AccountId: 011433970860
ContactId: 2a68f851-90d6-4268-b942-7971c9795e73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 723140 ms
Total Talk Time (AGENT): 390073 ms
Total Talk Time (CUSTOMER): 283933 ms
Interruptions: 5
Overall Sentiment: AGENT=1.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/2a68f851-90d6-4268-b942-7971c9795e73_20250312T16:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am, uh, [PII], uh, uh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, I'm sorry, I'm [PII] and I just see.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] I I've received a letter for the estimation of benefits.
[CUSTOMER][NEUTRAL] Don't quite understand it. Uh, it gives a remark on the descriptions, uh, saying like in order to complete the process the processes of your claims, we need kind of my statements or service provider listen to diagnosis. I haven't received any bill, uh, from the hospital yet. That's what I'm waiting on so I can transfer that to the negotiator, uh, to get the ball rolling on this. She said that.
[AGENT][NEUTRAL] OK, Mr. [PII], so you're wanting to check on a claim status for a claim that we've reviewed? Yes, I will, I can help you with that. What is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number, please, Mr. [PII]?
[CUSTOMER][NEUTRAL] I just be on the uh insurance card?
[AGENT][NEUTRAL] It will be on your insurance card and it would also be on your explanation of benefits that you received from us.
[CUSTOMER][NEUTRAL] OK, I'm, I'm sorry, I got it it's 0249.
[CUSTOMER][NEUTRAL] 0104. I just wanna, I just didn't wanna, I don't wanna miss anything and uh get left out here.
[AGENT][POSITIVE] OK, thank you so.
[AGENT][POSITIVE] OK. Yes, sir. I understand. So give me just a couple of moments, Mr. [PII] to get all of your information pulled up and then I'll be happy to go over that with you, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, Mr. [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. And as I said, I will need to verify several things with you first, for security purposes. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And also your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. The phone number we have for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Yes, sir. Thank you. And lastly your email address please.
[CUSTOMER][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] [PII]. No, I'm sorry, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] My birth year at [PII].
[AGENT][POSITIVE] OK, thank you so much. Now, Mr. [PII], I do have a question for you. Have you ever set up your profile in our online service center so that you can have access to your information online also?
[AGENT][NEUTRAL] And you can actually
[CUSTOMER][NEUTRAL] Uh, that would be the what?
[AGENT][NEUTRAL] The online service center.
[CUSTOMER][NEUTRAL] OK, that would be the website.
[CUSTOMER][NEUTRAL] OK, that'd be the website at the bottom of this letter [PII].
[AGENT][NEUTRAL] OK, the website portal is secure that's our main website. You can get to the log in page for the online service center from that main web page by clicking sign in, but I'll be happy to email you the user guide for the portal that gives you the information on how to set that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you would like for me to do that and that way once you have the additional information that we're needing you can actually if you have access to a computer you can upload that directly into the portal for our review.
[CUSTOMER][NEUTRAL] OK, you can send that and I can, I can save it in my archives.
[AGENT][NEUTRAL] OK, so give me just one moment.
[AGENT][NEUTRAL] And just so that you're aware of what to look for, the email that you're gonna receive will come from [PII] at [PII], Mr. [PII]. I did put APL online service center portal in your subject line again, it shouldn't go to your junk mail, but if you haven't seen that, you know, in your inbox shortly, check your junk or spam folder if we've not sent you an email before because it might would go there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this claim, let me look at the remarks. Give me one moment, please.
[AGENT][NEUTRAL] OK, so yes, sir, I can see that uh I do see the comment, the same one that you read in order to complete the processing of your claim. We need itemized statements of services provided listing the diagnosis code so you can contact the facility that you were at.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To request that information and you can read that remark.
[AGENT][NEUTRAL] To them so that they will know what you need.
[AGENT][NEUTRAL] You would either contact their billing office or their medical records department. It just depends. They would be able to tell you, you know, when you call.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so just the information I have to go. It was the surgery was performed at Jupiter Medical uh hospital, OK.
[AGENT][NEUTRAL] Yes, sir, so that's who you would need to contact. Mhm. And you would, yes, sir, and you would let them know that for your insurance and then just read them that comment.
[CUSTOMER][NEUTRAL] Contact them.
[AGENT][NEUTRAL] That's on there.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] For us to be able to fully process your claim, that is what we're needing an itemized bill including the diagnosis code.
[CUSTOMER][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] Out of my statements or service provider this and OK, now this would be now I already paid for some services, the minor services. This is, this would be the main hospital bill.
[AGENT][NEUTRAL] Yes, sir. That is what this claim is for. Mhm. This is.
[CUSTOMER][NEUTRAL] That I need, I'm cleaning.
[CUSTOMER][NEUTRAL] The main hospital bill, OK.
[AGENT][NEUTRAL] Yes, sir, for Jupiter Medical Center, that was what this claim was for.
[CUSTOMER][NEUTRAL] Yeah, OK, because everything was done there.
[CUSTOMER][NEUTRAL] And uh uh the surgery and all so anesthesia, I paid that bill and a couple other bills.
[CUSTOMER][NEUTRAL] That I uh uh pay after uh.
[CUSTOMER][NEUTRAL] After it was adjusted, then I paid the balance.
[CUSTOMER][NEUTRAL] So, OK, just read them off this tomorrow because you know what I'm saying, and I guess they'll mail those out to me.
[AGENT][POSITIVE] Yes, sir, they should know what that. Mhm. And then once you receive that, if you set up your portal, like I said, you can upload that information directly in there. That user guide will give you the instructions on how to go about doing all of that, but if you need any help with it, Mr. [PII], just give us a call and we'd be very happy to to help you with it.
[CUSTOMER][NEUTRAL] OK then, I understand.
[CUSTOMER][NEUTRAL] OK, then. I'm very swift with this, but my wife and grandchildren, my grands no more than I know. But, but anyway, ma'am, uh,
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] It takes helpers.
[AGENT][NEUTRAL] And they say it takes a village, so I understand. I work with computers every day, but, you know, my children are, they're grown, but they're very techy, so sometimes mom has to send an SOS, so I get it.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I tell you, um.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] And your, your, your, your, uh, your, your schedule, uh, you open because she gets in about 5, maybe a little bit before.
[AGENT][NEUTRAL] Yes, so we are open.
[CUSTOMER][NEUTRAL] And so I know your your hours.
[AGENT][NEUTRAL] Yes, so we're here Monday through Friday from [PII] Central time.
[CUSTOMER][NEUTRAL] [PII] central, so you'll be a, it'll be [PII] here, but it'd be [PII] there.
[AGENT][NEUTRAL] Yes sir, you're now let's see, you're in [PII], yeah, you're an hour ahead. So yes, sir, when it's [PII] your time, it'll be [PII] our time. We're an hour behind you. You're on Eastern time? Are you on Eastern time? Yes sir, so we're an hour behind you.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK, then.
[CUSTOMER][NEUTRAL] Yes, uh huh uh huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so if she gets in at [PII], we'll, you're an hour behind you before there, so I have an hour. So you close at [PII] OK, I understand that. OK then, ma'am.
[AGENT][NEUTRAL] Yes, sir, now.
[AGENT][NEUTRAL] [PII], yes, sir. Now, one last thing, Mr. [PII], when, if your wife, if you're gonna get her to help you with this, you will have to be present to authorize us to be able to speak to her if you're wanting us to help because we can't, for security purposes, we can only do certain things with you and you would have to give us a verbal authorization for that phone call to speak to anyone else.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Sure, mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK then, so first thing would be first, uh, just send me the information. I'm gonna go ahead and save that so she gets in, we can get started. But 1st, 1st I need to get the information from the hospital too. That's the very first thing I believe.
[AGENT][NEUTRAL] Yes, sir. Mhm. Yes, sir.
[CUSTOMER][POSITIVE] OK, do, then we can go from there. OK, ma'am, thanks for your time.
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] OK. Well, you are certainly welcome, Mr. [PII], and again, is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] Uh, you don't happen to know the amount of the hospital bill, do you?
[AGENT][NEUTRAL] Uh, let's see. I can pull up this document. Just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Because see that they don't send it to me. Seem like I have to request it I guess. I, I got every other bill.
[AGENT][NEUTRAL] Right, you do. Yes, sir, they'll send you a bill, but as far as an itemized bill that includes that diagnosis code, that is something, you know, it's just more detailed and that is something you would have to request. They're not going to
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just in that so what we received was your claim form and.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Just uh
[AGENT][NEUTRAL] We received your explanation. Well, one moment, it takes my system a second.
[AGENT][NEUTRAL] Now the total on this claim before any adjustments are allowable, you know, anything that they did like that, the total bill was $58,611.45.
[CUSTOMER][NEUTRAL] OK, and I told it was and I was told it was down to like 41,000 or something.
[AGENT][NEUTRAL] On here it shows you're allowable and then it was 41 and you're, yes, 41.
[AGENT][NEUTRAL] 02801, according to this information.
[CUSTOMER][NEGATIVE] Well, that's almost a down payment on a house these days. I couldn't afford that. Not, not even though I know I'm not the only one, but not even on monthly payments. So, OK then I get the information in and I'd be calling the adjuster with that and uh uh she's she's.
[AGENT][NEUTRAL] Yes, sir, it is. Yes, sir, it is.
[AGENT][NEUTRAL] Yeah, that
[AGENT][POSITIVE] Yes sir and again if you have any other questions call us and we'd be very happy to, to help you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, ma'am. I appreciate your time again. Thank you very much.
[AGENT][POSITIVE] You're certainly welcome. Yes, sir. And is there anything else at the moment, Mr. [PII], I can help you with?
[CUSTOMER][POSITIVE] Uh, that'd be all, ma'am. I appreciate it.
[AGENT][POSITIVE] OK, well, you're very welcome and thank you again for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.