AccountId: 011433970860
ContactId: 88eb40cd-e253-4db1-a109-5e58a5254e9c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 493630 ms
Total Talk Time (AGENT): 254651 ms
Total Talk Time (CUSTOMER): 111984 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/88eb40cd-e253-4db1-a109-5e58a5254e9c_20250331T21:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], I wanted to get some information. I had submitted some um the uh uh EOBs, and I wanted to see if they have been processed.
[AGENT][NEUTRAL] OK, we just need to check on the status of those claims.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Got it. OK, we can take a look at that. What was your name?
[CUSTOMER][NEUTRAL] Oh, [PII] [PII].
[AGENT][NEUTRAL] OK and then can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yeah. Yeah, [PII].
[AGENT][NEUTRAL] Thank you. And then do you have your policy number?
[CUSTOMER][NEUTRAL] Sure, yes, um.
[CUSTOMER][NEUTRAL] 154993
[AGENT][NEUTRAL] I'm sorry, that was 15493.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, that's gonna be a bit too short to be one of our policy numbers. Oh, OK, I see. OK, give me just a moment let me try to find you that way.
[CUSTOMER][NEUTRAL] That's a group number.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] The city of [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm sorry, your last name one more time please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you one moment this is quite a large group let me try to find you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Um maybe I'm, I'm on Perez, could be too. Perez and Como.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, because I don't see Becommo. Let's take a look. Give me just a moment.
[AGENT][NEUTRAL] OK, and then could you spell your first name for me as well?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] There you are. OK, got it.
[AGENT][NEUTRAL] OK, awesome. I'm just gonna verify some information really quick. Um, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then can I get your um mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you. uh, looks like it's a Hotmail account.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Correct, [PII].
[AGENT][POSITIVE] Awesome thank you so much for verifying that information. Alrighty, bear with me just a moment, let me take a look at this claim.
[AGENT][NEUTRAL] OK, uh, so this looks like there was quite a lot of information submitted on this claim so there were a few items that were not covered, um, it did just complete processing today, um, so charges that are incurred in an independent lab are not going to be covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there were a few others that you filed that it looks like the provider had already filed that claim and so that that payment had already been sent to the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK. Let me ask you, when I go to the doctor to my general physician that I pay the $10 co-payment, uh, do I, is that mine or you guys cover that?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This policy is designed to help with copay, deductible and co-insurance. Now of course every facility or provider's office, they might be a bit different, um, they might be willing to bill you for that later or you know they some of them do require it up front, but either way, um, that is something that can be claimed absolutely um again as long as it's um for a covered service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think I claimed that, I think.
[CUSTOMER][NEUTRAL] Yeah, I think I claimed it. Did you, do you guys have that?
[AGENT][NEUTRAL] Um, I do see quite a bit here, so there are, I'm actually going to just go back and look if this is all from the same.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Provider, let's see.
[AGENT][NEUTRAL] Yeah, so any of these from Labor, uh, would not be covered as that's just simply not a covered facility under this policy, um, so the the independent labs just aren't covered. um, let me take a look at these others. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like there are a few.
[AGENT][NEGATIVE] That we are just missing some information.
[AGENT][NEUTRAL] And let me find out exactly where those were from give me just a moment.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, that was for um.
[AGENT][NEUTRAL] Pathology Associates.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK yeah so for those uh that you submitted from them it looks like we were just missing some information so um we would need the itemized statement that shows diagnosis and procedure codes so you can contact them they'll have that information and then you can just send that to us and we can continue getting those processed sorry?
[CUSTOMER][NEUTRAL] And who are those?
[CUSTOMER][NEUTRAL] And who, who are those?
[AGENT][NEUTRAL] This was for uh pathology Associates.
[CUSTOMER][NEUTRAL] And what day would that be on because I can.
[AGENT][NEUTRAL] This was from uh the date of service was [PII].
[CUSTOMER][NEUTRAL] OK, and what is it exactly that you need?
[AGENT][NEUTRAL] Yes, uh, the itemized statement.
[AGENT][NEUTRAL] That shows diagnosis, yes, yes, let me know when you're ready, uh huh.
[CUSTOMER][NEUTRAL] Let me write this down. I 9.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I my statement
[CUSTOMER][NEUTRAL] OK, are my statement?
[AGENT][NEUTRAL] Yes, that shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Mm let's see if they give that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And does it say what doctors are?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Does it say what doctor is that?
[AGENT][NEUTRAL] Uh, all of the pro the provider that I'm showing was pathology Associates.
[CUSTOMER][NEUTRAL] Yeah, I wouldn't know.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let's see, as for all of the others again, uh, you know, the lab core isn't covered and then um.
[CUSTOMER][NEUTRAL] Yeah, I wouldn't know.
[AGENT][NEUTRAL] I think that was Gastro Health South Miami Hospital, um, Vital MD Group Holding that information was sent to um the providers. They had already filed those claims, so we went ahead and sent that benefit payment to them.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, just wanted to see um what was the status. Thank you so much for your help. OK.
[AGENT][POSITIVE] Absolutely you should be getting that information of course you should be getting all of this soon as it just completed processing today, so you should be getting all of that here in a little bit. Did you have any other questions for me, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, no, that's it. Thank you.
[AGENT][POSITIVE] All right, of course, thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] OK, you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mm mm bye.