AccountId: 011433970860
ContactId: 418095a3-e493-49fd-a903-b375e22a6408
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 657440 ms
Total Talk Time (AGENT): 272472 ms
Total Talk Time (CUSTOMER): 286978 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/418095a3-e493-49fd-a903-b375e22a6408_20250205T15:06_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] More let me see.
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm calling from University of Miami Hospital and Clinics. How are you doing?
[AGENT][NEUTRAL] I'm good, and [PII], my name is [PII].
[CUSTOMER][NEUTRAL] I'm sorry, [PII]. How are you doing?
[AGENT][NEUTRAL] Mhm. I'm good, and yourself?
[CUSTOMER][NEUTRAL] Good. I called the other day in in reference to a claim for a patient that I was told it was gonna be mailed. I just, the only claim that we have for the patient, it doesn't specify what I was told when I called back on [PII]. So I just need clarification.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so you're needing clarification on a claim, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, yes, ma'am. I can help you with that, and um what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Hold on 1349433 M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] OK, thank you. So give me a couple of moments to get all of the member's information pulled up, please, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so first off, [PII], any information that's provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm. It is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and total bill amount for her that you're calling about?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. The date of service in question, it is [PII]. Bill amount $31,498.
[AGENT][NEUTRAL] OK, thank you. Now, the policy number you gave me is an old policy number. That policy number actually termed 11 of 2019. Were you given her currently active policy number when you called APL?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] No, cause when I called, I provided this and the rep never told me anything that that wasn't updated.
[AGENT][NEUTRAL] OK, so just one moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Cause the rep just told me that as per the claim denied for Max uh benefit Max already met, and they were gonna mail us, they were gonna mail us the EOB, but the EOB that I see it, it doesn't say anything of that, it just says 0000, like there's no specification, so, and this was back in December.
[CUSTOMER][NEGATIVE] So, I don't understand.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] OK, so you do have an explanation of benefits?
[CUSTOMER][NEUTRAL] We have it, I don't know if it's the actual explanation of benefits because it says this is not a bill, but then it shows the patient's date of service, it shows total bill amount, but on their comments it says certificate 0 inpatient 0 outpatient 0 emergency room 0 like but it doesn't say that the claim was denied for Benefit max already met, like I was told on [PII] of this year.
[AGENT][NEUTRAL] OK, so I'll have to locate, um, because that doesn't and that does say APL that's an American Public Life.
[AGENT][NEUTRAL] Explanation of benefits because it would have, cause it would have the policy number, which is the correct number that you should have is 01669855.
[CUSTOMER][NEUTRAL] Let me double check. Yes, it says.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] That's what it says on it, and it says reference, and then it says the insured name, it says check date [PII], 0 amount, but it doesn't specify that it was denied for plan benefits max already met. It just says $0. It says this product does not have participating provider benefits have not been reduced, 0000.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and did you receive one page that's front and back or two pages? Because all of our explanation of benefits are 2 pages. That's why I was asking that.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] This was only yeah, this one is one page that they uploaded.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yes, ma'am, because the remarks, the reason I was asking you that [PII], is the remarks are on the second page related to anything on page one. So, again, give me just a moment. So the policy number that's on that explanation of benefits is the correct policy number, not the one you gave me. Again, that's an old policy number. And this policy number that's on that explanation of benefits, it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the data service and total bill amount in question?
[CUSTOMER][NEUTRAL] Hold on, let me try to fix the policy here, subscriber. I'm gonna put it here. Hold on a second. Let me add this one which is the 01669855, correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] That is correct. Yes ma'am. That's the one that um is active.
[CUSTOMER][NEUTRAL] I just added it and the, what was the question you were asking?
[AGENT][NEUTRAL] The data service and total bill amount?
[CUSTOMER][NEUTRAL] [PII] $31,498.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, all right, so just one moment please.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Mmm. Hey mama. Hey mama.
[AGENT][NEUTRAL] OK, and is the claim number on there the 3543843?
[CUSTOMER][NEUTRAL] Let me go back to it, I believe so. Let me go to this one then.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, let me see here.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Hold on a second. Uh, it has 3543843, yes.
[AGENT][NEUTRAL] OK, so yes ma'am, that is the correct claim number. OK, so were you given the website for our portal, Anna, so that you can actually print the explanation of benefits from?
[AGENT][NEUTRAL] They would have both pages.
[CUSTOMER][NEUTRAL] No. No. No.
[AGENT][POSITIVE] OK. Well, I'll be happy that our web.
[CUSTOMER][NEGATIVE] And it's kind of hard for us to go to the portal. It's kind of hard because every time I get told any other insurance, go to the portal, I always have a hard time.
[CUSTOMER][NEGATIVE] To get anything. That's why we always have a fax, mail, like, I could go to the portal, but every time I go I get hard times to access, print or anything.
[AGENT][NEUTRAL] So you have
[AGENT][NEUTRAL] OK, so you already have our portal and you weren't able to access it. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what website do you have for our portal?
[CUSTOMER][NEUTRAL] It is the [PII].
[AGENT][NEUTRAL] OK, so that's not the portal website. Our portal website, [PII] is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I see it. I'm on it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So give me just a minute, are you wanting this faxed to you?
[CUSTOMER][NEGATIVE] Can it be fax and I'll try to do those newer, you know, try to do this again cause it's very hard to get, you know, when you register, you don't get response. Like I'm having hard troubles trying to, you know, get into the portal.
[AGENT][NEUTRAL] So what, uh, yes ma'am. I can fax it, but it should, yes ma'am, now that you have that claim number, it is easier. I can tell you that um currently once you have the claim number to locate the claim.
[AGENT][NEUTRAL] Or to locate the EOB rather, but let's.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Let me see, just takes a moment to load up all this information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And on the EOB does it say that the plan benefits maxed out?
[AGENT][NEUTRAL] Uh-huh, on page 2, that's what I'm saying. Whoever uploaded your, when you say it was uploaded, that was somebody at your clinic or your
[AGENT][NEUTRAL] The facility that uploaded it, all of our explanation of benefits right are 2 pages. The first page is what you have. The second page of all of our explanation of benefits is the page that has the remarks that go along with the code in the remark column on page 1.
[CUSTOMER][NEUTRAL] Yeah, it's a department, yeah.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Um, so let's see.
[AGENT][NEUTRAL] And will the facts need to be put to your attention, [PII], or is that not necessary?
[CUSTOMER][NEUTRAL] Yes, just put it to my name, [PII].
[AGENT][NEUTRAL] And do you spell [PII] with two [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] OK, I mean [PII] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is your fax number please, [PII]?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Again, that is [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. So I have just uh faxed that to you so provided that there's not any technical issue and it being received, you should be receiving that uh.
[AGENT][NEUTRAL] Within the next several minutes.
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. Is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] That's it. Thank you.
[AGENT][NEUTRAL] You're