AccountId: 011433970860
ContactId: 924f05aa-5339-4974-ac9f-1102b0179937
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446019 ms
Total Talk Time (AGENT): 162474 ms
Total Talk Time (CUSTOMER): 173539 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/924f05aa-5339-4974-ac9f-1102b0179937_20250522T19:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, good afternoon. My, uh, let me see, my policy number.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's um I have to outpatient benefit and inpatient, so I have a claim for both.
[CUSTOMER][NEUTRAL] Let's start with uh outpatient 01986454.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] M as in Mary. L as in Larry, number 8.
[AGENT][NEUTRAL] OK. Can I get your first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII], [PII].
[AGENT][NEUTRAL] And then can you verify your address for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then you have a good callback number in case we're disconnected.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, Mr. [PII]. Um, what data service are we looking at?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I send you 3 faxes, 3 different claims. Uh, I just want to make sure you got it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK. Uh, let's see. It looks like we've got 2 for your outpatient policy.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Looks like we've just received 2 that are being indexed.
[CUSTOMER][NEUTRAL] OK, yesterday I sent 3 faxes.
[AGENT][NEUTRAL] OK. I don't think I can see what.
[CUSTOMER][NEUTRAL] Because 12 of them needed 2 of them needed an update, the explanation of benefits, and then another one went in for the outpatient, I mean for the inpatient, well that would be a different policy number.
[AGENT][NEUTRAL] OK, yeah, it's under, it's all under the same account though. Um, let's see. uh, what was the one for inpatient? Do you know who the provider was?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] The provider was Humana.
[CUSTOMER][NEUTRAL] And that took place in [PII].
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Let me see if I can pull up the images. They may not be in the system yet. I can see we've received something, but may not be able to see what they are yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Uh, looks like we've got
[AGENT][NEUTRAL] The claim form and then attached is
[CUSTOMER][NEUTRAL] All the procedures, billings, everything, it was a cardiac surgery.
[CUSTOMER][NEGATIVE] And the bill was, I don't know how much over 100,000, it, it, it went, I went through my out of pocket and deductibles, everything.
[CUSTOMER][NEUTRAL] So the hospital is 67 days and 6 days.
[CUSTOMER][NEUTRAL] Actually [PII].
[AGENT][NEUTRAL] OK, we got your [PII] blue.
[AGENT][NEUTRAL] Looks like your explanation of it.
[CUSTOMER][NEUTRAL] OK, we're talking again about [PII] was Humana.
[AGENT][NEUTRAL] OK, this, OK, I see it. This is for.
[AGENT][NEUTRAL] dates of service in [PII].
[CUSTOMER][NEUTRAL] Then [PII] Blue for the other [PII] and I mean [PII].
[AGENT][NEUTRAL] OK, let me get that pulled up, the other one that we received. OK, I see [PII].
[AGENT][NEUTRAL] Um, let's see so.
[AGENT][NEUTRAL] OK, yes, so it looks like we received one claim that has.
[AGENT][NEUTRAL] All the
[AGENT][NEUTRAL] From the Broward Health Medical Center, correct? For [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 29.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] And then at the end it's the explanation of benefits from Humana what they, what they cover.
[AGENT][NEUTRAL] OK, I see that. Yes, got that one and then the other one was from the [PII] Blue for dates of service in [PII].
[CUSTOMER][NEUTRAL] Yeah, so the other two you sent me a notice saying that you're missing explanation of benefits. I attached it now to and we sent the two claims with the EOB at the end.
[AGENT][NEUTRAL] OK, I see that.
[AGENT][NEUTRAL] Um, yes, so we've got that.
[CUSTOMER][POSITIVE] So I just wanna make sure you got it you have it and and there I've complied with all everything you need.
[AGENT][NEUTRAL] Yes, it looks like we have all the information and it's currently in processing, so it usually takes about up to 7 working days for our claims department to review and process.
[CUSTOMER][POSITIVE] Sounds good. So basically if I understand the coverage correctly, if I had to go through.
[CUSTOMER][NEGATIVE] Uh, through my, you know, you know, blow up my insurance and then everything I needed to pay was done then you cover that gap, correct?
[AGENT][NEUTRAL] Uh, yes, let me pull up what your amounts are.
[AGENT][NEUTRAL] Um, looks like for inpatient, um, and this is not a guarantee of payment, it's a basic outline of the policy. Inpatient pays up to 2000 per calendar year.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then your outpatient pays.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, the same, up to 2000 per calendar year.
[CUSTOMER][NEUTRAL] Yeah, so there were two in [PII]. The one was a kidney stone surgery outpatient.
[CUSTOMER][NEUTRAL] Uh, and then the, the one at Broward Health on the [PII], and then in [PII], there was another kidney stone, uh, surgery.
[AGENT][NEUTRAL] OK, yeah, it's, let's see, we've got to make sure.
[CUSTOMER][NEUTRAL] Oh, no, no, actually, what I was saying, it wasn't a kidney stone, it was a hip surgery.
[CUSTOMER][NEUTRAL] Memorial.
[CUSTOMER][NEUTRAL] See it.
[CUSTOMER][NEUTRAL] The 1 in [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, and I don't show you've used anything in [PII], so you'd have that full amount available.
[AGENT][NEUTRAL] And same for [PII].
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] That's correct
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So as far as you can see it looks complete right?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][POSITIVE] OK, thank you. I'll wait to hear.
[AGENT][NEUTRAL] OK. Anything else I can help with, Mr. [PII]?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Do you notify by email or how do you notify?
[AGENT][NEUTRAL] Uh, we will mail you an explanation of benefits, and did you upload these on our portal?
[CUSTOMER][NEUTRAL] I can't get in because I'm not not active.
[AGENT][NEUTRAL] Oh, OK, OK, so did you fax or you faxed them to us? So we'll, we will send you a notification by mail. It will be by regular mail.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can you do it by email?
[AGENT][NEGATIVE] Uh, no, unfortunately not. We don't have a secure way to send that, so.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] OK, thanks for calling [PII]. I hope you have a good day.
[CUSTOMER][POSITIVE] Have a good day have a good weekend bye.
[AGENT][POSITIVE] Thank you, bye-bye.