AccountId: 011433970860
ContactId: 5bf4015c-878b-4493-b424-d81f34caa1f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514200 ms
Total Talk Time (AGENT): 208149 ms
Total Talk Time (CUSTOMER): 154044 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/5bf4015c-878b-4493-b424-d81f34caa1f8_20250521T21:46_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, dear, um, I have a question about an old claim to see if you could assist me.
[AGENT][NEUTRAL] OK, is it for yourself?
[CUSTOMER][NEUTRAL] Uh for one of my dependents.
[AGENT][NEUTRAL] OK. Do you have your policy number handy?
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's um
[CUSTOMER][NEUTRAL] 023.
[CUSTOMER][NEUTRAL] 63
[CUSTOMER][NEUTRAL] I'm so sorry, excuse me, 908. So once again, 0363908.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And can I have your first and last name and your date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And just need two more pieces of information, your address and your email address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. And which dependent are we looking at?
[CUSTOMER][NEUTRAL] Uh, it's I said it was an air transportation, uh, for an accident with one of my children.
[CUSTOMER][POSITIVE] And uh ATL paid half of the bill. It was in.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, and which child was it? I'm sorry, I missed that.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK and the date of service again? I'm sorry.
[CUSTOMER][NEUTRAL] In [PII], uh, I'm not sure if [PII] or [PII], something around that date.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said it was for ambulance, is that right?
[CUSTOMER][NEUTRAL] Yeah, um, helicopter.
[AGENT][NEUTRAL] Let me pull this up, one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Yes, looks like we paid 41294.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. And how can I help you?
[CUSTOMER][NEUTRAL] Uh, oh, what
[CUSTOMER][NEGATIVE] Unfortunately I'm still dragging with this bill.
[CUSTOMER][NEGATIVE] The other half and I just learned from the the the the accounting department that my primary insurance declined covering.
[CUSTOMER][NEUTRAL] Because of my deductible.
[CUSTOMER][NEUTRAL] So I decided to call APL to find out if in that case if wouldn't APL take care of the whole thing when the primary didn't kick in.
[AGENT][NEUTRAL] So did they apply all of it to your deductible? Is that what happened?
[CUSTOMER][NEUTRAL] They say that I have not met the deductible, so they couldn't provide coverage.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] And this is for the 8870 from the Miami-Dade Fire Rescue, right, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, so it looks like, let's see what happened here.
[AGENT][NEUTRAL] They, so, so we only pay on what they approve and they only approved for 1294.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] But when they say only they approved, that means that they would have paid the prior portion.
[AGENT][NEUTRAL] Well, so, so because it's an ambulance claim, it looks like your primary insurance, they only, they only approved 4 1294.
[AGENT][NEUTRAL] And that's all that was applied towards your deductible. So we, we can't pay in excess of what they would apply towards a deductible or co-insurance.
[AGENT][NEUTRAL] So we would have to have something showing that they applied the entire 870 to your deductible.
[AGENT][NEGATIVE] And that that's not what we've received.
[CUSTOMER][NEUTRAL] Can you guide me again so I can go back to them?
[AGENT][NEUTRAL] Well, so it looks like the from what I'm seeing from the explanation of benefits from
[AGENT][NEUTRAL] Uh, Florida blue.
[AGENT][NEUTRAL] Because the ambulance service was out of network.
[AGENT][NEUTRAL] There was a charge that exceeded what's reasonable and customary for an ambulance, and that amount was
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Rest of it, the 402-94.
[AGENT][NEUTRAL] Or I'm sorry, the 4 1294.
[AGENT][NEUTRAL] I'm sorry, I'm 45706. I'm so sorry. I'm looking at your EOB. Um, so on our end, we can only cover what they have allowed and approved. So they did not approve 45706 of the charges.
[AGENT][NEUTRAL] So we would have to have something from Florida Blue that shows that they approved the entire amount of 870 instead of just the 41294.
[AGENT][NEUTRAL] And I, you can call and ask them if they can provide that. I don't know that they will, but um, definitely you can call them and ask. But that from our end, we only pay up to what they approve and allow. If there's a dollar amount that they don't allow, we won't consider that portion.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Understood. I saw, um, yeah, I just, my interpretation was that I have for the Blue to cover the very first portion of whatever it is and whatever they don't cover APL just kick in immediately, but apparently not if what I if Florida Blue approves, then that's what you guys think.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So it's kind of connected. I thought the APR was completely independent from from the primary insurance.
[AGENT][NEUTRAL] Uh, well, we're, we're a secondary insurance, so we do depend on your primary insurance and we look at how they've considered the claim, since we are a secondary like gap insurance.
[AGENT][NEUTRAL] We do have to consider what did they approve and then that's what we can pick up and pay on is what was approved by them.
[CUSTOMER][NEUTRAL] OK, so in the case that I call them and they do approve the other balance then APR would still pay.
[AGENT][NEUTRAL] Yes, if there's, if there's still money left on your policy for that year, yes, whatever funds were available, we could potentially pick up the rest. We would just need a corrected explanation of benefits from Florida Blue showing that they improved or approved the entire 870 instead of just approving the 41294.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you very much for your help.
[AGENT][NEUTRAL] OK, is there anything else I can help with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you for that.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a good evening.
[CUSTOMER][NEUTRAL] It's