AccountId: 011433970860
ContactId: 94b100be-da51-492b-9ddb-a874f95aaaa0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 489839 ms
Total Talk Time (AGENT): 231776 ms
Total Talk Time (CUSTOMER): 231085 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/94b100be-da51-492b-9ddb-a874f95aaaa0_20250404T14:29_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah my name is [PII] and I have uh y'all's insurance as a supplement with my health insurance through my employer, and I just, I have a question. I have been going to the doctor, uh, had
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just like checkups and stuff and then I had a little procedure done and it's my understanding that your insurance helps pay towards our deductible of our health insurance, is that correct?
[AGENT][NEUTRAL] Um, the, the policy, the secondary policy is set up to help with the deductibles, co-payment, and co-insurance. Now, all the benefits are different based on the policy that you have or the policy that was offered to that group. Um, so what I can do is, um, pull your information and see what type of benefits you have under your policy, and we can go from there, Ms. [PII]. OK, um, let, let me have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] OK. OK. OK. OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number, Miss?
[CUSTOMER][NEUTRAL] Uh, yeah, let me get my card. Hold on one second.
[AGENT][NEUTRAL] Sure, yes.
[CUSTOMER][NEUTRAL] Alright, uh, policy certificate number is 01677933.
[AGENT][NEUTRAL] OK. For security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] OK, date of birth is [PII]. Email address is [PII]. And what else did you need?
[AGENT][NEUTRAL] The mailing address on file.
[CUSTOMER][NEUTRAL] Date of birth? Oh, my home address [PII].
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Perfect, thank you. All right, let's see.
[AGENT][POSITIVE] And bear with me just a minute. I'm just gonna pull all your benefits and see what we got, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because I got an EOB. I have Blue Cross as primary, and I got an EOB and I'm thinking why wasn't some of this maybe it hadn't been filed with y'all. I don't know, um.
[AGENT][NEUTRAL] Mm, yeah, it can be a possibility that we have not received it, but um, so let me go ahead and um tell you your benefits. This is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. Um, so you have outpatient and inpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, the outpatient benefits, you have 1000 per covered person per calendar year, and this includes office procedures, cancer procedures, lab work, doable medical equipment, emergency rooms, and a little bit more. Um, we have surgeries, diagnostic testing, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The, the only thing that I don't see is an office visit co-payment. So the office visit co-payment is the only thing that we do not cover, but we do cover procedures done in the office. Um, what is the date of service for that claim, for that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, I have several here, um, the first one I'll tell you that it's, uh, [PII] is who the provider is.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the date of service was [PII].
[AGENT][NEGATIVE] OK, so we don't have anything for [PII], so it has not been received.
[CUSTOMER][NEUTRAL] OK, so they need to, they, they need to file it, OK.
[AGENT][NEUTRAL] They need to send that, uh-huh, yes.
[CUSTOMER][NEUTRAL] OK, and then I, I have several. Can I just go through them with you?
[AGENT][NEUTRAL] Yeah, yes, go ahead. Uh-huh.
[CUSTOMER][NEUTRAL] OK, OK, next one, the provider is dermatology and Cosmetics Center of Oklahoma.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a data service for that one?
[CUSTOMER][NEUTRAL] Oh yes, I'm sorry uh 33 of 25.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] All right, so 33 of 25. Let me look at this claim and see if that's it. I do see one, let's see.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Now
[AGENT][NEUTRAL] Uh you lab.
[AGENT][NEUTRAL] And you said this one was for dermatology, right?
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Dermatology and cosmeticsent that.
[AGENT][NEUTRAL] OK, let me see if um the claim itself will have that information because this one is saying that it isn't.
[AGENT][NEUTRAL] Pathology or lab board or something like that let me see.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] This is yeah this is in the lab apology.
[CUSTOMER][NEUTRAL] Yeah, I had some I had some I had some pathology.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, so the one for the dermatologist's office, we did not receive. The only one we have is the uh um pathology lab associates.
[CUSTOMER][NEUTRAL] OK, so they need to file too with APL.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then, OK, so you have pathology service on 3325.
[AGENT][POSITIVE] Yes, that will be processed and paid. Mhm, yeah.
[CUSTOMER][NEUTRAL] So you have that one? OK.
[CUSTOMER][NEGATIVE] OK, and then, oh, they sent me, why did they send me two pathology bills from 3325 or 2 I'm looking at the EOBs is what I'm looking at from Blue Cross. They sent two, there's 22 charges on 33325 from pathology lab associates.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK. Um, it may be different charges, um, if you see that the uh name of the doctor, and doctor, is it the same?
[CUSTOMER][NEUTRAL] Let's see, we have reviewed the claim that's privilege to process following shows that the claim. Oh, they adjusted. OK, they adjusted it. So did you guys pay on that then?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, we pay the remaining $68.85.
[CUSTOMER][NEUTRAL] OK, so I shouldn't owe anything to them then. OK, there it is. I see it now. I wasn't looking down at the bottom of the page, just the top of the page, which happens. OK, so, uh, Doctor [PII]'s office and dermatology, they need to file the APL with you guys.
[AGENT][NEUTRAL] Yeah. All right.
[AGENT][NEUTRAL] It's OK. Mhm.
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] And then that, will that be everything that you have medical wise on me?
[CUSTOMER][NEGATIVE] So far.
[AGENT][NEUTRAL] Um, let me see, for, for this year, um, let's see.
[AGENT][NEUTRAL] Yeah, for this year, that's the only one we have received in pay. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, I will contact their offices and let them know that they need to file this with you guys and then they might get paid. So, OK, alright, well, I, I, I appreciate your help.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Ms. [PII] now?
[CUSTOMER][NEUTRAL] I don't think so unless there's something you need to tell me.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, no, so far, I don't see anything, anything here that is pending or anything here that, um, that we know that is missing. Yeah, OK.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. OK, all right, thank you.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day. Good weekend, Mr.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye you too bye bye.
[AGENT][POSITIVE] Bye bye. Thank you.