AccountId: 011433970860
ContactId: 5048e2a8-731f-4231-a7c7-10c1d121f72c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 448279 ms
Total Talk Time (AGENT): 235562 ms
Total Talk Time (CUSTOMER): 166634 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/5048e2a8-731f-4231-a7c7-10c1d121f72c_20250519T14:46_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] Hi [PII], this is [PII], and I'm a policyholder of APL.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And I I recently submitted my claim with an uploaded forms.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And wanted to know.
[CUSTOMER][NEUTRAL] Uh, if, if it's been uploaded, if it.
[CUSTOMER][NEUTRAL] Because when I do look at when I do go to APL to to my um my uh website here with APL it it doesn't say that claims were uploaded.
[AGENT][NEUTRAL] OK, Mr. [PII], so you tried to upload some information for review into your portal and you're wanting to verify if it was received.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, sir. I can help you with that. And Mr. [PII], what is your callback number?
[CUSTOMER][NEUTRAL] I'm sorry, what what number policy?
[AGENT][NEUTRAL] Phone number?
[CUSTOMER][NEUTRAL] Oh, phone [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number now, please?
[CUSTOMER][NEUTRAL] OK, I'm sorry, my policy number?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, 2605164.
[AGENT][NEUTRAL] OK, Mr. [PII], thank you. Give me a few moments please to get your policy information pulled up. Then I will have to verify several things with you first for security. So one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so first off, Mr. [PII], any information provided will be a verification of benefits and not a guarantee of payment. If you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Also your home mailing address.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me. One of them is, uh, well, I'm sorry, both of them are. So that is the best contact number that we should have for you. Is that correct?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, thank you and lastly your email address?
[CUSTOMER][NEUTRAL] It is [PII]
[CUSTOMER][NEUTRAL] OK, I think I get my personal, so it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you so much. All right, so just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so did you um did you upload this information today, Mr. [PII]?
[CUSTOMER][NEUTRAL] I did it on.
[CUSTOMER][NEUTRAL] I think it was [PII], which was Friday.
[AGENT][NEUTRAL] OK. So yes, sir, I do see that there was, actually, I see something was uploaded on the [PII].
[AGENT][NEUTRAL] And it was reviewed on the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see. That's the most recent claims information that we've received. So I believe the [PII] actually was on Thursday. Yes, sir. That was Thursday.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You're correct.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, and that was for daycare urgent care. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so now this claim and you should be able to see this claim number that I'm about to give you in your portal, it's 360.
[AGENT][NEUTRAL] 2575.
[CUSTOMER][NEUTRAL] Yep I see it in my portal, yep.
[AGENT][NEUTRAL] OK. So that claim was denied and the reason for the denial on it, Mr. [PII], it states to please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] OK, if you look at claim number.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 3591362 you will see the attached um.
[CUSTOMER][POSITIVE] Benefits from my primary provider.
[AGENT][NEUTRAL] OK, so on that claim, the number that you just gave me, I do see that that one was denied as office visits are not covered under your under your policy. That's Pinellas County Primary Care.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, I'm sorry. OK, check, check this one.
[CUSTOMER][NEUTRAL] You are correct. OK, hold on, I think it's 358-6104. Let me see.
[CUSTOMER][NEUTRAL] Open that up.
[CUSTOMER][NEUTRAL] Yep, 35, there we go, look at the other 1 358-6104 there you'll see the explanation of let me just see, hold on.
[AGENT][NEUTRAL] Cause I see we were also asking for the explanation of benefits for that as well as a diagnosis code.
[CUSTOMER][NEUTRAL] 452.
[CUSTOMER][NEUTRAL] But that's all the same visit.
[CUSTOMER][NEUTRAL] Everything was [PII]. Forget about that office visit. That was, that, that's, I, I realized I'm not uh there's no reimbursement for that, but.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] But we were still, it still shows on that particular claim number that you just gave me, the 358-6104, that we needed your primary insurance company's explanation of benefits for that as well. There were two different things we needed.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The primary insurance and then the diagnosis.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So all you need to upload is just your explanation of benefits from your primary insurance company. That's all you need to submit for the data service of 37.
[CUSTOMER][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when I go OK explanation of benefits, right?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] From your primary insurance. Uh-huh. Yes, sir.
[CUSTOMER][NEUTRAL] From my primary.
[CUSTOMER][NEUTRAL] And do I create a new upload or how do I handle that?
[AGENT][NEUTRAL] You will just, it's going to somewhat appear like you're filing a new claim, so you're just gonna click on the upload files and that's all and just go through the steps just like you did on uploading your other information. And once we review that, we will be able to tell that that explanation of benefits is a piece of missing information that we needed on another claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] OK, alrighty, I will get that. Thank you very much.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, you are certainly very welcome. So is there anything else, Mr. [PII] that I could help you with at the moment?
[CUSTOMER][POSITIVE] No, but thanks for your help have a good day.
[AGENT][POSITIVE] Oh, you're, I hope you have a great day too, and thank you again for calling APL. Yes, sir.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK bye bye.
[AGENT][NEUTRAL] Bye-bye.