AccountId: 011433970860
ContactId: 90710b60-4e2c-4b6d-809b-350703bf1b98
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 764780 ms
Total Talk Time (AGENT): 292613 ms
Total Talk Time (CUSTOMER): 242495 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/90710b60-4e2c-4b6d-809b-350703bf1b98_20250304T15:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATM. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I need to check the status on the claim.
[AGENT][NEUTRAL] OK, I can help you claim status can I please get your name and your call back?
[CUSTOMER][NEUTRAL] Is it'll be under my husband's name it's [PII]. Phone number is [PII].
[AGENT][NEUTRAL] OK, and what is the seat number please?
[CUSTOMER][NEUTRAL] It's 02505681 ML8.
[AGENT][NEUTRAL] OK, let me look up that policy.
[AGENT][NEUTRAL] OK, is [PII] there where I can get um a verbal consent to discuss his policy with you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, yes, one second here. Hi, how are you doing?
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi [PII], this is [PII] with APL. I just need your verbal consent to discuss your policy.
[AGENT][NEUTRAL] With um your wife. Can I please have her name?
[CUSTOMER][NEUTRAL] Yeah, let's uh
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then I just need you to verify your policy for me real quick, can you please give me your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then also your address, phone number and email address that we have on the policy for you, sir.
[CUSTOMER][NEUTRAL] OK, [PII] uh [PII] and what else you need?
[AGENT][NEUTRAL] Your cell phone number that's on the policy.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK thank you I appreciate you verifying your information for me. You can go ahead and put Ms. [PII] back on the phone now if you'd like to.
[CUSTOMER][POSITIVE] Thank you. I'm back.
[AGENT][POSITIVE] You're welcome, sir. Hi Miss [PII], this is [PII] back with you again.
[CUSTOMER][NEUTRAL] Yes mhm.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Your which claim are you checking? Do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Data service is 514 of 24.
[AGENT][NEUTRAL] 514 of 24.
[AGENT][NEUTRAL] OK, and do you know how much the charge amount is?
[CUSTOMER][NEUTRAL] The full charge is 213,000 but the charge that's pending is 6000 and something.
[AGENT][NEUTRAL] OK, and do you know what the name of the facility that um he went to?
[CUSTOMER][NEUTRAL] The facility is HC something Kendall Regional Hospital.
[AGENT][NEUTRAL] Kendall.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Alright, let me see if I can find that real quick for you guys.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, it's raining hard now.
[AGENT][NEUTRAL] Where are you guys at?
[AGENT][NEUTRAL] You're in [PII]?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So, yeah, [PII].
[AGENT][NEUTRAL] Are you guys in [PII]?
[AGENT][NEUTRAL] Yeah, we're supposed to be getting bad weather today too we're in [PII].
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Oh wow. Yeah, it's raining here now.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So looking.
[AGENT][NEUTRAL] On date of service of [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I see a claim but not the amount that you've given me and it's already been paid.
[CUSTOMER][NEUTRAL] And how much is that amount?
[AGENT][NEUTRAL] Um, it is, let's see, let's look at it. You've got one, claim 351-764-9 that was paid.
[AGENT][NEUTRAL] Uh, let me see what was that one was paid. Let me pull up the claim itself.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If they leave the phone.
[AGENT][NEUTRAL] OK, so the total paid on it was $708.33.
[CUSTOMER][NEUTRAL] 708
[AGENT][NEUTRAL] 70833 and it was paid to hospital medicine services. Let me, let me pull up that um check 2008313 the number.
[AGENT][NEUTRAL] I'm gonna look and see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, Hospital medicine Services of Florida.
[AGENT][NEUTRAL] And it was paid $708.33.
[CUSTOMER][NEUTRAL] OK, and that's for the
[CUSTOMER][NEUTRAL] OK, yeah, yeah, I'm, I'm aware of that one, but there's another one and they called the hospital and they said that on [PII] you guys have an acknowledgment of receipt and it's 6000 something.
[CUSTOMER][NEUTRAL] Um, that's, that was pending for an explanation of benefit or something apparently they resent it and they said it was [PII] that you guys did the acknowledgement. So I don't know if it's still pending to process or if you can check if you got it, and it's pending the process or.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't see anything for [PII], um, but let me keep looking because I do see that uh we have.
[AGENT][NEUTRAL] Multiple options for a claim.
[AGENT][NEUTRAL] And I'm gonna check to see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's pulling it up for me now.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Let's see if I find the claim number.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm looking I'm just clicking on everyone to see, OK, so the data service was 425.
[CUSTOMER][NEUTRAL] The what? I'm sorry?
[AGENT][NEUTRAL] 2024 to the day of service was [PII]. Does that sound familiar?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look on that data service and see what we have.
[AGENT][NEUTRAL] 35.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] It's gonna be just a second while I look at these claims to make sure I can find [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] No, no problem.
[CUSTOMER][NEUTRAL] Most of these say [PII], but April does ring a bell.
[CUSTOMER][NEUTRAL] [PII], did you have the surgery in April or May?
[AGENT][NEUTRAL] It looks like that
[CUSTOMER][NEUTRAL] For me.
[CUSTOMER][NEUTRAL] That's what I thought. Yeah, that's what I thought.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] I did find the the in reading the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm. Uh-huh.
[AGENT][NEUTRAL] Um, because.
[AGENT][NEUTRAL] The information that was sent in didn't say if there was a patient responsibility for deductible co-pay or co-insurance.
[AGENT][NEUTRAL] Um, so we need the primary carriers EOB.
[AGENT][NEUTRAL] Showing that there was.
[AGENT][NEUTRAL] Patient responsibility for deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] So that's what that's what you need.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And you can get the primary EOB from your primary insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And I think that I downloaded that it
[AGENT][NEUTRAL] And it's for data service.
[CUSTOMER][NEUTRAL] Did, can you see in, in through my, through the app, what I have?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Downloaded cause there's an explanation of benefit.
[CUSTOMER][NEUTRAL] That says I know deductible 6000 deductible use 6000.
[CUSTOMER][NEUTRAL] Um, and it's got that charge.
[CUSTOMER][NEUTRAL] Of the $6,652.
[CUSTOMER][NEUTRAL] Um, I don't know if that's what you're looking for.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I think I downloaded that in the APL app.
[CUSTOMER][NEUTRAL] And this comes from Aetna, which is the primary insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, and that is um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is the one that I that I read off to you that we need the explanation of benefits that matches the claim information.
[AGENT][NEUTRAL] And primary carrier's explanation of benefits.
[AGENT][NEUTRAL] That shows patient responsibility for deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, so you need an explanation of benefits that says what the patient deductible was and what it covered.
[AGENT][NEUTRAL] Right, that shows
[CUSTOMER][NEUTRAL] Is, is that, is that right? Is that the right word so I can call the hospital?
[AGENT][NEUTRAL] There's a patient responsibility for coinsurance.
[CUSTOMER][NEUTRAL] And patient.
[CUSTOMER][NEUTRAL] Responsibility for car insurance.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if there's any
[CUSTOMER][NEUTRAL] All right. So, and I, and, and that comes from the hospital or from Aetna?
[CUSTOMER][NEUTRAL] Which is the primary insurance.
[AGENT][NEUTRAL] That will come from your primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And then let me call then the primary care um insurance company and see what, if they can provide that.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, I'll try with that. OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and would you like the claim number so that you have that handy?
[CUSTOMER][POSITIVE] Thank you so much. Mhm.
[CUSTOMER][POSITIVE] Yes, please. Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. That's 354.
[AGENT][NEUTRAL] 7265.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK 354-726-5.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, let me call in now and then and find out what they can provide for me. OK, thank you so much. I appreciate it.
[AGENT][POSITIVE] OK, you're very welcome if you need anything else, please pick up the phone and call us, OK?
[CUSTOMER][POSITIVE] No problem thank you so much.
[AGENT][POSITIVE] You're welcome Miss [PII] thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye bye bye bye.
[CUSTOMER][NEUTRAL] Bye bye. Yes.