AccountId: 011433970860
ContactId: 5d6cc333-c2f7-4630-9996-736bfe93665e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1240459 ms
Total Talk Time (AGENT): 277212 ms
Total Talk Time (CUSTOMER): 439618 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/5d6cc333-c2f7-4630-9996-736bfe93665e_20250103T19:48_UTC.wav
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[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] He looks sort of. Hello.
[AGENT][NEUTRAL] How may I help you?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, this is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], sorry, I didn't hear you. This is [PII], uh, from Tropic Supply. I have a question.
[CUSTOMER][NEUTRAL] If um if uh.
[AGENT][NEUTRAL] OK, I can barely hear you. You said your name is [PII]?
[CUSTOMER][POSITIVE] That's correct, [PII]. How about now? Is that better?
[AGENT][POSITIVE] That's a little better.
[CUSTOMER][NEUTRAL] OK, I'll try to keep this, this mouthpiece right up next to my face.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Thank you, thank you. So, um, the reason for my call is my my provider, my, uh.
[CUSTOMER][NEUTRAL] Uh, primary care provider billed me for a co-pay that was from July.
[CUSTOMER][NEUTRAL] And I'm wondering if uh co-pays would be uh potentially covered by GAP or APL.
[AGENT][NEUTRAL] OK. I can check that out for you, [PII]. Do you have your policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 02369465 M as in Mary, L as in liberty and then either 8 or 7.
[AGENT][NEUTRAL] OK, thank you and what's your phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, at the uh store here we are [PII].
[AGENT][POSITIVE] Thank you, let me pull up your information.
[CUSTOMER][POSITIVE] Sure, thanks.
[AGENT][NEUTRAL] [PII], can you verify your date of birth, your complete mailing address, and then your email for me?
[CUSTOMER][NEUTRAL] Sure, uh, date of birth is [PII].
[CUSTOMER][NEUTRAL] Uh, complete mailing address [PII]. Um, email, did you ask me for my email? I have my business on it, so that would be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] It's the latter one, your, uh, it looks like it's your work email address that we have on file. Thank you for verifying.
[CUSTOMER][POSITIVE] My pleasure.
[AGENT][NEUTRAL] OK, and so this is for which what what is the data service?
[CUSTOMER][NEUTRAL] Uh, 79, I believe I don't have it in front of me and I left my phone home. I think I take a picture.
[AGENT][NEUTRAL] 79 or 719.
[CUSTOMER][NEUTRAL] 79 I believe.
[CUSTOMER][NEUTRAL] [PII] at Dr. [PII].
[AGENT][NEUTRAL] [PII], uh, that doctor with skin cancer and associates?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] No, uh, that's Doctor [PII].
[AGENT][NEUTRAL] OK. OK, that's not the one. OK.
[CUSTOMER][NEUTRAL] So I'm sorry, so maybe I have the date wrong. I know it was in July.
[CUSTOMER][NEUTRAL] Uh, just, and I remember there's a [PII], so it's either it could be [PII] and not [PII].
[AGENT][NEUTRAL] You know that's the data service that I have, uh, the only claim I have for you, it looks to be July [PII] of [PII].
[CUSTOMER][POSITIVE] OK, sorry about that, yep, yep.
[AGENT][NEUTRAL] And so let's see, we actually are requesting some additional information. It looks like you sent us the claim [PII] so they're probably billing you because we've not completed the process yet um because we requested additional information from you. Let me see what that is.
[AGENT][NEUTRAL] OK, so you're probably receiving a bill because we're requesting additional information from you, [PII]. It looks like you submitted the claim to us so we're requesting that you provide us with the diagnosis code.
[CUSTOMER][NEUTRAL] OK, so I think you're, you're sorry, we have, we're talking about two different, um, claims here which I appreciate you updating me though on that one. that was Dr. [PII] you're talking about and I did email those diagnostic codes if you're saying you haven't received them.
[AGENT][NEUTRAL] Date of service.
[CUSTOMER][NEGATIVE] We're gonna have a problem. I'm gonna have to I can resend that to you. I sent it separately.
[AGENT][NEUTRAL] When did you email them?
[CUSTOMER][NEUTRAL] Uh, let's see here, hold on a second.
[CUSTOMER][NEUTRAL] APL customer service here it is.
[CUSTOMER][NEUTRAL] This is dated [PII]. Let me preview it, make sure I got the right one here.
[CUSTOMER][NEUTRAL] With the diagnostic, yeah, that's it.
[AGENT][NEUTRAL] Yeah, are you referring to the procedure codes? I see procedure codes, but not the diagnosis code.
[CUSTOMER][NEUTRAL] Uh, let's see here.
[CUSTOMER][POSITIVE] Approval by
[AGENT][NEUTRAL] And then we have the explanation of benefits from neighborhood health.
[CUSTOMER][NEUTRAL] Oh, OK, so I see under diagnosis or nature of illness or injury there is, there are codes there.
[CUSTOMER][NEUTRAL] Number line 21, you're saying those are procedure codes and that it says diagnosis or nature.
[AGENT][NEUTRAL] OK, when did, what you're looking at, has that been submitted to us? And if so, when did you send it to us?
[CUSTOMER][NEUTRAL] OK, so that's what I just mentioned to you. I emailed it to [PII] on [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I'm not showing that in your file then. The last document we received was on the [PII], which I believe is the initial claim.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] It says customer [PII].
[AGENT][NEUTRAL] So it's actually.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so no customer just [PII].
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] is that correct?
[AGENT][NEUTRAL] Yeah, in this instance I'm gonna have you to remove the APL just send it to [PII] that way I can see it when you send it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so, so just send it to [PII].
[AGENT][NEUTRAL] Care team at AMpublic.com mhm.
[CUSTOMER][NEUTRAL] [PII] oh I'm sorry, [PII].
[AGENT][NEUTRAL] M as in Mary,
[CUSTOMER][NEGATIVE] [PII]. I'm writing it down wrong, must be [PII].
[AGENT][NEUTRAL] [PII]. Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, so [PII]. OK, I will, uh, send that right now.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I can forward it.
[AGENT][NEUTRAL] And does it give a description of the diagnosis or does it give the, the code?
[CUSTOMER][POSITIVE] Sorry about that. I got
[CUSTOMER][NEUTRAL] Uh, let me see, I just clicked out of there, so give me just a second here. I'm back in there.
[CUSTOMER][NEUTRAL] OK [PII]. Should I put something in the subject line I right now I got
[AGENT][NEUTRAL] Your policy number.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Your policy number.
[CUSTOMER][NEUTRAL] OK, yeah, it's it's in there, uh.
[CUSTOMER][NEUTRAL] Maybe a little extra information I got. I'll take out ga claim out pay. How about out.
[CUSTOMER][NEUTRAL] Benefit cert certificate number that's my, I believe that's my.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, diagnostic codes.
[CUSTOMER][NEUTRAL] Alright, so we sent that now you asked me what did I see there? You should have that there in a minute.
[CUSTOMER][NEUTRAL] Uh descriptions.
[CUSTOMER][NEUTRAL] I really don't see descriptions here. It just looks like, uh, L 57. So there's a code there, code there, code 4 different codes. Sure, uh, letter A, it's L as in liberty 57.8.
[AGENT][NEUTRAL] Give me that code again.
[CUSTOMER][NEUTRAL] And then it's got another code it looks like letter B.
[CUSTOMER][NEUTRAL] And I believe that's a Z as in zebra 08.
[CUSTOMER][NEUTRAL] And then it's got a it's got two more codes you want both of them.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Those are not procedure codes. Have you, have you sent that via email?
[CUSTOMER][NEUTRAL] Oh yeah, I just sent it.
[AGENT][NEUTRAL] OK, I think this is it.
[AGENT][NEUTRAL] You with Tropic supply?
[CUSTOMER][POSITIVE] That's correct, yeah.
[AGENT][NEUTRAL] Was there to have been an attachment to this email?
[CUSTOMER][NEUTRAL] Uh, there's supposed to be a scan. It's just a scanned a PDF.
[CUSTOMER][NEUTRAL] As the attachment.
[CUSTOMER][NEUTRAL] Right now 8614.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] the one
[CUSTOMER][NEUTRAL] always.
[CUSTOMER][NEUTRAL] Oh wow, maybe he didn't get it. I'm looking at it now. I's.
[AGENT][NEUTRAL] Yeah, I see it, but I don't see an attachment.
[CUSTOMER][NEUTRAL] You don't see an attachment. I'm sorry. Well, I thought forwarding it would would it didn't forward it to you.
[AGENT][NEUTRAL] Mm. Mm.
[CUSTOMER][NEUTRAL] Oh yeah, yeah, alright, let me try this again. Hold on just a second. Alright, it's doing that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Here.
[CUSTOMER][NEUTRAL] No, we don't carry.
[CUSTOMER][NEUTRAL] give you a
[CUSTOMER][NEUTRAL] That sells Lanier, but I'm not sure if they sell.
[CUSTOMER][NEUTRAL] But you can give him a call and then.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Wow, I not paste it. I didn't I paste it?
[CUSTOMER][NEUTRAL] Let's try one more time.
[CUSTOMER][NEUTRAL] Alright, just tell me one.
[CUSTOMER][NEUTRAL] Alright, so I just sent it to you.
[AGENT][NEUTRAL] OK. I'll give it a, I'll give it a few minutes.
[CUSTOMER][POSITIVE] Thank you for your patience, yeah.
[CUSTOMER][POSITIVE] I'm glad you brought that to my attention. Uh, that one was done.
[CUSTOMER][POSITIVE] Thank you for doing that.
[CUSTOMER][NEUTRAL] OK, so their name is, um, it's spelled [PII].
[AGENT][NEUTRAL] Let's check and see.
[CUSTOMER][NEUTRAL] A as in apple
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Z as in zebra
[CUSTOMER][NEUTRAL] It's [PII] and [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 23
[CUSTOMER][NEUTRAL] One
[CUSTOMER][POSITIVE] Oh good luck. I hope, I hope you can get them.
[CUSTOMER][POSITIVE] Good luck. You're welcome.
[AGENT][NEUTRAL] OK, I just got it.
[CUSTOMER][POSITIVE] Oh OK, great.
[AGENT][POSITIVE] Alright, yeah, this is the CMS 1400 form, OK, so it's Z08. OK, this is perfect.
[CUSTOMER][POSITIVE] Wonderful, wonderful.
[AGENT][NEUTRAL] And let me match it to the procedure codes that's on the claim.
[CUSTOMER][NEUTRAL] Oh, I see the procedures now, yeah.
[AGENT][NEUTRAL] Yeah, and so the diagnosis codes are those that are in box number 21.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][POSITIVE] OK, so great, so then what we will do.
[AGENT][NEUTRAL] I get this uploaded into your file.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] So we'll get this uploaded into your file, [PII], today is Friday, um, it's usually uploaded pretty quick, so you may want to check back next week. I mean our standard processing time is 7 to 10 business days from the date that we received the information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, excellent. Well, uh, you're [PII].
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][POSITIVE] And I appreciate the time and thank you for your help today.
[AGENT][NEUTRAL] You're welcome. Did you have any other questions for us, [PII]?
[CUSTOMER][NEUTRAL] Uh, so on the other one, the other question that I called about, uh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Is it the 79 data service?
[CUSTOMER][NEUTRAL] That was a
[CUSTOMER][NEGATIVE] Yes, correct, yeah, I don't think you're gonna have that because I haven't filed anything yet because I, because it's a co-pay and I didn't think, well, they, and then I when I realized there's a co-pay. I figured, well, that's probably my responsibility, but it's [PII]. I mean they just billed it for me few days before [PII], you know.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right, let me, let me look at your policy benefits. So, correct, the copay is not gonna be covered. It's the treatment in the office that will be considered.
[CUSTOMER][NEUTRAL] So I don't know uh.
[CUSTOMER][NEUTRAL] Right, OK, alright, so I'll, I'll have a little more careful look at the bill. I don't, I think it's the co-pay. I looked at it. I looked at it before the holidays.
[AGENT][NEUTRAL] Well, let me, let me
[AGENT][NEUTRAL] Let me take that back. I don't know if you have the treatment right or under your policy.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] What is your diagnosis?
[CUSTOMER][NEUTRAL] Um, for, for which one?
[AGENT][NEUTRAL] Just just for the one that you just sent, what is the diagnosis for that one?
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Uh, let me see, diagnosis, where, where would that be on the form that, um, that I sent you?
[AGENT][NEUTRAL] That's OK. I'll I'll, I'll look at it. I'll look at it real quick.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] Good morning
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] There is a cancer writer under the policy, so if the treatment is as a result of a, a positive diagnosis of cancer, those can be considered, so they'll have to review that claim that you sent today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Is that on the uh is that on this form here somewhere the diagnosis?
[AGENT][NEUTRAL] on what you just sent it is it's in box 21.
[CUSTOMER][NEUTRAL] Oh, OK, so, uh, there's no way for me to know what those codes stand for though so I try to Google them or something.
[AGENT][NEUTRAL] Yeah, there's several, yeah
[CUSTOMER][POSITIVE] OK, alright, so I'll call back in 7 to 10 days. I appreciate your help today.
[AGENT][NEUTRAL] OK, now did you have a question regarding the [PII]?
[CUSTOMER][NEUTRAL] Well, I think you, you just told me that uh, the copay, if that's correct, is not covered, right, even, even if they are billing before 5 months later, seems kind of.
[AGENT][NEUTRAL] Well, and so.
[AGENT][NEUTRAL] Well, but if the diagnosis is, is a result of a cancer diagnosis, that will change that cause you have a cancer, a treatment writer under the policy.
[AGENT][NEUTRAL] That's why I was asking that question.
[CUSTOMER][NEUTRAL] So that was
[CUSTOMER][NEUTRAL] That that was the other one is my uh my primary care physician I think that was just uh a a check up that I was there for yeah.
[AGENT][NEUTRAL] OK. OK, then that, that one, that co-pay would not be covered.
[CUSTOMER][NEUTRAL] Yeah, that copay would not be covered. OK, alright, very good.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, very good, I appreciate your help today.
[AGENT][POSITIVE] All right. Any other questions I can help out with today?
[CUSTOMER][POSITIVE] No, that's great. I'll call back in like I said, 7 to 10 days.
[AGENT][POSITIVE] OK. Thank you, sir. Have a good weekend.
[CUSTOMER][POSITIVE] Yeah thank you thank you you too bye bye.
[AGENT][NEUTRAL] Bye bye.