AccountId: 011433970860
ContactId: 43d9b4e5-5404-4658-8036-6bef3a24a95e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 684859 ms
Total Talk Time (AGENT): 202331 ms
Total Talk Time (CUSTOMER): 192228 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/43d9b4e5-5404-4658-8036-6bef3a24a95e_20250404T13:58_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I wanna, uh, follow up on a claim that I filed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is it for yourself?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Uh, do you have your policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, uh, 256-453-2.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And can I get your last name and your date of birth?
[CUSTOMER][POSITIVE] [PII] [PII].
[AGENT][NEUTRAL] And just you know a few other pieces of information. What is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And then a good callback number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Was the claim for yourself?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what was that date of service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Day of service I believe was.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let's
[AGENT][NEUTRAL] OK, give me one moment pulling that up.
[AGENT][NEUTRAL] Um, let's see, so I'm looking at.
[AGENT][NEGATIVE] It looks like we had requested the primary explanation of benefits, but then they also denied for.
[AGENT][NEUTRAL] The policy does not provide a benefit for services in which no charges were incurred.
[AGENT][NEUTRAL] Let me see what we received.
[CUSTOMER][NEUTRAL] Yeah, but I, I submitted an itemized uh an itemized invoice for $185 so I don't know what they're talking about.
[AGENT][NEUTRAL] OK, let me pull up what we got.
[CUSTOMER][NEUTRAL] I submit, I first I first submitted the claim on 3 on 331.
[CUSTOMER][NEGATIVE] I got back that I had to submit the explanation of benefits and and an itemized invoice. I submitted it and then today I get a response saying that the policy provides not the policy provides no benefits for the treatment of conditions other than sickness or injury.
[CUSTOMER][NEUTRAL] So it's $185.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It's a procedure.
[AGENT][NEUTRAL] Um, let me see what we received. Did you submit this or did the pay or the, uh, provider? This was submitted by you, it looks like, OK.
[CUSTOMER][NEUTRAL] I did.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I'm not looking for the 385. I'm looking for the 185 only.
[AGENT][NEUTRAL] OK, let me see. I see where we received the first.
[AGENT][NEUTRAL] Fax you'd sent in looks like your statement it showed you have a
[CUSTOMER][NEUTRAL] Yeah, I sent the wrong documents, but then I send the right documents afterwards.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, let me look at the other thing that we received.
[AGENT][NEUTRAL] That was
[AGENT][NEUTRAL] Su
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Sorry, I'm just scrolling through these um documents.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, your cost 112.
[AGENT][NEUTRAL] OK, so you submitted your Florida Blue.
[AGENT][NEUTRAL] OK, I'm pulling that up I'm looking, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I, I see quite a few other charges on here but I'm not seeing the.
[AGENT][NEUTRAL] Sleep study. Let's see what I'm looking at let me see.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] It looks like you submitted your explanation of benefits. It looks like you had some routine services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then there were 3 13 2025.
[AGENT][NEUTRAL] 3:17, 317, 319, 312.
[AGENT][NEUTRAL] 311, 311.
[AGENT][NEUTRAL] So do you have the EOB that shows how your insurance process for the.
[AGENT][NEUTRAL] 325 data service.
[CUSTOMER][NEUTRAL] I'm not sure what you're talking about. Can you please explain?
[AGENT][NEUTRAL] So you're Florida Blue, did they have they processed this claim?
[CUSTOMER][NEUTRAL] I guess, yes, why?
[AGENT][NEUTRAL] I don't show it on the documents that we received.
[CUSTOMER][NEUTRAL] So what do you need from from Florida Blue? You need the EOB?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I, I downloaded the the latest EOB that's what I did.
[AGENT][NEUTRAL] OK, so that that's what I'm looking at is the latest DOB that you downloaded.
[AGENT][NEUTRAL] And it doesn't have that date of service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this is the one
[CUSTOMER][NEUTRAL] So I need a, so I need a more current.
[AGENT][NEUTRAL] Yeah, so the dates of service, yes, correct, the, the dates of service that are listed on what you downloaded, they don't include that 325, um, date of service.
[CUSTOMER][NEUTRAL] EOB?
[AGENT][NEUTRAL] They include several other dates of service for March, but there's no 325 in here.
[CUSTOMER][NEUTRAL] Got it let me see if I can find something here in the web in the app.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, it says pending. I, I'm in the app right now for the $45 co-pay, and it says pending.
[CUSTOMER][NEUTRAL] I don't have the sleep one yet.
[AGENT][NEUTRAL] Oh, OK. So, so for the $185 we do need that EOB.
[AGENT][NEUTRAL] So, um, once it.
[CUSTOMER][NEUTRAL] And updated you'll be right, which reflects the 185.
[AGENT][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] Yeah, that reflects yes that's correct, yeah, so when that process is completely through if you can upload that then we can start processing on this.
[CUSTOMER][NEUTRAL] And why are you saying in the last feedback that.
[CUSTOMER][NEUTRAL] In order to, no, you're saying in the last feedback that I got today. Policy provides no benefits for the treatment of conditions other than a sickness or injury as defined by the policy.
[AGENT][NEUTRAL] Well, we all we have on file that we can work off of right now is that $185 statement because like I said, the EOBs that you attached, they don't include this date of service.
[AGENT][NEUTRAL] So we can't make a full determination.
[CUSTOMER][NEUTRAL] Got it, so I have to wait for an updated one.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Got it. OK, so I'll just, I'll just wait and I'll keep you posted.
[AGENT][POSITIVE] OK, perfect. That sounds good.
[CUSTOMER][NEUTRAL] Oh wait, wait, wait, wait, 3:17 integrated sleep care.
[CUSTOMER][NEUTRAL] Denied
[CUSTOMER][NEUTRAL] Reserved
[CUSTOMER][NEUTRAL] Wait, Interior sleep care 317.
[CUSTOMER][NEUTRAL] Maybe you do have it here. Give me one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, so if I go to my Florida Blue uh app.
[CUSTOMER][NEUTRAL] I have 3:17 integrated sleep status denied cost says 0. I don't know why.
[CUSTOMER][NEUTRAL] Pending
[AGENT][NEUTRAL] Yeah, we're looking, so the one you submitted was for 325, so for the sleep study.
[AGENT][NEUTRAL] So that's the one that we're looking for.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 326 $45 pending.
[CUSTOMER][NEUTRAL] I don't see the $185 here.
[CUSTOMER][NEUTRAL] I only see the $45 copay.
[CUSTOMER][NEUTRAL] Uh, this one has no cost, so I don't know what this is.
[AGENT][NEUTRAL] Yeah, I don't, I don't know about the Florida Blue site, so I, because I can't see that, so.
[CUSTOMER][NEUTRAL] And it was, it was 32.
[CUSTOMER][NEUTRAL] Mm, oh man.
[CUSTOMER][NEUTRAL] 3:17. Everything is 3:17. I don't see it at 3:25 yet, so I guess I'll have to wait.
[AGENT][NEUTRAL] Yeah, maybe they haven't submitted it yet that's entirely possible.
[CUSTOMER][POSITIVE] Got it. OK, I'll wait a few more days and I'll keep you posted. Thank you.
[AGENT][POSITIVE] OK, well, thank you for calling APL. I hope you have a good weekend.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye.