AccountId: 011433970860
ContactId: 481ee227-7de2-4917-8972-0c3a8613ecb4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 829760 ms
Total Talk Time (AGENT): 260345 ms
Total Talk Time (CUSTOMER): 351935 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/481ee227-7de2-4917-8972-0c3a8613ecb4_20250623T22:12_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yes, I have a couple questions I'm hoping you can help me with.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, do you need my policy number first?
[AGENT][NEUTRAL] And your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] 247 8.
[CUSTOMER][NEUTRAL] 752.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and Miss [PII], verify your date of birth, mailing address and email address, please.
[CUSTOMER][NEUTRAL] It's [PII]. Email is [PII], and my mailing address is [PII].
[AGENT][NEUTRAL] OK, and how may I assist you today?
[CUSTOMER][NEUTRAL] OK, I have two questions. One is my husband received a claim and we're not sure what it was for, and we're hoping you could verify that.
[CUSTOMER][NEUTRAL] It was for um.
[CUSTOMER][NEUTRAL] [PII]. His name is [PII].
[AGENT][NEUTRAL] OK, do you happen to have a claim number?
[CUSTOMER][NEUTRAL] And they were
[CUSTOMER][NEUTRAL] Uh, yeah, let's see.
[CUSTOMER][NEUTRAL] Patient account where it's an explanation benefits from APL. Where was the claim number? Where's the claim number on this form?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] At the top
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maybe it's on the other side, hold on. Claim number 3610547.
[AGENT][NEUTRAL] OK, it looks like the claim was from Boca Care.
[AGENT][NEUTRAL] For, uh, looks like an office visit.
[CUSTOMER][NEUTRAL] And why was that covered?
[AGENT][NEUTRAL] Because there is a cancer writer on the policy to where it covers services in office as outpatient, so we paid under the outpatient benefit.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So does that mean every he, he is being treated for cancer? So does that mean every time he goes to the oncologist or the urologist or for any time like he's been twice to the radiation oncologist for a consult, are they supposed to be putting in for each of those?
[AGENT][NEUTRAL] They can, uh, if they have uh charter for visits, they can submit since it will go towards the outpatient benefit under that rider.
[CUSTOMER][NEUTRAL] So any, any cancer, anything that he's being treated for cancer for any office visit, we can submit the EOB for that.
[AGENT][NEUTRAL] Uh, the billing and the primary, it'll be, yes, ma'am.
[CUSTOMER][NEUTRAL] So do does the does the office because obviously he's had a lot of business and that's the only one I don't know if that's the only one submitted or the only one paid can you look in his and see if anybody else submitted and they just turned it down or they just didn't submit?
[AGENT][NEUTRAL] Well, it's also dependent on diagnosis codes cause it was another office visit that was received, but the diagnosis wasn't in relation to cancer, so it wouldn't be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So [PII], do you hear what I'm discussing? I know that you're I know you have, you don't have hundreds of claims, but she's saying that the diagnosis code has to correspond with your cancer.
[CUSTOMER][NEUTRAL] Corresponding tonesia or something.
[AGENT][NEUTRAL] Uh correspond with the diagnosis cause
[CUSTOMER][NEUTRAL] Where is the correspond?
[CUSTOMER][NEUTRAL] So, so when, yeah, go ahead. I'm sorry.
[AGENT][NEUTRAL] No, no, you're fine. Um, if like there's a visit, but it doesn't show the diagnosis in relation to cancer, it wouldn't be covered. But since you have a cancer writer on the plan, any codes that are relation to cancer and if performed in the office that is covered under the plan. So it all depends on how it's coded as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so we need to start watching out for the coding. OK, second of all.
[CUSTOMER][NEUTRAL] I just was reimbursed for some physical therapy visits, and I don't think that I have.
[CUSTOMER][NEUTRAL] I see, I don't think I have the POC on this. I know the money went into my account and I have an online account, but nothing's showing on it. I log into my online.
[AGENT][NEUTRAL] Ma'am, I can't hear you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I'm back, hold on.
[CUSTOMER][NEUTRAL] I have an online account but it doesn't show my claims or anything in it and I think it's because your system went down and I had to reregister.
[CUSTOMER][NEUTRAL] So I have some claims that I put in for.
[CUSTOMER][NEUTRAL] Let me see, um.
[CUSTOMER][NEUTRAL] I don't know. I just was reimbursed for a bunch of physical therapy visits.
[CUSTOMER][NEUTRAL] And what I don't know is which ones I was reimbursed for and which ones I haven't been. Can you read those to me so I could check them off?
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] And nothing's in my online portal, but maybe it's because I registered for the online portal. It, do you remember a few weeks ago your system went down and everybody had to re-register?
[AGENT][NEUTRAL] Well, it wasn't a system going down. It was our system was updated and so everyone had to re-register.
[CUSTOMER][NEUTRAL] OK, so I don't know what happened to my claims, but I can't view them.
[CUSTOMER][NEUTRAL] And I think maybe they were in the old system and it didn't transfer. I don't know.
[AGENT][NEUTRAL] Or it could be something they're working on for, I know, um.
[AGENT][NEUTRAL] Couple weeks ago they were working on the online service center as far as viewing the ELBs, but, uh, the most recent claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] shown for
[CUSTOMER][NEUTRAL] I put in a bunch today but I'm, I'm not talking about the ones I put in today.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, show one for [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] So these were all paid, correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, keep going.
[AGENT][NEUTRAL] Uh, [PII], did I say that one?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII].
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] And then there were a bunch from April as well.
[AGENT][NEUTRAL] Uh, see.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, looks like another for [PII].
[CUSTOMER][NEUTRAL] OK, these are paid, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yeah, perfect. OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And [PII].
[CUSTOMER][NEUTRAL] OK, not [PII] or the [PII]?
[AGENT][NEUTRAL] Um, one moment.
[CUSTOMER][NEUTRAL] And then I also have early April, end of March, early April, so I guess I need to.
[CUSTOMER][NEUTRAL] Now at least you're telling me what I haven't submitted maybe.
[AGENT][POSITIVE] Well, it's showing [PII] was paid but it just looks funny on my screen. Let me see.
[CUSTOMER][NEUTRAL] It was paid
[AGENT][NEUTRAL] Yes, ma'am. Uh, there were some in March and they were processed as Give me a moment.
[AGENT][NEUTRAL] You're showing as duplicate, so it must have been received previously give me one moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] This is exactly what I needed you for. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the one for, uh, it looks like.
[AGENT][NEUTRAL] [PII] and [PII], they were processed as primary paid in full.
[CUSTOMER][NEUTRAL] Oh, OK, you're right because [PII] is my new deductible year.
[CUSTOMER][NEUTRAL] So those weren't eligible. What about 4243, wait, what about 42 and 44?
[CUSTOMER][NEUTRAL] Do you show any, did I, did I ever submit it for 4244 or 423?
[AGENT][NEUTRAL] Uh, looks like for 42, uh, that process is primary paid in full.
[AGENT][NEUTRAL] And what was the other dates? you said 42?
[CUSTOMER][NEUTRAL] 4444.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Uh, the 44 was also processed as, uh, primary paid in full.
[CUSTOMER][NEUTRAL] Pay, which means I didn't have anything to pay.
[CUSTOMER][NEUTRAL] So you don't reimburse me, is that correct?
[AGENT][NEUTRAL] Which
[AGENT][NEUTRAL] Which it shows on the EOB, the primary did not apply any amounts towards deductible, co-pay or co-insurance, so there's nothing for us to pick up and pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what about 4:23?
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] Do you show anything? I might have just forgotten to submit that.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, for 423, uh, looks like they processed it as needing the primary EOB.
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] The primary insurance explanation of benefits for that data service, the EOB.
[CUSTOMER][NEUTRAL] Yeah, what, what about it? Did you receive my EOB or I forgot to send it?
[AGENT][NEUTRAL] It's needed
[AGENT][NEUTRAL] Is needed for that date for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I need to resubmit for [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] So how could I look this up on my own? It's not in my account.
[AGENT][NEUTRAL] Well, like I said, there could be issues with the online service center, so I'm not sure uh when that should be updated, but once it's fixed or once it's moving smoothly, you should be able to see it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And I submitted 6 more today and they don't show in my account that I submitted them, but it said submitted when I sent it.
[AGENT][NEUTRAL] Yes, I do show those claims and they are in line for processing.
[CUSTOMER][NEGATIVE] I'm just frustrated that.
[CUSTOMER][POSITIVE] Oh, got it. OK, thank you so very much for your help. You answered all my questions. OK. Thank you.
[AGENT][POSITIVE] Alright, you're welcome. Good deal. Thank you for calling APM Miss [PII]. Have a great day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye.
[AGENT][NEUTRAL] Bye.