AccountId: 011433970860
ContactId: 3355ebf0-1a42-4415-81e6-2b8584a94966
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 581119 ms
Total Talk Time (AGENT): 283181 ms
Total Talk Time (CUSTOMER): 170720 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/3355ebf0-1a42-4415-81e6-2b8584a94966_20250516T13:57_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] For contacting ATM. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, you sound, um, muffled. Can I, hello?
[AGENT][NEUTRAL] Yeah, I'm sorry, I can't, I can barely hear you. Um, my name is [PII]. I'm with American Public Lis. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I have a claim, um, that I think it was processed and I wanted to find out why it was processed for so low.
[CUSTOMER][NEUTRAL] Um, I'll give you the claim number.
[AGENT][NEUTRAL] OK, and what is
[AGENT][NEUTRAL] Yes, and uh what is, is this your policy?
[CUSTOMER][NEUTRAL] 36
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah and the and the claim number is 36.
[CUSTOMER][NEUTRAL] 1748.
[AGENT][NEUTRAL] OK, thank you. If I could verify your name, and date of birth, and a phone number, please?
[CUSTOMER][NEUTRAL] it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And the name of the insured that is listed on, on the
[AGENT][NEUTRAL] On the phone.
[CUSTOMER][NEUTRAL] Myself, [PII].
[AGENT][NEUTRAL] OK, let's see if I've got that. OK, so you said that the claim number was 36.
[AGENT][NEUTRAL] 1748, is that correct?
[CUSTOMER][NEUTRAL] No, 360-1748.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just checking here.
[AGENT][NEUTRAL] And I'm just, just pulling up your policy here.
[CUSTOMER][NEGATIVE] I think that the sound is not very good in the back.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, I'm sorry about that. Um, it looks like we received your claim on the [PII].
[AGENT][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And it looks like we processed it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me, and there should be a uh a benefit of $11.41 coming to you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so that's the nature of my call. My question is why? because the claim is for $404.
[AGENT][NEUTRAL] OK, let's look at that.
[CUSTOMER][NEUTRAL] 404.25.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] We got several claims that we have here. Let me just check.
[CUSTOMER][NEGATIVE] It's the same, it's just that one is 1 page and the second one is 14 pages with everything I.
[AGENT][NEUTRAL] Right, yes, yeah, we saw that. Um.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So let me, I, and I'm just waiting for my system to bring it up and I apologize for the delay. I'm just waiting for all of this stuff to come.
[AGENT][NEUTRAL] Because it looks like there were several submissions and.
[AGENT][NEUTRAL] Looks like it's also the same thing so we need to see what we have here.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] That was for the
[AGENT][NEUTRAL] OK, so we're looking at your [PII], but this is uh one of the, um, one of the documents that you uh submitted to, and it says claim activity for and then it says you. And this is for data service [PII], and it showed one,
[AGENT][NEUTRAL] One procedure that was uh 82533 and it said $404.25. Now, Blue Cross and Blue Shield.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] Yes, Blue Cross and Blue Shield allowed uh what they do is they, they, um.
[AGENT][NEUTRAL] There's, there's the charged amount the bill amount from the provider, and then there's how much your insurance company, uh, Blue Cross and Blue Shield will, um, allow, you know, this is what their contractual obligate or or contractual agreement is with the provider.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Allowed out of that $404 they allowed $11.41 and put it towards your deductible. Now the, the, um, I think that you should, you should have this EOB, um, it says, uh, your health statements. This is not a bill. Florida Blue, your local Blue Cross and Blue Shield.
[AGENT][NEUTRAL] And when you're.
[CUSTOMER][POSITIVE] Yeah, I understand all that. I understand all that, and I've been going back and forth, so that's what they allow because LabCorp is a non participant of Blue Cross Blue Shield. But that is exactly what I'm calling APL, my, my gap insurance, because I already got taken care of with Blue Claw Blue Shield. It took me 3 months to get this claim processed, and in order for me to get an estimate, uh, EOB.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But now we're paying for APL, which is my gap insurance, to cover. The purpose of your company is to cover the medical expenses that were not covered by Blue Cross Blue Shield. So that's why I'm calling.
[AGENT][NEUTRAL] The deductible copayment of insurance.
[AGENT][NEUTRAL] No, no, it's not. I'm sorry, [PII], yeah, you're, um, what we do is we, we pick up the deductible, co-payment or co-insurance from your major medical. So as, as your gap insurance, what we will do is we will pay the, uh, what Blue Cross and Blue Shield puts towards your deductible, co-payment or co-insurance, and in this case, um, it was only $11.41. So the, your, what we don't do is if, if, um.
[AGENT][NEUTRAL] If Blue Cross and Blue Shield disallowed or, or doesn't, um, uh, doesn't allow a certain amount of, of money, we don't pick that up. What we do is we pick up what they put towards your deductible co-payment for insurance.
[AGENT][NEUTRAL] And in this case, this is the only amount that they put towards that. Now, if at any time they um they re adjudicate the the claim and put more towards your deductible or co-payment or co-insurance, then we can certainly look at that about paying it, but that is what we pay we pay what they put towards your deductible co-payment or co-insurance.
[AGENT][NEUTRAL] And in this case, the only amount that they put towards that, and I realized that the bill was $404.25 but the only amount that they allowed for that for all of that was the $11.41. And so that is all that your gap insurance will pay.
[AGENT][NEUTRAL] So that's what we do is we'll pick up that deductible co-payment of phone insurance, but we, we won't pay what, what, uh, Blue Cross Blue Shield is disallowed. They're, they're basically saying that that is above and, uh, um, beyond their uh their contractual obligation with the uh non-network providers.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And so it's, let's see, I think they actually they actually put that on there.
[AGENT][NEUTRAL] That um they are.
[CUSTOMER][NEUTRAL] Yeah, yeah, I was waiting for that EOB for a while, so.
[CUSTOMER][NEUTRAL] OK, so that then is my, my misunderstanding of the what APL does then um.
[CUSTOMER][NEUTRAL] What the purpose of the gap insurance, so you just pick up what the, the, the Florida Blue did not pay, but, um, so in my case, OK, so Florida Blue did not pay the entire bill, but then you pick it up and you tell me, no, it has to be, you still abide by the Florida Blue Cross Blue Shield law, which is, um, whatever is not out of network, they won't charge, so then, therefore, APL does not charge, OK.
[AGENT][NEUTRAL] Yes, that's what we have to do, yeah.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Alright, well, I'm gonna talk to my human resources person because that's, I thought it was different. OK, OK, well, uh, thank you very much. So I guess those $11.41 will be sent to my account.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, the, the whatever I have in the system, uh, are you gonna send a check or are you gonna direct deposit?
[AGENT][NEUTRAL] So, let's see, let's check and see.
[AGENT][NEUTRAL] It looks like on the policy.
[AGENT][NEUTRAL] That you um
[AGENT][NEUTRAL] You have direct deposit. It looks like you filled that one.
[AGENT][NEUTRAL] So what it will do is it will, uh, I, I don't know uh.
[AGENT][NEUTRAL] It would have been transferred over to your account in the morning, so I don't know when it will show up in your bank account.
[CUSTOMER][NEGATIVE] OK, so I do have direct deposit. OK. OK. I, OK, well, thank you, thank you, very disappointed. I have to put out 400 bucks out of my pocket. Oh my [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, well, it's the nice thing I can help with. Thanks, thanks for time.
[AGENT][POSITIVE] Yeah, I'm sorry.
[AGENT][NEUTRAL] Very very sorry, yeah.
[CUSTOMER][NEUTRAL] OK, for, for blood work. Yeah, it's a lot. OK, thank you.
[AGENT][POSITIVE] OK, thanks for contacting A.
[CUSTOMER][NEUTRAL] OK, bye-bye.