AccountId: 011433970860
ContactId: 6de5f944-7abe-4814-b2fa-32761d7a8aa8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471600 ms
Total Talk Time (AGENT): 159136 ms
Total Talk Time (CUSTOMER): 270827 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/6de5f944-7abe-4814-b2fa-32761d7a8aa8_20250128T16:42_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm hoping that you can, um, long story short, I took an ambulance ride to the hospital and I have
[CUSTOMER][NEUTRAL] During this time, it was the end of [PII]. I had Blue Cross and Blue Shield and I had APL as the secondary gap coverage. I received a bill from the ambulance ride for $1400.28 and I am trying to see, I had a PPO on the Blue Cross, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I am trying to see so I could essentially go out of network. Apparently the ambulance driver was out of network, didn't know I had to ask that when I had a [PII] emergency, but in any event, I got the bill for $1400 and I thought that I processed, I put the claim through to you guys in addition to Blue Cross, but I'm just looking at the
[CUSTOMER][NEUTRAL] Um, explanation of benefits. I got the back that my claim, I guess was processed and it's showing that it looks like APL is paying for the hospital co-pay and then there's underneath is $100. I think that's like the practitioner that assisted me at the hospital. It's like a separate line item but I was curious if, do I get any help on the ambulance ride?
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with your benefits. Um, first, could I get your name again and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, so my name is [PII] You can call me back on my cell, which is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need your policy number, please.
[CUSTOMER][NEUTRAL] Sure, it's 1479643 ML 7.
[AGENT][NEUTRAL] Thank you. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII] and I don't know if you have the [PII] or the [PII], which one are you, do you have my [PII] address or?
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] OK, so it's [PII].
[AGENT][NEUTRAL] OK. And your email address, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. And were you admitted into the hospital or was this for outpatient?
[CUSTOMER][NEUTRAL] No, it was, I took an ambulance. I took an ambulance, um, and then I was just in the emergency room and then I was let go, so I was there a couple of hours.
[AGENT][NEUTRAL] OK. Yeah, I'm showing that under your policy for outpatient benefits, we cover up to 2500 per calendar year and ambulance ride um for an ER visit is covered.
[AGENT][NEUTRAL] So let's see.
[AGENT][NEUTRAL] So, um, you can um contact the ambulance company and let them know about us. Give them um, your policy number and our phone number so they can call to verify your benefits and see how to submit a claim if they're not familiar with us, or you can file the claim yourself.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I don't mind filing the claim. I have the, so I have the, um, can you look to see the claims that I filed? I, I think I only sent it for the um what you call it, the ER visit from the hospital. I don't think I sent you guys the invoice from the ambulance ride, but are you able to see that?
[CUSTOMER][NEUTRAL] On your side?
[AGENT][NEUTRAL] Yes, ma'am. What date of service?
[CUSTOMER][NEUTRAL] The date of service was [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Yes, ma'am. I do show the claim that you submitted for the ER service. It was paid to the hospital and then the other line item, you're correct, for $100 that was for the um provider.
[CUSTOMER][NEUTRAL] OK, so now here's the weird part. So I called, I just called the bill, the company that sent the bill, which is the, I guess it's the hospital it's.
[AGENT][NEUTRAL] That you saw.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, emergency medical services, I don't know if they use a third party, but they sent me the $100 bill, so I just called them and I said I'm looking at APL and they're covering it, so why would I pay you when they're supposed to be paying you? So I gave her your information so I'm assuming they're gonna call you guys to make sure that obviously you guys are sending them the payment, is that correct?
[AGENT][NEUTRAL] Well, I'm showing that this payment here was sent to you.
[AGENT][NEUTRAL] For the
[CUSTOMER][NEUTRAL] Me personally?
[AGENT][NEUTRAL] Yeah, for the hospital, the $100 payment, yeah, for the ER and for the hospital. The $300 payment, that was it.
[CUSTOMER][NEUTRAL] So they pay me instead of the.
[CUSTOMER][NEUTRAL] To which address, the [PII] address or the sample [PII] address?
[AGENT][NEUTRAL] The sample road address that's the one we have on file. Yeah, that was sent out on the [PII].
[CUSTOMER][NEUTRAL] OK, so you you guys.
[CUSTOMER][NEUTRAL] OK, so there's a good chance it's in my mailbox.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I thought you guys sent it to them directly. OK, that makes sense to me. OK, that just cleared up that. Thank you for that. OK, so now the emergency bill, so you're saying that for the emergency I should call them up and give them your secondary insurance?
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] My secondary insurance? I'm sorry.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am, let them know that where you're if um if you prefer for them to file the claim, yeah, let them know and um what they'll do is send us the copy of the explanation of benefits along with their claim, and we can get that processed for you. I'm showing that you still have benefits from last year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK, alright, so I guess what do you know what I had last year I had what I still have like what 140 or $1500 left. Can you see that?
[AGENT][NEUTRAL] Um, yeah, we cover up to 2500 and let's see how much you have left. One moment.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, yeah, I'm showing that you have 1,624 left.
[CUSTOMER][NEUTRAL] OK, so now let's say I wanted to process this myself with you guys and not get them involved because at least I know I'm gonna do it. I can just, what do I do just upload it on the I saw that it's looks like I can upload the document right to your website, right?
[AGENT][NEUTRAL] Yes, ma'am. The same way that you filed the last claim. Um, did you file it online or did you fax it to us?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I did no, I filed it online. It was much faster. I couldn't believe it how quickly the turnaround time was.
[CUSTOMER][NEUTRAL] OK, so then I upload, do I have to upload my, my, um, regular, the Blue Cross 12 so you have the to show that I have the Blue Cross PPO or I had it last year when this happened? Do you need both of those documents?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, ma'am. All we'll need is a documentation um for the ambulance ride.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] The coverage the explanation and benefits for that and we'll also need your diagnosis code. Um, go ahead and write that on the documentation.
[CUSTOMER][NEUTRAL] OK, so you need the diagnosis code and what was the other thing? I'm sorry.
[AGENT][NEUTRAL] The explanation of benefits for the ambulance ride.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] From your primary insurance company from Blue Cross.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright perfect thank you so much I really appreciate all your help.
[AGENT][POSITIVE] Oh, no problem. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Nope, that'll do it thank you so much.
[AGENT][POSITIVE] OK. I thank you again, [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank