AccountId: 011433970860
ContactId: 8a507c89-9646-4a6d-9d2b-8ab6ffdf48d4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 965960 ms
Total Talk Time (AGENT): 492855 ms
Total Talk Time (CUSTOMER): 392650 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/8a507c89-9646-4a6d-9d2b-8ab6ffdf48d4_20250131T17:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII], and, um, I need help trying to figure out how to do the claim here. I'm having, I don't understand, I submitted the forms in, but I don't, I don't know what, I don't know how to do this. Can you help me?
[AGENT][NEUTRAL] Yes ma'am I can help you Ms. [PII] um can I get um with your claim, can I get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And then Ms. [PII], what is your uh policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Does it have it on here? Because all I see is a oh I see OK um.
[CUSTOMER][NEUTRAL] I guess I have to download the card it's telling me.
[AGENT][NEUTRAL] Um, you could give me your social security number if you wanted me to pull it in that way.
[CUSTOMER][NEUTRAL] Uh, OK, here it is.
[CUSTOMER][NEUTRAL] OK, um, yeah because it's telling me you couldn't download it. It's [PII].
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEGATIVE] It's not letting me download it. Could not download browser browser crashed.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] OK [PII], for security reasons can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Thank you ma'am, and then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Um, I don't know if you have, um,
[CUSTOMER][NEUTRAL] [PII] or [PII].
[CUSTOMER][NEUTRAL] Uh, [PII], um, phone number is [PII].
[CUSTOMER][NEUTRAL] Um, what else did you ask me? The email [PII] or now the card opened up at [PII] or it could be at live or it could be [PII] or at live at over.
[AGENT][NEUTRAL] It looks
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, ma'am. It looks like it's um for your work.
[CUSTOMER][NEUTRAL] Oh, and, uh, [PII].
[AGENT][NEUTRAL] Yes, that's correct. And the address that I have is a [PII] box number.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, [PII]. It's so weird because like I can't get mail at my address, so it's kind of sometimes a pain, um, so I have to give them like the PO box physical post office box number which is crazy.
[AGENT][NEUTRAL] Oh, yes. Yes, ma'am. I understand.
[CUSTOMER][NEGATIVE] So I, I never, I can't keep track.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh, that's OK that's OK, but we've got the PO box and we have your work email address so um just so you'll know, I do see that um a claim was sent in today.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Did you, and you.
[CUSTOMER][NEGATIVE] Well, I just uploaded another paper cause I, I got a bill from [PII] Sinai, the hospital, so I uploaded that, but it's like this is not a bill basically because I paid the $150 and that's the bill I sent to you guys that I paid the receipt, but it shows that all those other ones like it doesn't show me anything, it's like a zero amount and I don't understand where did the money go from the other ones that were paid out? Like I don't know how this all works. Like I don't.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEGATIVE] I'm so confused.
[AGENT][NEUTRAL] Yes, ma'am, I understand. I do see that, um,
[AGENT][NEUTRAL] We need copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] What? OK, let me write that down. I don't even know what that is called.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And I'm what I'm gonna do is I'm gonna give you a website to go to because we have a cheat sheet on our claim form.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] I use it all the time when I'm helping people.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] It's really, it, it's really beneficial. Um, if you go to our website at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm on the website.
[AGENT][NEUTRAL] Click on claims and forms.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you're gonna choose the Medin claim form. It's M E D L I N K. I think it's the second page and it's gonna be the third one down.
[CUSTOMER][NEUTRAL] Um, OK, let me see.
[CUSTOMER][NEGATIVE] Second page gotta shrink this. It's like all big um Need link claim form download form.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When you download it that very first page that comes up.
[CUSTOMER][NEUTRAL] Let me print that.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Well, did they take it? Oh, that very first at the top, at the very top. You'll see instructions for the insured or patient. You'll need, it'll tell you what you need. You need the itemized bill with the diagnosis from the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You'll need the explanation of benefits from your primary insurance carrier along with your claim form. All three things need to be together when you send your claim in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so when I, because we just switched um.
[CUSTOMER][NEGATIVE] Insurances and now we have Florida Blue, which I have no idea. I, it's so much more than what we were paying before like everything's gone up, I know, but I'm just like, and I have all these, I have to get this procedure done and I'm like, I'm just so overwhelmed with these bills right now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah. Yeah.
[AGENT][POSITIVE] Yes, ma'am. I'm so sorry. It is a lot. Now, the, um, insurance that you had on the date of service when you went.
[AGENT][NEUTRAL] And the day that you had the service done, you'll need the explanation of benefits from that insurance carrier, the insurance you had on that day of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I don't, I think I have to call them to get it cause I, I have no idea. Like, I don't see anything on their website.
[CUSTOMER][NEUTRAL] Um, I don't know if it's under my claims cause I, I'm just, I need to see cause like all these bills are adding up.
[AGENT][NEUTRAL] Yes, ma'am. Well, just know if it.
[CUSTOMER][NEUTRAL] And then I, I have another major surgery.
[AGENT][NEUTRAL] If it helps you any to help ease your mind a little bit, just know with us there's not a timely filing limit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So as long as your insurance was active on the date of service, you can file your claim at any time.
[CUSTOMER][NEGATIVE] OK, see, and I didn't understand how some of those things got paid and then some of them didn't, so I'm so confused because it like one of them shows $250. Like where did that go? amount paid, who did they pay that to or the amount $50? How do I know? It doesn't tell me where that was paid to.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] Do you have um a claim number and I can look at it and tell you?
[CUSTOMER][NEUTRAL] Um, like this one, it says 341-923-9.
[AGENT][POSITIVE] Yes ma'am, let me look at that one for you.
[AGENT][NEUTRAL] That one was paid $50 because your this insurance is your supplement. It's your secondary insurance. So the primary is billed first and then we're billed second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And it helps with
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Uh, deductible, co-pay, and co-insurance. That's what this insurance helps you with. So this one was paid to, let me look real quick and see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I gotta pull up the check so I can tell you who it was sent to.
[CUSTOMER][NEUTRAL] Yeah, I I'm just confused like who.
[CUSTOMER][NEUTRAL] How this all works.
[AGENT][NEUTRAL] OK. Yes, ma'am. OK, so that claim number that you gave me, $50 was paid to Fisherman's Health.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so.
[CUSTOMER][NEUTRAL] The itemized portion that comes from the doctor.
[AGENT][NEUTRAL] Yes, the itemized statement with your diagnosis and procedure codes on it comes from the doctor's office, the physician.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the explanation of benefits comes from the insurance, so.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Not my insurance policy? Like I'm not really sure, you plan activity.
[AGENT][NEUTRAL] The insurance company.
[AGENT][NEUTRAL] So when um so when you go to the doctor and they file your file on your insurance, it's called a claim when they file the claim for you, they're they're going to send it to your insurance company. Your insurance company pays their part and that's called an EOB is what they send back explanation of benefits to show where they paid their part, so you would get that from the insurance company.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, sometimes the doctor's office has it. You can ask them and if they have it, then you only have one call to make and you can get your explanation of benefits and your itemized statement all right there. Sometimes they don't. If they don't have it then you'll have to call your insurance and tell them I need my explanation of benefits for this date of service and give them the day, and they should be able to um send it to you.
[CUSTOMER][NEUTRAL] And all of, so I don't remember I I never filled out this form, so they all need this form.
[AGENT][NEUTRAL] The ones that that you're filing for yourself. Now the ones that are already paid.
[AGENT][NEUTRAL] They were all paid to
[CUSTOMER][NEUTRAL] Cause I never filled that form out, I don't think.
[AGENT][NEUTRAL] Right, right, your, um your provider, the office that you went to like Fisherman's, they filed the claim for you.
[AGENT][NEUTRAL] So you won't have to file again on those because then it'll come back to us as a duplicate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we'll send you a letter telling you it was a duplicate claim, so the ones that were paid that I'm showing and I can give you all the claim numbers.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] All of these were paid to the provider where you went and had your services done.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the first one is the one that
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] You gave me that was paid to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, cause I've been giving them that number like cause like the hospital I gave them that, but I gave like Mount Sinai that um the the little card, the paper that you guys have, the little, you know, I guess insurance card, and they didn't pay it, they made me pay 150.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEGATIVE] So I got a bill from Moun[PII] saying that this is not a bill, but it says I paid 150 and I got the receipt that I paid 150 and then this is saying that it's pending the insurance, but then Florida Blue sent me a statement.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, but it's like a statement. I don't really know if this is what you're asking for. Is this what because it just says same activity and totals and stuff. This particular bill I'm looking at one it says one, not one.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] It will actually say explanation of benefits or it'll say EOB on it.
[CUSTOMER][NEUTRAL] OK. Is this just says um,
[CUSTOMER][NEUTRAL] This is just, it just says it says explanation of the amount showed um based on my policy what was paid.
[CUSTOMER][NEUTRAL] So this is not it, because it does, it keeps saying explanation of amount shown, but this is a statement from Florida Blue.
[AGENT][NEUTRAL] OK, um, it's an explanation of amount shown that is showing your benefits that were paid for that date of service, it'll have it all, um.
[AGENT][POSITIVE] I'll laid out for you it'll tell you exactly what was paid for each benefit and they'll have um procedure code.
[AGENT][NEUTRAL] Um, procedure codes are 5 digits long, OK.
[CUSTOMER][NEUTRAL] Oh yeah, so this is it then because this is a statement and it does.
[CUSTOMER][NEUTRAL] Yep, because it does say procedure code date of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I match this up with, with.
[AGENT][NEUTRAL] And then it also your
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, and I'll have your diagnosis code and the diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, usually starts with a letter and two numbers.
[AGENT][NEUTRAL] Like ICD 10.
[CUSTOMER][NEUTRAL] It has description of service.
[AGENT][NEUTRAL] So have
[CUSTOMER][NEUTRAL] Procedure code amount billed amount paid.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Amount of deductible.
[AGENT][POSITIVE] Yes, that's what you need. You need.
[CUSTOMER][NEUTRAL] OK, so save the statements, got it.
[AGENT][NEUTRAL] Yes, that's what you need. That's, that sounds like it's a, uh, OK.
[CUSTOMER][NEUTRAL] OK, so, and I can keep trying this until I figure this out because so do I need to fill out this form every time though?
[AGENT][NEUTRAL] I would because you've been um.
[CUSTOMER][NEUTRAL] When I submit a claim?
[AGENT][NEUTRAL] Yeah, when you submitted claims, uh, you didn't have everything that you needed?
[AGENT][NEUTRAL] So I would do the claim form, the explanation of benefits, and the itemized statement and send all three together at one time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause, so I guess I got a call. I don't even know. I'm like, so.
[CUSTOMER][NEUTRAL] I know my bill, so that's a bill from the provider that they gave me. OK, so I guess I gotta call all these people, OK.
[CUSTOMER][NEUTRAL] And then upload them.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] And just remember you need those 3 things on your claim to have everything that you need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I have to organize all. I'm trying to organize all these papers and, OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, you're very welcome, and I promise you.
[CUSTOMER][NEUTRAL] And you said there's no time frame for them?
[AGENT][NEUTRAL] There's no time limit on filing a claim with us as long as you had coverage on the date that you went to the doctor, the date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I'll, I'll try and organize that. OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And look, if you get stuck again, if you get stuck again, pick up the phone and call us, we'll help you through it. I promise you by the time you get done with all this, you'll be, you'll be uh a pro at it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, I'm just, I'm just freaking out cause I gotta have another procedure done and I'm like, I don't know how much this one's gonna be cause it's a surgery where they have to go in and close the hole in my heart. So I'm like, oh, this is gonna be fabulous.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh bless it.
[AGENT][POSITIVE] Yeah. Well, I really, I'm gonna pray for you that everything goes well for you, for your surgery. And you're very welcome. I know it's a little overwhelming and can give you anxiety, but, but you're gonna be OK. You're gonna get it. It's gonna be all right. And just take your time. You're very welcome.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Well, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, you have a blessed day and thanks for calling APL.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] You're welcome. Bye-bye, Ms. [PII].
[CUSTOMER][POSITIVE] Thanks. Bye-bye.