AccountId: 011433970860
ContactId: 818c1987-da69-45a1-8c1f-fec212ae479e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 663049 ms
Total Talk Time (AGENT): 173901 ms
Total Talk Time (CUSTOMER): 356443 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/818c1987-da69-45a1-8c1f-fec212ae479e_20250321T22:12_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I have a question because I got a letter back on
[CUSTOMER][NEUTRAL] The, um, um, you know, the bills that I have paid and I sent them in to you, um, I need to find out exactly what it is that you need.
[CUSTOMER][NEUTRAL] So that I can get it for you because you say you need additional information?
[AGENT][POSITIVE] OK, I'm happy to.
[CUSTOMER][NEUTRAL] So can I give you
[CUSTOMER][NEUTRAL] Mhm. Can I give you the information?
[AGENT][NEUTRAL] Yeah, absolutely. I can check on the claim for you. Do you have the policy number, the claim number? What do you have?
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] You know what, let me, let me go grab that sheet that I got.
[CUSTOMER][NEUTRAL] Because like everything came back on one sheet and it said um and I'm trying to figure out exactly what it is.
[CUSTOMER][POSITIVE] That you need so that I can.
[CUSTOMER][NEUTRAL] You know, forward it to you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me, let me go grab it.
[CUSTOMER][NEUTRAL] OK, let me see. Alright, um, policy number?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that OK, 02415262.
[CUSTOMER][NEUTRAL] And there's a reference number.
[CUSTOMER][NEUTRAL] Do you need that also?
[AGENT][NEUTRAL] Um, what's the reference number that you have?
[CUSTOMER][NEUTRAL] Oh, it's the same number. I'm sorry, it's the same one.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] All right. And then if I can get your first and last name and date of birth.
[CUSTOMER][NEUTRAL] First
[CUSTOMER][NEUTRAL] Yes, it's [PII] and my date of birth is [PII], and the policy is under my husband's name which is [PII].
[AGENT][NEUTRAL] Give me just a second.
[AGENT][NEUTRAL] Let me read this policy number back. I copied down 02.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 41.
[CUSTOMER][NEUTRAL] 08 yeah.
[CUSTOMER][NEUTRAL] 5262.
[CUSTOMER][NEUTRAL] That's what's on the paper, so I'm just reading it off the paper. I mean on the card.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It just says group number 26087.
[CUSTOMER][NEUTRAL] That's all it has on the card.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, I've got it here, [PII]. I just had an extra 6. Sorry about that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, can I just verify to your, uh, street address and email address please?
[CUSTOMER][NEUTRAL] Yes, [PII], and um my email is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So let me pull this claim up and see what it's saying.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so, um, line one of the denial, it looks like was a claim you had submitted. It was a date of service from [PII].
[AGENT][NEUTRAL] And it was for MSMC Cardiology.
[AGENT][NEUTRAL] That particular denial reads that the provider had already submitted a claim for that date of service and had been paid.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so it would pay directly to the. OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] To the uh
[CUSTOMER][NEUTRAL] No doctor. OK, that's fine. All right, um, now the infusions that I get every month.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] I go in to the doctor's office and they told me that that was covered.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I go every month, I get an infusion, I don't see the doctor. And the day that I do see the doctor, I don't, I haven't submitted that claim, because they do like, they, they do two things, because Florida Blue, they, you know, they will only let them charge me for one thing, so it's like $55 for both seeing the doctor and getting the infusion. But on the other time.
[CUSTOMER][NEUTRAL] It's just infusion. I go in and, you know, someone, um, you know, puts the needle in my arm and infuses the medication. Um, and it takes about 45 minutes.
[AGENT][NEUTRAL] OK. On the other dates that you submitted, there were quite a few. I can list them off if you needed me to, but they're all the same as far as the denial. They're all just requesting the explanation of benefits from the primary.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so they wanna know, they wanna, OK, I got the copies from the, so I already, I already have the copies of how much, um, you know, um.
[AGENT][NEUTRAL] Yeah, so any time.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] Any time that you're doing a claim on here since we're your secondary, you'll want to make sure that you have the explanation of benefits from your primary to submit with because um the examiner needs to be able to see what your primary insurance paid and then what the responsibility was for you.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Right, and I did send in what my responsibility was $55 and the unfortunately, which you know the doctor's office complained they say the insurance doesn't pay, um, they only pay them $10.99. So, um, you know, the $55 is mine even though they charge, I don't know if it's $150 or $200. I think it's up to $200 now that they charge for doing the infusion, but.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You only get paid $10 which is ridiculous, but.
[CUSTOMER][NEUTRAL] What can I say? And then the rest, you know, the 55, it's what I pay, but um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, I have these. I printed them now there's so many pages because when I print it, it comes out, I end up with one.
[CUSTOMER][NEGATIVE] 234 pages could be 4 pages plus the um you know, the claim form that they give me, you know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, which is like a, like a bill.
[AGENT][NEUTRAL] Yeah, do you want the claim number that you can write on there just to reference that these are what those are for? Do you have that?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, now how can I send this to you because I mean I don't have a fax machine, so I'm trying to figure out how I mean I probably have to go somewhere.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, if you're not able to upload them on the website, then the other way would just be sending it in the regular mail or faxing it.
[CUSTOMER][NEUTRAL] Can
[CUSTOMER][NEUTRAL] I see, OK.
[CUSTOMER][NEUTRAL] Alright, so I'm gonna have to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll probably maybe I can go and ask someone that has a, a fax machine to do, you know, let me fax them from there, OK, um, so my question now is, um, what is the, the number that I should put the.
[CUSTOMER][NEUTRAL] You were saying you were gonna give me enough.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] The claim number.
[CUSTOMER][NEUTRAL] Oh, is it a policy claim number OK, claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the claim number that this is for is 357.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 2636.
[CUSTOMER][NEUTRAL] 3572636 and is this for all of everything that's on there?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that's for all those dates. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, perfect. OK. And then, um, do you, you have a fax number?
[AGENT][NEUTRAL] Absolutely. The fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, so I can actually I can, I'm gonna have to ask somebody that has an office if I can use their fax machine because there's so many pages for each one, you know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEGATIVE] Of the uh of the claims, so there's like 4 or 5 pages. I don't know why it comes out like I don't know why they can't have like one single page that has everything. It's like, you know, it's all these pages. So anyway, but um, yeah, OK, so then that's what I have to do.
[CUSTOMER][NEUTRAL] I guess that's it.
[AGENT][NEUTRAL] Yeah, that's, that's all that's being requested, [PII], it looks like at this time. So yeah, if you send those, you should be good to go, OK?
[CUSTOMER][POSITIVE] OK, perfect. Alright, I appreciate your help thank you very much.
[AGENT][POSITIVE] You're very welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.