AccountId: 011433970860
ContactId: 63c1915f-e24d-4234-b23e-096772c2b942
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 547070 ms
Total Talk Time (AGENT): 271968 ms
Total Talk Time (CUSTOMER): 192842 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/63c1915f-e24d-4234-b23e-096772c2b942_20250311T12:20_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], um, I have put in a claim, um, I just got the status back. um, there's no.
[CUSTOMER][NEUTRAL] Explanation of why um
[CUSTOMER][NEGATIVE] There's no, there's no money coming back for it, so I was wondering if you have something on your end that you can.
[CUSTOMER][NEGATIVE] Tell me why it wasn't accepted.
[AGENT][NEUTRAL] OK, so you're wanting to verify why the claim was not approved, is that correct?
[CUSTOMER][POSITIVE] Exactly, yeah.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm so sorry, [PII], there is a slight echo on our call. What was your last name?
[CUSTOMER][NEGATIVE] Oh sorry, let me.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][POSITIVE] OK, thank you. And Ms. [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and your policy number please?
[CUSTOMER][NEUTRAL] 227-8184
[AGENT][NEUTRAL] 227-8184. Is that correct?
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] OK thank you one moment while I get your information pulled up please.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, Ms. [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. I will also need to verify several things with you first for security purposes. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have for you is the same as the one you gave me, so that is your best contact number, is that correct? Thank you. And lastly your email address, please?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, I don't know which one you have. Hold on a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know if it if it's the [PII] or if it's the [PII] account.
[AGENT][NEUTRAL] The first one.
[CUSTOMER][NEUTRAL] [PII], it's [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And Miss [PII], what is the data service and total bill amount on the claim you're checking on?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] What, what was it? I don't have a total amount. Uh, let me see if it.
[AGENT][NEUTRAL] OK, you can just give me the date of service.
[CUSTOMER][NEUTRAL] I did open.
[CUSTOMER][NEUTRAL] It's my.
[CUSTOMER][NEUTRAL] Does it have your note in here?
[CUSTOMER][NEUTRAL] Um, it says total bill charges is $2,532.69.
[AGENT][NEUTRAL] I'm so sorry, could you please repeat that again? We do have a slight echo on our call.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm sorry, uh, total bill charges is $2,532.69.
[AGENT][NEUTRAL] 59.59.
[CUSTOMER][NEUTRAL] 253 2.69
[AGENT][NEUTRAL] 69. OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] Uh, [PII] of this year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have your claim number there on your exclamation of benefits, Ms. [PII]?
[CUSTOMER][NEUTRAL] I do. Um, it's 3573311.
[AGENT][POSITIVE] OK, thank you very much. One moment.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] OK, so this is um for a doctor, oh, I don't wanna mess her name up.
[AGENT][NEUTRAL] [PII]. OK. And also for Palm Beach pathology for [PII]. OK. So yes, I can see that this claim was denied. The reason for the denial and this information should also be on the second page of your explanation of benefits, but it states, please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I was self pay so I wouldn't have.
[CUSTOMER][NEGATIVE] I wouldn't have any benefits from the insurance company because they don't.
[AGENT][NEUTRAL] OK. So you, so the claim was not filed with your primary insurance?
[CUSTOMER][NEUTRAL] The, um, yeah.
[CUSTOMER][NEUTRAL] No, because they don't see um.
[CUSTOMER][NEGATIVE] The dermatologist does not accept uh my policy.
[AGENT][NEUTRAL] OK. So, on this.
[CUSTOMER][NEGATIVE] I have an HMO policy with Blue Cross, and they don't, they don't accept it, so it would be pointless for me to.
[AGENT][NEUTRAL] OK, so on this type of policy, Ms. [PII], that you have with APL, it is a supplemental policy to your primary health care insurance, and it helps you with your co-pays, deductibles, and co-insurance amounts of covered services. So if your primary insurance company does not cover something,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then this policy would not either.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Because when I spoke to our supplemental.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Agent, she said if Blue Cross doesn't take it, you can submit it because they they won't.
[CUSTOMER][NEUTRAL] They wouldn't put it towards my deductible since there is out of network, so that's what she told me to put in a claim with AP APL that's what I did.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right. So if they were applying it, right, but we have to see, we have to be able to see that your insurance company applied it towards your deductible.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, so if I put in a claim with Blue Cross and they come back as if they, if they accept it, if they don't accept it, how does that affect the claim with APO?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So if they don't accept it, if, if they don't apply, if they deny it, saying it's not covered or for whatever the reason is, and there's nothing applied to your deductible, co-pay or co-insurance by your primary, there would not be any benefits on this policy because those are the three categories that this plan helps with.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] Well, I'll try and I'll see what happens, but.
[CUSTOMER][NEGATIVE] That stinks, OK.
[AGENT][NEUTRAL] I'm so sorry, but yes, ma'am, um, again, that is what this plan is designed to help you with is to offset those costs for coverage services under this policy. So we can't, you know, when there's not anything or if your primary insurance is denied a claim completely for whatever reason, then there would not be, you know, any benefits under this policy either.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Got it OK.
[AGENT][NEUTRAL] So, yes, ma'am. If you do end up filing your claim with your primary insurance,
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Um, once that's been done and if they have applied something to one of those three categories, then yes ma'am, all you would need to do would be to send us that explanation of benefits showing that, and you can just upload it into your portal. You won't be able to tie it to this specific claim number, Ms. [PII], so it would be you would just upload it just like you did this information, but our system would know, you know, that that was a piece of missing information on this claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, got it right.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, alright, thank you for your help.
[AGENT][POSITIVE] Well, you are certainly very welcome. And is there anything else I can help you with this morning?
[CUSTOMER][NEUTRAL] Um, no, that's it for today.
[AGENT][POSITIVE] OK then well thank you so much for calling APL and I hope you have a very nice day.
[CUSTOMER][POSITIVE] Thank you. You as well. Take care.
[AGENT][POSITIVE] Yes, ma'am. Thank you too. Bye-bye.
[CUSTOMER][NEUTRAL] And