AccountId: 011433970860
ContactId: 8afdfb40-99d6-4e59-a7fa-6e38b7484eef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 877039 ms
Total Talk Time (AGENT): 447778 ms
Total Talk Time (CUSTOMER): 363741 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/8afdfb40-99d6-4e59-a7fa-6e38b7484eef_20250528T16:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII] um.
[CUSTOMER][NEUTRAL] Let me give you my information first so we can bring up the right account. Um, do you want the benefit certification number or the group number first?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I can take that certification number.
[CUSTOMER][NEUTRAL] OK, 01960211 M for Mary, L for Lisa, 8.
[AGENT][POSITIVE] Thank you and then uh what was your name please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then before we go any further, uh, [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright thank you and then just gonna verify some information really quick uh [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. The last thing I need is the email address that we've got on file for you. Looks like it is a Yahoo account.
[CUSTOMER][NEUTRAL] That would be [PII].
[AGENT][POSITIVE] OK, thank you for verifying all of that. What can we help you with today?
[CUSTOMER][NEUTRAL] Um, so I have a bill here all the way back from last February. They're looking to collect, collect some money for me and I called them and they're saying they sent the, they sent the bill to APL, so they said call up find out. So the data service was [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] And I have
[CUSTOMER][NEUTRAL] Uh huh do you show anything on that date on file for me?
[AGENT][NEUTRAL] OK, now was this for you or for uh one of your dependents or your spouse?
[CUSTOMER][NEUTRAL] Uh, this should be for myself. It doesn't say a dependent, just says.
[AGENT][NEUTRAL] It was for you, OK, give me just a moment let me try to find something for that data service.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, [PII]. Um, what was the name of the, uh, facility?
[CUSTOMER][NEUTRAL] South Miami Hospital or Baptist Health South Florida, one or the other?
[AGENT][NEUTRAL] OK. OK. Give me just a minute, let me take a look.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do have one it looks like it was a claim that uh well actually this was for.
[AGENT][NEUTRAL] [PII]. OK, never mind, let's take a look.
[CUSTOMER][NEUTRAL] For [PII] um I don't remember I think there was one around that time for him.
[AGENT][NEUTRAL] OK, yeah, so we did pay that claim I see that one let me check this other.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Critic care clinics.
[AGENT][NEUTRAL] No, I'm not showing that we've received anything from them for this date of service so they can um you you haven't paid anything have you?
[CUSTOMER][NEGATIVE] No they're asking for money they're saying they billed you guys. I wish I should probably get you both on the same line but I don't know if either of you can wait for each other so because I just spoke to them they're like.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I mean,
[CUSTOMER][NEUTRAL] We we build APL I'm like and they confirmed, you know, everything the group number, the outpatient hospital number, your, your address, your PO box, uh, in [PII].
[AGENT][NEUTRAL] Sure, all of the information, all of the information that um I have for this date of service has all been information that it's showing was sent in by you um or an insured and not by a facility or a provider so um we can verify they have this correct information or if it's easier you can just go ahead and submit that information [PII] um.
[AGENT][NEUTRAL] All we would need is of course the itemized statement that shows any diagnosis and procedure codes and then the explanation of benefits from your primary insurance. Sure, go ahead.
[CUSTOMER][NEUTRAL] Let me stop you for a second.
[CUSTOMER][NEGATIVE] Do I need an EOD? What do I need from them because this is just you owe us $100. No, there's no information here.
[AGENT][NEUTRAL] Yes, the
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I need EOB.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yes, so the primary EOB, so essentially showing what your primary insurance, uh, contributed on that date of service and the your provider will have that wherever you went for treatment, they'll have that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the um
[CUSTOMER][NEUTRAL] And then what else did you say?
[AGENT][NEUTRAL] Yes, the itemized statement that shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK, so them telling me they billed you is.
[CUSTOMER][NEGATIVE] Really like useless cause.
[AGENT][NEUTRAL] Well you can always try right I don't have anything um and I have no record of them sending anything to us as I said uh that being said I mean you can always ask them if they would give us a call and maybe we can just see if there was some sort of miscommunication that they might have incorrect information but if you would prefer you can absolutely just send this information in yourself.
[CUSTOMER][NEGATIVE] You don't have anything.
[CUSTOMER][NEGATIVE] Yeah it just seems like it's it's on my back now because they're like they're washing their hands yeah APL we haven't heard anything I'm like so.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You know they confirmed all the information but you clearly didn't get anything from them so.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And it is all keyed on the data service, right? I mean, unless they send you information that's incorrect, then of course you wouldn't know or right?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Right, so yes, again I just filtered in through [PII], um, and again all the information that we have is information that you had submitted.
[CUSTOMER][NEUTRAL] Right, and what did I submit to you?
[AGENT][NEUTRAL] So I've got one this is saying it's from Critic Care Clinics uh benefit that we paid of $100.
[AGENT][NEUTRAL] There was another let me take a look, give me just a moment.
[CUSTOMER][NEUTRAL] You tell me where you sent the payment to? Is that possible? So I can.
[AGENT][NEUTRAL] It would have been sent to you, sure, so the way that this policy works, yes, the way that this policy works is if the provider were to file the claim we would send that information or the benefit information to them that payment however if you file the claim we would send that to you.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, so I filed the claim on this?
[AGENT][NEUTRAL] That's what I'm showing you, sir.
[AGENT][NEUTRAL] Looks like it was through our uh online portal.
[CUSTOMER][NEGATIVE] Oh, so now I'm really lost so they didn't submit anything. I you you're saying I submitted something on the portal, huh.
[AGENT][NEGATIVE] Oh no.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][NEUTRAL] Can you give me the
[CUSTOMER][NEUTRAL] See if I have the APL should have it here. Let me just see if I can pull up APL's website, see what you're referring to.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, it's uh it's secured. [PII].
[CUSTOMER][NEUTRAL] Yeah, I have it here. OK, let me, uh, submit log in.
[CUSTOMER][NEUTRAL] OK, it's loading so.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Medliro Med support 1960211.
[CUSTOMER][NEUTRAL] Oh, that's me. OK, so.
[CUSTOMER][NEUTRAL] So I see a lot of things where it says upload confirmation like a lot of things say no files. What does that mean?
[AGENT][NEUTRAL] Um, OK, so I will say, um, our online portal has absolutely gone through, um, a bit of a transition, so it's a bit different than it was before, um, are you able to view any uh claims at all?
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Or do you see a section that would allow you to look at that information?
[CUSTOMER][NEUTRAL] Well, I see I'm looking at um 225-2024 for me. There was also [PII] that day.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] me as the applicant, [PII] is the dependent. I see a confirmation number that it was processed mine.
[CUSTOMER][NEUTRAL] Uh, amount paid 0 they completed 325, so I don't know. Oh, I have to click on the claim number to read more information, I guess there's a link here.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I'm opening up the claim number 343-533-33.
[CUSTOMER][NEUTRAL] See what it
[AGENT][NEUTRAL] OK, I'm viewing that one with you as well uh looks like for this one we're missing some information it states that we need the diagnosis code for the date of service.
[CUSTOMER][NEUTRAL] Where do you see that? I'm, I'm just looking. Oh please provide it. I, I see it on the second page.
[AGENT][NEUTRAL] No, you're OK.
[AGENT][NEUTRAL] Yeah I'm looking at a bit different. What I'm seeing is different than how you're seeing it. It's the same claim and everything. I'm looking in our actual system again our online portal kind of went through um a bit of a touch up lately so it might be a bit difficult to navigate.
[CUSTOMER][NEUTRAL] No, I, I see it it's it's fine, um, call them back and I need to find out, um, procedure codes for for what for what occurred, right? And then I.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Correct, um, now this one I'm showing this one is stating diagnostic codes or diagnosis codes, excuse me, um, and this one is showing it's from like, uh, critic care, uh, clinics.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Yeah, because it's it it's.
[CUSTOMER][NEUTRAL] It's, it's an urgent care.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which you guys typically the urgent care copays so whenever I had those I would send them over to well I would always give both my primary and my secondary and I don't know why they never you guys or I don't know why everything fell apart last year maybe it's just this this hos.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm not sure.
[AGENT][NEUTRAL] It might be
[CUSTOMER][NEUTRAL] This critical care place.
[AGENT][NEUTRAL] Every uh provider of course is very different like for example I do show several claims um that we've received from providers that we have paid um for different dates of service of course um like this one is from April of last year Beacon respiratory Services um it really does depend each provider you know they may or may not want to even mess with any sort of.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Secondary or supplemental coverage or anything like that, um, in which case, you know.
[CUSTOMER][NEUTRAL] That's for
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] I said that's ridiculous if someone comes in with a primary and why would they not secondary that's that's.
[AGENT][NEUTRAL] It is
[AGENT][NEUTRAL] Mhm.
[AGENT][MIXED] You're absolutely right, um, but it's unfortunately just one of those things that we do see from time to time, but that of course it is a little bit more roundabout for you unfortunately, um, but you can still file those claims regardless as long the general rule of thumb, as long as your primary insurance contributed then this policy can help.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So if it was something of course that your primary didn't pay anything on this policy can't but if your primary did you can absolutely still file those claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I will, uh, follow up with them and, um, try and get the diagnosis codes statement diagnosis, right? You don't need procedure, you need diagnosis was missing here.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I would go ahead and ask for that just in case this is for something different um if there were different things that were occurring on that date of service I would go ahead and ask for the itemized statement that shows diagnosis and procedure codes just to be safe um I'd hate for you to get it and there was something else and we weren't able to process it because that was missing and then of course the uh primary explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK, so primary EOB, which they should have because they would have received the EOB.
[AGENT][POSITIVE] Absolutely. Absolutely. You can get all of this information from that provider wherever you went for treatment.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Perfect thank you I'll I'll go bother them.
[AGENT][NEUTRAL] All right, I know that was information overload. Did you have any other questions for me [PII]?
[CUSTOMER][NEUTRAL] No, I just wanna get it all sorted out because it's over a year old and they're sending me, you know, you know.
[AGENT][NEUTRAL] I understand and I would of course too I don't know if it would do any good but the providers are more than welcome to give us a call as well and we can try straightening anything like that out if they're confused with anything.
[CUSTOMER][NEUTRAL] Yeah, it's just
[CUSTOMER][POSITIVE] Yeah it's like, you know, we build you so that's it that's what they told me well we build them.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] You know, so that
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] I don't know what you know but you already addressed you showed me I clicked into the thing they were missing information so you're not gonna do anything with it do you send that correspondence back to them hey you guys submitted this but you're missing something or you don't communicate back with the.
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well again
[AGENT][NEUTRAL] Right, so they weren't the ones to submit that information that that information did come from you through our online portal so again I'm not showing that they've sent us anything that we, we haven't received anything from them for this state of service.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] That's weird that I did it. I, I, I don't know that I've ever have you there are there a lot of them that I submit, or do you have to actually go through every one? I, I would imagine they do.
[AGENT][NEUTRAL] Um, let's see, well, um, I'm just looking at you. I'm not looking at your spouse or your dependents or anything for you. I have 12345. I have 5, and it looks like they were all done around the same time, um, between [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Everything else is information that we've received from providers.
[CUSTOMER][NEUTRAL] They were also
[CUSTOMER][NEUTRAL] And all those you just called out were all submitted by me?
[AGENT][NEUTRAL] Yes sir, that through that particular date frame, yes.
[CUSTOMER][POSITIVE] That's really interesting. I wonder why, why would I all of a sudden submit those.
[AGENT][NEUTRAL] It does look like it was all through our online portal as well.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] That's really weird. I don't recall. I mean, it's over a year ago. I don't remember what I did honestly or why.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yeah, alright, well thank you so much for all the information. Let me, I can move.
[AGENT][POSITIVE] Of course, absolutely, uh, let us know if you need anything else we'll do our best to help you out. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too thanks bye bye.
[AGENT][POSITIVE] Thank you bye bye.