AccountId: 011433970860
ContactId: 915b0e3d-1d97-4dd4-ae0a-7411be025279
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391540 ms
Total Talk Time (AGENT): 147197 ms
Total Talk Time (CUSTOMER): 170791 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/915b0e3d-1d97-4dd4-ae0a-7411be025279_20250613T21:13_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes ma'am um I am calling regarding a benefit that I mean a benefit, a claim that I have out there that I don't know there's been quite a bit of back and forth and I'm not really sure what the issue or status is would you be able to help me?
[AGENT][NEUTRAL] Yes, ma'am. I can verify claim status for you. And your name is?
[CUSTOMER][NEUTRAL] OK, my name is [PII], my last name is [PII] and it's [PII]
[AGENT][NEUTRAL] And Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] You know, I don't know that I have that handy. Um, would you be, I think it's, I think, uh, maybe I'm, is it 0 02446824?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It could be, give me one moment.
[AGENT][NEUTRAL] Uh yes, ma'am, and verify your date of birth, mailing address and email address for me, please. Excuse me.
[CUSTOMER][NEUTRAL] [PII] and my date of birth, wait, my mailing address is [PII].
[AGENT][NEUTRAL] OK, and your email address?
[CUSTOMER][NEUTRAL] I guess I don't know what you show if it's my work email [PII] or [PII]. It's one of the two.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. It's your work email. And um do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And it is a cell number or work number?
[CUSTOMER][NEUTRAL] It's my personal cell.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't think most people have home phones anymore.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, and Ms. [PII], do you have the data service you're inquiring about?
[CUSTOMER][NEUTRAL] Um, I don't know what the data services. It's just the one claim that's out there.
[CUSTOMER][NEUTRAL] There should only be one.
[CUSTOMER][NEUTRAL] And it's having to do with University of Miami.
[AGENT][NEUTRAL] It's University of Miami Hospital looks like for [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, yes, yes.
[AGENT][NEUTRAL] OK, it looks like they were needing the one moment.
[AGENT][NEUTRAL] Uh, itemized billing and primary EOB.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] I did send that.
[AGENT][NEUTRAL] Let me see, give me one moment.
[AGENT][NEUTRAL] I'm on computer.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] OK, it looks like um it was received and the claim processed as a primary paid in full. Meaning on the explanation, it means on the explanation benefits we receive, it does not show primary insurance applied anything towards deductible, co-pay or co-insurance. And that's what uh this policy is secondary does.
[CUSTOMER][NEUTRAL] What does that mean?
[CUSTOMER][NEUTRAL] Well, I did not know that. I thought it was well it's because I'm in the process of meeting my deductible.
[CUSTOMER][NEGATIVE] And that I mean that doesn't make sense.
[CUSTOMER][NEUTRAL] And I paid the full amount myself.
[AGENT][NEUTRAL] OK, well, um, for the explanation of benefits, it looks like they paid the allowed amount. It shows patient liability.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But it doesn't show anything applied towards deductible, co-pay or co-insurance, and that's what the policy picks up as secondary.
[AGENT][NEUTRAL] So if the primary doesn't apply anything, there's nothing for us to pick up and pay it secondary.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] It's wait, wait, wait, explain that again if the primary what?
[AGENT][NEUTRAL] Does not apply any amount towards, OK.
[CUSTOMER][NEUTRAL] I mean that's going
[CUSTOMER][NEGATIVE] Yeah, that's going towards my deductible, but I haven't met anything so I'm paying the full amount.
[AGENT][NEUTRAL] Well, part of the explanation of benefits we received, it doesn't show any amount applied towards the deductible.
[CUSTOMER][NEGATIVE] Wow you guys and I'm sorry and I don't wanna shoot the messenger, but this is really ridiculous. I mean you've got you show my re my receipt that I paid out um and yes that is going against my deductible because it's part of my policy.
[CUSTOMER][NEGATIVE] It's just it's one of the few, the initial charges of of my of my policy so how in the world do I fix this now because I have been going back and forth with you all for several weeks now and it's really exhausting.
[AGENT][NEUTRAL] Well, you can contact your primary uh insurance to verify if they're gonna reprocess the claim, but
[CUSTOMER][NEUTRAL] So what document do you need now?
[AGENT][NEUTRAL] There's no other information we would need unless you have another EOB where it shows amounts were applied towards deductible, co-pay or co-insurance for this data of service.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So it needs to be applied towards deductible or what? or co-insurance?
[AGENT][NEUTRAL] Deductible, co-pay, or co-insurance in order to be covered by the secondary.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] OK, let me, I'm gonna call them right now and I will look into that. This is just too much but anyway that's fine. I'll I'll call and I'll see what what they tell me, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, thanks.
[AGENT][POSITIVE] Alright, you're welcome. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Yeah, yeah.