AccountId: 011433970860
ContactId: 812383a9-b597-4e35-b0ea-cc65839859bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1237400 ms
Total Talk Time (AGENT): 373857 ms
Total Talk Time (CUSTOMER): 493059 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/812383a9-b597-4e35-b0ea-cc65839859bf_20250331T17:01_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], yes, um, can I give you my, um, outpatient benefit certification number?
[AGENT][NEUTRAL] Yes, sir. And may I ask who's calling?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have a callback number I can get in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And I'll take that policy number now.
[CUSTOMER][NEUTRAL] OK 019.
[CUSTOMER][NEUTRAL] 602.
[CUSTOMER][NEUTRAL] 11 ML 8.
[AGENT][POSITIVE] Thank you. Hold one moment, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And how did you pronounce your last name?
[CUSTOMER][NEUTRAL] Um, [PII], but we can just go with [PII], that'll be easier.
[AGENT][POSITIVE] Thank you, [PII], and you were.
[AGENT][NEUTRAL] Had a question about this policy, your policy.
[CUSTOMER][NEUTRAL] Yeah, let me, uh.
[CUSTOMER][NEUTRAL] One second here.
[AGENT][NEUTRAL] And can I verify your date of birth? I'm sorry.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Of course, [PII].
[AGENT][NEUTRAL] And can I verify your address and email address?
[CUSTOMER][NEUTRAL] Address is [PII].
[CUSTOMER][NEUTRAL] And I'm not sure which email address you guys use. Do you use a Yahoo or a Gmail? What do you see there?
[AGENT][NEUTRAL] It's the [PII].
[CUSTOMER][NEUTRAL] Yeah, so that would be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And how can I help you?
[CUSTOMER][NEUTRAL] OK, so I have some explanation of benefits here from.
[CUSTOMER][NEUTRAL] Uh, urgent care that I went to in [PII], uh, it seems like they all of a sudden forgot the bill and I'm getting all these bills all of a sudden, so should I, do we start with the data service?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or the patient, what's the best thing to start with for you?
[AGENT][NEUTRAL] Um, who's the patient?
[CUSTOMER][NEUTRAL] Well, I have one here for my wife, [PII].
[AGENT][NEUTRAL] [PII], OK, let's start with [PII]. And what date of service was that for [PII]?
[CUSTOMER][NEUTRAL] This is showing uh [PII].
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yes, I'm not sure when they ever filed that claim.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Interesting, uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, they said you made a payment on though.
[AGENT][NEUTRAL] We did.
[CUSTOMER][NEUTRAL] They said you guys paid $597.17.
[AGENT][NEUTRAL] Does it have a claim number? Do you have a claim number or?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have an account number. Would that work? should we try that?
[AGENT][NEUTRAL] What's it start with?
[CUSTOMER][NEUTRAL] A 1
[AGENT][NEUTRAL] No, our claim numbers usually start with a 3 or something like that, um.
[CUSTOMER][NEUTRAL] Oh, this is a statement from Baptist Health of South Florida. It's not something coming from you guys.
[AGENT][NEUTRAL] Oh, OK. No, we haven't received that claim.
[CUSTOMER][NEUTRAL] OK, uh.
[AGENT][NEUTRAL] Because if we go by the data service and it's we don't have that data service.
[CUSTOMER][NEUTRAL] OK, you don't, OK, so let's try something for [PII] now.
[CUSTOMER][NEUTRAL] My son data service here is [PII].
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We do not have that data service service either.
[CUSTOMER][NEUTRAL] And that's for [PII], right? Might it all be under my name gonna be under my dependent's name?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] It'll be under the dependent's name, whoever the claim is on, that's who it'll be under.
[CUSTOMER][NEUTRAL] Yeah, the patient name, OK, I have another one here for [PII], uh, back on [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, we do have that one. We are needing your explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Oh, OK, so.
[CUSTOMER][NEUTRAL] One second, take a note here.
[CUSTOMER][NEUTRAL] You need an EOB from my health insurance, OK.
[CUSTOMER][NEUTRAL] And if and when I get it, how do I send that over to you or do they need to send it to you guys?
[AGENT][NEUTRAL] Either way you can mail it, fax it or upload it to our online service center.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] What website do I go to to upload it?
[AGENT][POSITIVE] It is secured.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Secured in one word.
[AGENT][NEUTRAL] [PII], uh-huh.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sorry,
[CUSTOMER][NEUTRAL] Uh, AM [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what do I need to put in over there my outpatient benefit certification number to identify myself and then I can upload stuff?
[AGENT][NEUTRAL] Yes sir you just set your account up and then you can upload stuff you can see uh claim status, um.
[AGENT][NEUTRAL] If they were processed what we need and all of that.
[CUSTOMER][NEUTRAL] OK, do you guys ever send out a letter saying hey [PII], we're waiting on you for something or no you you you go back to the providers.
[AGENT][NEUTRAL] You would get a copy of the explanation of benefits saying that we need explanation of benefits from your primary, and they would get one also.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So every time we mail the provider something, it will, a copy will come to you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so I have another one here. Can we look up another one, please? This one's me is the patient, um, data service is 821-2024.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] We do not have that one.
[CUSTOMER][NEGATIVE] That's so weird because when I speak to Baptist Health they're telling me they I don't know where this is coming from, they're telling me APL paid $638.48 on this on this visit, but you did not obviously because you don't even see it.
[AGENT][NEGATIVE] I don't even see it at all, no, sir.
[CUSTOMER][NEUTRAL] Well, let me ask you, on my policy, you guys cover the copay, right?
[AGENT][NEUTRAL] We cover any deductible, co-pay or co-insurance that your primary applies to up to certain amounts depending on what the service was.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, all right, let's try another one for me.
[CUSTOMER][NEUTRAL] Uh, back on 225-24.
[CUSTOMER][NEUTRAL] You see that one?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] So did he show as South Miami Hospital, or do you see him as Baptist Health South Florida?
[AGENT][NEUTRAL] Hold on just a second, let me pull this one up because we actually did pay on this one. Hold on one moment.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Paid $100 to you.
[CUSTOMER][NEUTRAL] Oh, you paid me 100?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] When was this?
[AGENT][NEUTRAL] Let's see, hold on just a second.
[AGENT][NEUTRAL] It's, this is Critic Care Clinics.
[CUSTOMER][POSITIVE] Yeah, it's yeah it's urgent here exactly.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That this one we actually paid you $100 on this one.
[CUSTOMER][NEUTRAL] And when was that payment sent to me?
[AGENT][NEUTRAL] Hold on just a second and I'll look it up for you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 558.
[AGENT][NEUTRAL] 329, 24.
[CUSTOMER][NEGATIVE] Wow, that's like a year ago, jeez.
[CUSTOMER][NEUTRAL] Alright, so you sent me that.
[CUSTOMER][NEUTRAL] OK, that's good, let me see if there's.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So you didn't find anything from [PII].
[CUSTOMER][NEGATIVE] You didn't find anything for [PII]. This is so weird.
[CUSTOMER][NEUTRAL] But then another one from [PII], you guys need an EOB.
[AGENT][NEUTRAL] Yes, sir, for the 225.
[CUSTOMER][NEUTRAL] Yep, OK, just checking my notes here.
[CUSTOMER][NEGATIVE] And then you don't see the one for me.
[CUSTOMER][NEUTRAL] On [PII] but you did find the one for me.
[AGENT][NEUTRAL] For 225.
[CUSTOMER][NEUTRAL] On 220 you cut me a check back on 3-29-2024 last year.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's good. Next thing, um, I received something from you guys.
[CUSTOMER][NEUTRAL] Section
[CUSTOMER][NEUTRAL] there.
[CUSTOMER][NEUTRAL] So I received a letter from you guys on [PII] saying.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEGATIVE] You're requesting that I send the refund back. What's going on with this?
[AGENT][NEUTRAL] Do you know what data service there was or who the patient is?
[CUSTOMER][NEUTRAL] Hold on, uh.
[CUSTOMER][NEUTRAL] Looks like 4 26 24.
[AGENT][NEUTRAL] And who was the patient?
[CUSTOMER][NEUTRAL] Uh, me.
[AGENT][NEUTRAL] Hold on just a moment.
[AGENT][NEUTRAL] Hold on just a second. Um, it says we paid benefits to you for services rendered by another provider, so maybe they paid the wrong provider and they got to fix the history.
[AGENT][NEUTRAL] On that one.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] That's what it says in the letter.
[CUSTOMER][NEUTRAL] Right, um, data service, OK. During a routine out of our, uh, claim file, discovered that the following occurred during the during the processing and subsequent payment of an above mentioned claim. We pay benefits to you for services rendered by another provider. Therefore requesting a full refund the amount of 4401. Does that mean once you get the money back from me, you're gonna send it to them? What does that mean?
[AGENT][NEUTRAL] Right, um, they just paid the wrong provider. They paid that red, let's see what was on that.
[AGENT][NEGATIVE] They paid Red MD LLC and should have paid.
[AGENT][NEGATIVE] Beacon respiratory Services, so they paid the wrong provider.
[CUSTOMER][NEGATIVE] So how am I supposed to get, so do you reach out to the provider? You're just letting me know?
[AGENT][NEUTRAL] Right, it's nothing you have to do. We're, we contacted the provider. We just have to send you a copy of everything we send the providers.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I got you because it almost makes it seem like I owe you the money.
[AGENT][NEGATIVE] No, you do not.
[CUSTOMER][NEUTRAL] OK, so who owes you that one again? Sorry, [PII] who who who was that?
[AGENT][NEGATIVE] We sent it to the incorrect provider. We sent it to Red MD.
[AGENT][NEUTRAL] Red me
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah, RedMed LLC instead of the other provider, the correct provider. It was just a key and error, so we contacted them to get the money back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did they ever get it to you, this red MD?
[AGENT][NEUTRAL] They have not yet.
[AGENT][NEUTRAL] But it just went out on the [PII], so sometimes it takes them a while to get the money back.
[CUSTOMER][POSITIVE] OK thanks.
[CUSTOMER][NEUTRAL] Um, so I have a question now. You guys cover medical durable medical equipment, so I, I got a CPAP machine last year.
[CUSTOMER][NEGATIVE] And I, I don't remember that it was like $950 or something like that and this beacon place they've been, I don't know why they did this. I said I, I'm gonna submit the total bill to my APL to pay this the day I was there they said, yeah, OK, no problem, and from then on I started getting billing charges exactly $4401 a month and I said what are you guys doing? and it was like.
[CUSTOMER][NEGATIVE] I don't know they have this billing thing in [PII] I couldn't talk to anyone I've been struggling with this year now.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Is there any way you can find out or you can show me or tell me what you have remitted to Beacon for that machine? Have you made certain payments to them? I've lost track at this point and I, I called them, I said you just need to get.
[CUSTOMER][NEUTRAL] A bill showing the cost of the machine so I can submit it or you can submit it to APL and they I just it's just like talking to three different worlds. I, I can't line this up.
[CUSTOMER][NEUTRAL] Like can you pull up as a provider and.
[AGENT][NEUTRAL] I don't
[AGENT][NEUTRAL] I don't have a print print I can't pull up the exact provider. I'd have to pull up every claim to see which one.
[AGENT][NEUTRAL] was paid to him, but it was, um, you said it was for the medical equipment?
[CUSTOMER][NEUTRAL] Oh my.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah, I, I, I, I do recall calling you guys way back when and you guys, I know you guys covered durable medical equipment which is a CPAP machine.
[CUSTOMER][NEUTRAL] For my apnea.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Is there any way I can go on to your site and find all the stuff that you gave to Beacon if you gave anything yet? Like how do I manage this?
[AGENT][NEUTRAL] Yes, you can go on the site and look at all the claims that's been paid on your policy.
[CUSTOMER][NEUTRAL] Will it say where it's going to it'll say who it went to?
[AGENT][NEUTRAL] Yes, it'll have all the explanation of benefits on there and it'll tell you who it's going to and who we paid and how much we paid.
[CUSTOMER][NEUTRAL] But again I can't just say provider is Beacon Hill. I can't do it. I gotta go through every item one by one, is that right?
[AGENT][NEUTRAL] It, yeah, it would be just medical, the medical equipment, so it, it would probably be easy to find just the medical equipment.
[AGENT][NEUTRAL] But it would tell you each one that we paid to them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me see who this is. 354-5674.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we paid 826 24, 4401 to Beacon.
[CUSTOMER][NEUTRAL] Say, say it again 8 what was this? Oh, on [PII].
[AGENT][NEUTRAL] 8624 uh-huh.
[AGENT][NEUTRAL] We pay
[CUSTOMER][NEUTRAL] You paid 4401.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] 6:20.
[CUSTOMER][NEUTRAL] Are you able to pull this up by the name Beacon or you're looking up that hard medical stuff?
[AGENT][NEUTRAL] I'm just looking up by the claim numbers.
[CUSTOMER][NEUTRAL] Oh well you were saying I could restrict it to just medical equipment or something?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, DME. You would be able to see it by DME. It'll say DME on the explanation of benefits, yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then we paid 4401 for 62624.
[CUSTOMER][NEUTRAL] And what day was that? I'm sorry?
[AGENT][NEUTRAL] Uh, 62624.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 426.
[CUSTOMER][NEUTRAL] See these are the
[AGENT][NEUTRAL] 24
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] These are these.
[AGENT][NEUTRAL] No, that's the one that was paid wrong. Let's see, hold on just a second.
[AGENT][NEUTRAL] Yes, we did pay them for 426. We went ahead and paid them the 4401.
[AGENT][NEUTRAL] For 426, 24.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, alright, I gotta call Beacon back and find out what's going on if they ever submitted a bill to you don't see a bigger one, so let me, let me call him back and find out what's going on. I they were supposed to straighten all this out, but this has literally been a month a year now.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] This is ridiculous.
[AGENT][NEUTRAL] Um, now we did pay $247 to Beacon that was for $426 as well.
[CUSTOMER][NEUTRAL] 426 24, how much was it?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, 247.
[CUSTOMER][NEUTRAL] To what?
[CUSTOMER][NEUTRAL] 247 even?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] And that was the me also?
[AGENT][NEUTRAL] It was.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I'm gonna try and find out what's going on with them, see if they can get you.
[CUSTOMER][NEUTRAL] A bill for the full equipment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Alright, or get me one so I can submit it to you guys.
[AGENT][NEUTRAL] Is there anything else?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Uh, no, thank you so much for your help today. I appreciate it. Have a great day.
[AGENT][POSITIVE] Thank you, [PII] for calling APL. You have a good day as well. If you need anything else, give us a call back.
[CUSTOMER][POSITIVE] Thank you bye bye.
[CUSTOMER][POSITIVE] You've been very helpful, thanks so much bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.