, so that was uh [PII] or [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, actually it was [PII]. I'm sorry, I'm confused. It's been a while, thank [PII].
[AGENT][POSITIVE] No, you're all right.
[AGENT][POSITIVE] You are OK. I just again wanna make sure that we're looking at the right thing here, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It was that um air transportation.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Alright, it looks like we've got quite a few claims for that date of service for Lucas.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, I found one from uh Miami-Dade Fire Rescue. um, let me take a look here. OK, this is the one we're looking at?
[CUSTOMER][NEUTRAL] All right. That's the one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, OK, so this one looks like that was a duplicate, so bear with me just a moment let me try to find the original.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, I think I found the original, um, so one that I did find from [PII], Miami Dade Fire Rescue, um, looks like that total amount was $412.94. Does that sound right to you?
[CUSTOMER][NEUTRAL] Uh, that's how much I paid for, but the total.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The total amount was 855.
[AGENT][NEUTRAL] OK, let me just try to see if I can't find something with that.
[AGENT][NEUTRAL] OK, so I see the confusion, um, so I did find the original claim looks like we received this claim a total of 3 times.
[AGENT][NEUTRAL] Um, and I found the original, the first one that was sent for 855, that one, as this is your secondary medical policy, stated that we needed a copy of the primary EOB essentially showing what your primary contributed to this bill, um, and with that was when we got the claim for the $412.
[AGENT][NEUTRAL] Um, and then of course we got another after that that was a duplicate. So from what we received that $412.94 was what was left over after your primary medical paid.
[CUSTOMER][NEUTRAL] Well, my primary medical didn't pay for the other portion.
[AGENT][NEUTRAL] OK, so then we would need that updated information because again based off of the information we received that was the maximum amount payable that we could pay left over by major medical.
[CUSTOMER][NEUTRAL] Which was the remainder balance after them.
[AGENT][NEUTRAL] So yes, so in short this policy is designed to help with copay, deductible and co-insurance. So when we get the primary EOB yeah showing anything that they contributed to that, um, and then what's left over is what we would pay up to of course your outpatient or inpatient maximum.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, yes, I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, now I need to go back to them to see what happened that they didn't see the other portion because you are the secondary. I understand that clearly. OK, thank you very much for your help.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, I'm sorry I know it's a bit confusing um did I answer your question? Was there anything else I could help you with?
[CUSTOMER][POSITIVE] No, I'm good.
[CUSTOMER][NEUTRAL] Mm, uh, yes. Can I get a statement?
[CUSTOMER][NEUTRAL] Of
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Oh no, no, I'm good I'm good. I already have the statement. Thank you very much. I'm sorry about that. Thank you. That's all for today.
[AGENT][NEUTRAL] No, no, you're fine. Um, I was gonna say, uh, do you have uh access to our online portal? Have you ever used that before?
[CUSTOMER][POSITIVE] I'm good. I'm thank, thank you, love. I gotta go. Thank you.
[AGENT][NEUTRAL] OK.