AccountId: 011433970860
ContactId: 91c05fe1-4696-4816-92e5-b6b111756ec6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 545739 ms
Total Talk Time (AGENT): 166766 ms
Total Talk Time (CUSTOMER): 184634 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/91c05fe1-4696-4816-92e5-b6b111756ec6_20250110T21:49_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, I was wanting to check, um, about a submission of some claims that I had made back in November.
[AGENT][NEUTRAL] OK, I can check claim status for you. Um, may I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And do you have the policy number?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes, 02515497.
[AGENT][POSITIVE] All right. Thank you. One moment.
[AGENT][NEUTRAL] For security, may I have your date of birth, mailing address, and email address?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you said that it was a claim um that you submitted to us?
[CUSTOMER][NEUTRAL] Yeah, and I've had 3 different claims that I kinda was wanting to check into and I think they were all probably around November, the end of November.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They were like resubmitted claims.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, Miss [PII], um, I'm looking at the history and um,
[AGENT][NEUTRAL] The only thing we have received in process is for [PII].
[CUSTOMER][NEUTRAL] OK, that might be one of them.
[AGENT][NEUTRAL] But that's the only one we have received as of today for this policy.
[CUSTOMER][NEUTRAL] OK, and what's the status on that one?
[AGENT][NEUTRAL] OK, for [PII], we did process. We send a benefit amount of $7.92 92 cents, which it was for the procedure done in the office, which we do cover the procedure. Um, the office visit was denied because we do not cover the office visit, so we just cover the procedure.
[CUSTOMER][NEUTRAL] OK. And how much was the procedure?
[AGENT][NEUTRAL] $7.92.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It only costs $7.92 for the procedure.
[AGENT][NEUTRAL] That's the charge amount they send us, yeah, $7.92 was applied towards the member's responsibility and that's why we picked up.
[CUSTOMER][NEUTRAL] OK, um, OK.
[CUSTOMER][NEUTRAL] And the office visit was like 50.
[AGENT][NEUTRAL] Let me check and see how much they applied for the office.
[AGENT][NEUTRAL] Bear with me let me pull the details because I'm looking at the explanation of benefits, one moment.
[AGENT][NEUTRAL] depending on the documents.
[AGENT][NEUTRAL] I'm so sorry it's taking a little bit to pull up the information.
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Uh, cause my Blue Cross and Blue Shield, whenever I look at it, they have two different charges for the McBride clinic. So the $488.01 I think is the procedure that you're talking about.
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yeah, uh, yeah, they applied $50 which, that $50 is the one that we did not cover.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so I shouldn't owe anything for the procedure portion.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And then, um, the one that is the doctor's visit, it shows that it was like 175 and that I may owe 5177, um, but I already had paid.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Whenever I went for that portion.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so I guess.
[CUSTOMER][NEUTRAL] So that should be covered too.
[AGENT][NEUTRAL] And it was not covered by us, but yeah, you can, if you want to, you can check with them and see, make sure that you don't owe anything. But yeah, if you pay out of pocket, more than likely it's just gonna show because of processing, um, and in the end of the doctors in the clinic, then more than likely they have a different amount or either a 0 or they have an amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then you guys don't have any information about the two DLO claims that I tried to resubmit?
[AGENT][NEUTRAL] No, we don't have any other claims that we have received as of today.
[CUSTOMER][NEUTRAL] So, when I've called before, they said that it was resubmitted on [PII].
[CUSTOMER][NEGATIVE] And they said that there would be a 90 day hold and I should shouldn't call any sooner than 30 days.
[CUSTOMER][NEUTRAL] So, but it's been more than 30 days now.
[AGENT][NEUTRAL] Yeah, I'm not sure what about a 30 day. I know that once we receive the claim, um, we take 7 to 10 business days to process the claim, um, and that's the most we take to process a claim, but we have not received that claim, so I'm not sure what happened to the claim, but it, it didn't get to us. Um, did you send it by fax, mail, or did they send it directly from the provider?
[CUSTOMER][NEUTRAL] So maybe that's the deal is I was talking with the DLO people and so maybe they just haven't gotten it to you guys yet.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, but yeah, they the provider should be sending it to you, but I guess you guys just haven't received it yet.
[AGENT][NEUTRAL] We have not.
[CUSTOMER][POSITIVE] OK, OK, well thank you very much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Nope, that's it. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good afternoon.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Yeah