AccountId: 011433970860
ContactId: 412eba30-d74a-4eaa-948f-9de741c43332
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 561820 ms
Total Talk Time (AGENT): 258017 ms
Total Talk Time (CUSTOMER): 282973 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/412eba30-d74a-4eaa-948f-9de741c43332_20250115T21:04_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Which
[CUSTOMER][NEUTRAL] Hi [PII], I had called earlier. This is [PII] with RDMI. How are you?
[AGENT][POSITIVE] Oh, I'm doing wonderful. Miss [PII], how about yourself today?
[CUSTOMER][NEUTRAL] Good, good, thank you for asking. I was calling because I spoke to a representative earlier regarding a claim that we sent through the fax, and she was telling me that she did not receive the explanation of benefits on the primary insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Do you have that claim number and I can look it up for you?
[CUSTOMER][NEUTRAL] Yes, it is 351-137-20.
[AGENT][POSITIVE] OK, perfect. Give me just a second to get that pulled up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure sure sure.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure sure yeah.
[AGENT][NEUTRAL] 351-137-20
[CUSTOMER][NEUTRAL] 351-1 yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I am really sorry. Do you mind if I actually start with the policy number because I don't have that claim pulling up anything.
[CUSTOMER][NEUTRAL] Alright, 02473332.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Perfect. Let me try that for you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Alright, I do see that I have that claim number with just 11. It's 3513.
[CUSTOMER][NEUTRAL] Shot
[CUSTOMER][NEUTRAL] Oh, OK, fine.
[AGENT][NEUTRAL] I believe, um, yeah, [PII] you said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] S
[CUSTOMER][NEUTRAL] She said she received the claim, but she did, she said she did not get the explanation of benefits from Florida Blue.
[AGENT][NEUTRAL] OK. Let me take a look at that claim for you real fast.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Shit shit.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah yeah yeah and and and.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, so what I'm seeing on here, um, just like on their claim remarks is the way it reads to me is that major medical needs to pay, so it says benefits are only payable um if your major medical insurance provider provides benefits, if this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the reason for that is this plan tries to pick up and pay on things that are applied to the co-pay, the co-insurance, or the deductible, and I do see that we have the EOB from Florida Blue, but it doesn't look like they've made any um payment on it and they didn't apply anything to the co-pay, the deductible or the co-insurance.
[CUSTOMER][NEUTRAL] Yeah, it says line. I don't know if you're looking at the same page line level information, um, build amount allowed amount pay 0 copay 0 deductible. It was patients responsibility. They applied it to the deductible.
[CUSTOMER][NEUTRAL] S
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Shoot.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, let me see, sorry, I don't process claims, so I'm like doing my best to like look at all this information and make sure. I like I'm just trying my best to make sure I see exactly what's going on, um.
[CUSTOMER][POSITIVE] Uh, no, no, thank you, thank you for your help.
[CUSTOMER][NEUTRAL] Let me, let me.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, would you mind, and um I know you've already called twice today, but would you mind if I just escalated this and had somebody who processes claims review it and reach out with a call back?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] I just want to make sure that you're like getting the right information and I don't want to tell you something that I'm not 100% sure of, but whoever processes claims, I know that they would be able in a better position to either look at it and be like, oh maybe we made a mistake or to explain to you what was going on when they had to process it, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Um, and then I'm gonna have you just, I'm gonna fill out this request super, super, super quick and make sure I get your information right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 247-3332.
[CUSTOMER][NEUTRAL] Yeah yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah yeah.
[AGENT][NEUTRAL] How's your day going otherwise?
[CUSTOMER][POSITIVE] It's good how's your day going?
[AGENT][POSITIVE] Hey, I'm doing great, thanks for asking.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Good good to hear that.
[AGENT][NEUTRAL] We're like almost done with the week at this point.
[CUSTOMER][NEUTRAL] Yes, today is [PII].
[AGENT][NEGATIVE] Yes, and we're like after lunch is always that downhill slide.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] All right, and hold on so quick.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have any awesome plans for the weekend or is it gonna get cold where you are?
[CUSTOMER][POSITIVE] No, actually it's not gonna be cold, and yes, we have a birthday this weekend, so we're trying to do it together.
[AGENT][POSITIVE] Good. It's supposed to like get below freezing where I'm at.
[CUSTOMER][NEUTRAL] Where are you at?
[AGENT][NEUTRAL] Uh, we're [PII] based.
[CUSTOMER][NEUTRAL] Oh Jesus, God, that's co[PII].
[CUSTOMER][NEUTRAL] Very cold. So what is, what is the weather now over there?
[AGENT][POSITIVE] Uh, today it's nice. It's like 50 degrees and sunny, and it'll be nice tomorrow and it'll start cooling off after that and then by the weekend we're
[AGENT][NEGATIVE] Freezing.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] You got it.
[AGENT][POSITIVE] I'm trying to enjoy that sun and that, I don't even know, air out my house, all those small things.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then.
[AGENT][NEUTRAL] All right. And then Ms. [PII], um, can I get your last initial, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, perfect. And then that same callback number you gave me, oh, did I even get a call? No, I'm so sorry. Can I get a good callback number from you? I never even asked.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I have [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And do you have a particular time of day that um you would like them to aim to call back or to avoid?
[CUSTOMER][NEUTRAL] Well, I'm only here until [PII] and in the morning, actually if I'm, you can call after [PII], but um if I'm not available you can ask for [PII].
[AGENT][NEUTRAL] OK, so please, please call between [PII] no, you're Eastern Standard, right? You're in [PII]?
[CUSTOMER][POSITIVE] Yes, it, it's a yes.
[AGENT][POSITIVE] Perfect and then if not available please ask for [PII].
[CUSTOMER][NEUTRAL] Yes mhm.
[AGENT][NEUTRAL] OK, perfect. Um, I am putting that request in now. Typically the callback requests take 24 hours. Um, if you do not hear anything in 48 hours, please reach out to us, um, because it shouldn't take that long, you should have somebody call you back within 24 hours, OK?
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Hey, it's my pleasure thank you so much for your patience and your understanding and we will be in touch, my friend.
[CUSTOMER][POSITIVE] Thank you have a great day have a great weekend.
[AGENT][POSITIVE] Well, you too, enjoy.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Bye bye.