AccountId: 011433970860
ContactId: 744ecd0c-185d-418c-981c-7f940b37ab58
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363609 ms
Total Talk Time (AGENT): 90447 ms
Total Talk Time (CUSTOMER): 251089 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/744ecd0c-185d-418c-981c-7f940b37ab58_20250110T19:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I just wanna, um, I have an explanation of benefits in front of me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That is saying on the back, please provide copies of your explanation of benefits from your primary insurance carrier.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Um, it looks like the bill 295, which would have been a lot more, but I just found out that they never that they billed my primary insurance and my primary insurance denied the bill, um, saying that I didn't have coverage at the time, so I just spoke to and it was because the previous insurance never told them that I was no longer active in the whatever, so they're dealing with that.
[AGENT][POSITIVE] Bless your heart. Mhm.
[CUSTOMER][NEUTRAL] And then they're going to deal with that and they're going to reprocess that claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when that claim gets reprocessed.
[CUSTOMER][NEUTRAL] I believe
[CUSTOMER][NEUTRAL] So I, I think when that claim gets reprocessed, I don't think they're gonna, so I think what happened is the
[CUSTOMER][NEUTRAL] I can't speak. I don't even know how you guys ended up with a claim because.
[CUSTOMER][NEUTRAL] When the primary wouldn't
[CUSTOMER][NEUTRAL] Pay the claim or take the claim.
[CUSTOMER][NEUTRAL] It shouldn't have gone to you, right?
[CUSTOMER][NEUTRAL] Um, and I don't even know where they come up with that amount, so, so what I need to know from you is like.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The pro the claim in my it's Blue Cross Blue Shield will be reprocessing the claim now because I did have insurance, um, and then they will, you know, whatever they're gonna come back to.
[CUSTOMER][NEUTRAL] Me and the provider and say that I have a deductible um so I'm gonna get a bill is what's gonna happen. I had asked the provider to submit the claim to Blue Cros Blue Shield and the APL right? so that it they got you guys paid the the portion that you would pay.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Well it sounds like they sort of did, except I don't know how they got 295, um, but it sounds like um I, I, because I don't know where they're pulling that from because Florida Blue never paid like.
[CUSTOMER][NEUTRAL] Never they just denied the claim, so I don't know how they got a number.
[CUSTOMER][NEUTRAL] But, uh, so my question to you is,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] That number's probably not accurate.
[CUSTOMER][NEUTRAL] Right? Because
[AGENT][NEUTRAL] You're like, what's going on?
[CUSTOMER][NEUTRAL] Because the number's not accurate, right, because Florida Blue didn't do anything, so the number needs to be based on the Florida Blues.
[CUSTOMER][NEUTRAL] Contracted rate and payment and whatever, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right now the bill's $7000. I'm going to guess the Florida Blues contracted rate is not $7000.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] They're going to go through Florida Blue. Florida Blue's gonna come back and say.
[CUSTOMER][NEUTRAL] She has a deductible. Our contracted rate is, I don't know, $1200 and now, you know, charged the patient, right? And then I'm gonna ask them to submit it to APL to pay the $1000 of that $1200 because that's what my plan does.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. Right.
[CUSTOMER][NEUTRAL] Right. So, I guess what I need to know from you is, do I need to call the hospital and ask them to resubmit it to you after Blue Cross Blue Shield reprocesses it?
[AGENT][NEUTRAL] What's the claim number? Let me pull it up and take a look and see if I can be of further assistance to you.
[CUSTOMER][NEUTRAL] 53-622-1
[AGENT][NEUTRAL] 353-6221. What is your name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] All right, thank you. Do you mind verifying your current mailing address and email and phone number while I've got you on the line?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, I don't even know what you guys have. The mailing address is [PII]. I don't know what phone number you have, um, and I don't know what email you have, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It just
[AGENT][NEUTRAL] OK, so I don't have an email on file so I can add one for you.
[CUSTOMER][NEUTRAL] I don't know, I don't need one. That's why.
[AGENT][NEUTRAL] OK, well, I do need a callback number just in case we get disconnected I can get right back to you.
[CUSTOMER][NEUTRAL] [PII]. I really just need to know what I need to do once Florida Blue processes the claim. Do I need to ask the hospital to resubmit it to you after Florida Blue reprocesses it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] That's really all I need to figure out.
[AGENT][NEUTRAL] Yeah, got you. OK, so I would assume.
[CUSTOMER][POSITIVE] Good
[AGENT][NEUTRAL] That, that comprehensive pathology associates would send in an updated EOB. Now, having said that,
[CUSTOMER][NEUTRAL] At
[AGENT][NEUTRAL] You may wanna just kind of follow up with them.
[AGENT][NEUTRAL] To see if they can.
[AGENT][NEUTRAL] Submit the claim after Florida Blue reprocesses.
[CUSTOMER][NEUTRAL] OK, the other thing I realized, they only sent you the claim for comprehensive pathology, but I am getting a $7000 bill because I, it was an outpatient surgery, so I'm not sure why they're only sending you one part of that, which isn't even a big part, right? It's the hospital fee that's the big part.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, we don't have a hospital claim on file. They haven't sent it to us and it may be because [PII] [PII] denied it.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, uh, [PII] [PII] denied all of it though, so that's the thing it's like none of this makes sense. So I just need to ask the hospital when [PII] [PII] comes back.
[CUSTOMER][NEUTRAL] And reprocesses the claim to resubmit whatever my responsibility is back to APL. That's what it sounds like.
[AGENT][NEUTRAL] That's right and make sure that they have the APL information to submit that claim because since we don't have it on file.
[CUSTOMER][NEUTRAL] They do. That's how they, so they, they, if they didn't have your information, they wouldn't have been able to send the pathology in the first place. So I will.
[CUSTOMER][NEUTRAL] So when
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] We processes.
[CUSTOMER][NEUTRAL] Resubmit
[CUSTOMER][NEUTRAL] To APL.
[CUSTOMER][POSITIVE] Got it OK perfect thank you very much.
[AGENT][POSITIVE] It's been my pleasure to assist you, Miss [PII]. Thank you for calling APL, and I hope you have a great day.