AccountId: 011433970860
ContactId: 927f9eeb-69c4-44ea-8ccc-61064cadc1a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 416140 ms
Total Talk Time (AGENT): 192675 ms
Total Talk Time (CUSTOMER): 242317 ms
Interruptions: 13
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/927f9eeb-69c4-44ea-8ccc-61064cadc1a3_20250227T20:29_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. I'm here with [PII], uh, [PII] on the phone with us. How are you?
[AGENT][NEUTRAL] Fine. Who am I speaking with?
[CUSTOMER][NEUTRAL] Hey [PII], well, well, you're speaking with uh Ocean's Insurance. I'm [PII]'s uh personal insurance broker, and I got [PII] on the line with me. He was calling you guys earlier but he wasn't getting through on the verification. [PII], are you there? Yes.
[CUSTOMER][NEUTRAL] Um, ma'am, he, he, he, he, he would like to verify his information again with me on the phone because I'm trying to help him file a claim.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, and what is your name?
[CUSTOMER][NEUTRAL] You want my name or his name?
[AGENT][NEUTRAL] I need your name.
[CUSTOMER][NEUTRAL] Oh, my name is [PII] of Ocean's Insurance Group [PII].
[AGENT][NEUTRAL] OK, thank you. And [PII], what is the, uh, excuse me, a good callback number for you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] OK, thank you, and I actually have Mr. [PII]'s information. I spoke to him a moment ago.
[CUSTOMER][POSITIVE] Oh great, great, thank you. I, I remember my, uh, my, uh, email me, I couldn't, I got too much stuff going on.
[AGENT][NEUTRAL] OK, so that's fine. Let me get your information pulled back up.
[CUSTOMER][POSITIVE] Perfect. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Would it be better for Mr. [PII] to contact the hospital and just provide him with uh his APL and have them file direct? And will it cause any kind of conflict on what he's already done with you guys or?
[CUSTOMER][NEUTRAL] From that date, um, showing that this whole thing should have been 300.
[AGENT][NEUTRAL] Uh, just one moment, please.
[CUSTOMER][NEUTRAL] Ah.
[AGENT][NEUTRAL] OK, and [PII], if you could just please verify your email, your email address first.
[CUSTOMER][NEUTRAL] My email address is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so um if you would go ahead.
[CUSTOMER][NEUTRAL] It's [PII], then uh [PII]
[AGENT][NEUTRAL] And verify your email with me, Mr. [PII].
[AGENT][NEUTRAL] Mhm. OK, thank you. So on the two claims that we have, which you did set up your portal profile so you can log in to the online service center to see exactly what is needed because the remarks for those two claims that we have started to review are on page 2 of your explanation of benefits.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] Mhm, no, the issue that I was having was trying to get the, the bill from um from the medical group. It's been, it's been difficult to get like the itemized stuff that you guys were looking for.
[AGENT][NEUTRAL] Yes sir, so one of two things either you will, you know, have to obtain that from them and submit it to us, that information that we were in need of. You can try and see if if they would file your insurance for you, if they will allow you to provide.
[CUSTOMER][NEUTRAL] I'm looking to the claim because I have several.
[AGENT][NEUTRAL] That to them and they will do that, but that would be up to the to the provider. I always recommend that any time you go for medical services, you know, in the future always present them with your APL ID card and your primary health care insurance because it is a lot easier if if the provider will help you in filing.
[CUSTOMER][NEUTRAL] Mhm mhm. [PII], is the is the claim that you guys that you filed pertaining to the emergency room claim with Baptist or there's a second claim? No no it's.
[AGENT][NEUTRAL] It's multiple dates of service, 3 different dates of service that you filed claims for.
[CUSTOMER][NEGATIVE] What are those dates of service, it was, it was all the same day. It should have been [PII] and [PII] all all on one ELB from the insurance company.
[AGENT][NEUTRAL] And then there's also
[AGENT][NEUTRAL] OK, we received information from you also that was uploaded on [PII], Mr. [PII], related to a 12-15-2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was a claim form.
[AGENT][NEUTRAL] And it has the service date is [PII].
[CUSTOMER][NEUTRAL] Yeah, that was.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Let me see the date. Forgive me, I'm not in front of it, uh, but it would, it would all pertain to the same date.
[AGENT][NEUTRAL] OK, I'm not sure we have information on file for a a [PII] data service. The other claims information is for dates of service in October.
[CUSTOMER][NEUTRAL] And that should have been.
[CUSTOMER][NEUTRAL] OK no it should have been [PII]. [PII], [PII] was for the emergency room, which was, I'm looking at the, the EOB that you sent me the, hold on.
[AGENT][NEUTRAL] That's for claim number 3552109.
[AGENT][NEUTRAL] It's for the emergency room visits in October.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right. [PII], all, all one emergency room, correct?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So what do you, what do you guys, what do you guys need for the [PII]?
[CUSTOMER][NEUTRAL] And [PII] emergency room.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Specifically.
[AGENT][NEUTRAL] OK, um, I can read the remarks on the claim. Give me just one moment.
[CUSTOMER][POSITIVE] Yeah, but even if it was in p[PII]. Thank you.
[AGENT][NEUTRAL] For the [PII] and the [PII], we need the diagnosis code for the state of service and also the
[CUSTOMER][NEUTRAL] You mentioned it was $533. He paid over $2000.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, $2000 of his money for a $500.
[AGENT][NEUTRAL] Itemized hospital bills with the admission and discharge dates and times.
[CUSTOMER][NEUTRAL] OK, the diagnosis code, is that something we can give you over the phone or?
[AGENT][NEUTRAL] No, sir, it isn't. That's gonna have to come from the.
[CUSTOMER][NEUTRAL] So you're gonna find out what's going on with this plane.
[CUSTOMER][NEUTRAL] OK, so that, that takes me back to my, to, to my, my question I was trying to ask you.
[AGENT][NEUTRAL] The facility. Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I is he able to just contact the hospital in this case it's Baptist and Baptist and give him and give Baptist the American public life information and have them file with you? Will it, will it have any bearing on what you already have filed now or?
[AGENT][NEUTRAL] I yeah.
[CUSTOMER][NEUTRAL] Save by so I think some of it.
[AGENT][NEUTRAL] Um, this has been denied at this point. If they provided all of the, you know, information and depending on how they have the assignment of benefits, then, you know, if they file with complete information, any benefits payable would be paid to the facility.
[CUSTOMER][NEUTRAL] It seems like that.
[CUSTOMER][POSITIVE] Oh, OK, OK, so it will probably be easier to do that. OK, all right, well thank you so much. I appreciate it.
[AGENT][POSITIVE] Well, you are both very welcome. Is there anything else that I can help you out with today?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] No, no, that's all. Thanks, [PII]. Thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you both for calling APL. Have a wonderful afternoon.
[CUSTOMER][POSITIVE] You too you too you too bye bye.
[AGENT][POSITIVE] All right, thank you. Uh-huh.
[CUSTOMER][NEUTRAL] You