AccountId: 011433970860
ContactId: 965a9a76-c96d-445f-a179-785a8cbf6a9e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 599119 ms
Total Talk Time (AGENT): 308491 ms
Total Talk Time (CUSTOMER): 148245 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/965a9a76-c96d-445f-a179-785a8cbf6a9e_20250218T18:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII], and uh I have insurance with you guys. I have a question.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I did a surgery in December.
[CUSTOMER][NEUTRAL] For United um University of Miami Healthcare System.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I have done the same surgery 2 years ago.
[CUSTOMER][NEGATIVE] Is the eye surgery, and they didn't charge me anything. And now I received the bill for $92.50. They say APL is not gonna pay. I wonder why.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah we could definitely take a look. Let's first make sure that we did receive that claim and see what's going on with that, [PII]. um, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3991664
[AGENT][NEUTRAL] Thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 01823316
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, [PII], just gonna verify some information really quick. Can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you for verifying that information. Give me just a moment, let me take a look. I'm sorry, when did you say that the surgery was?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Uh, the surgery was done in December.
[AGENT][NEUTRAL] It was in December. OK, let me take a look here. Give me just a moment.
[CUSTOMER][NEUTRAL] Uh, [PII] or I'm not sure. I'm so oh, I'm sorry, [PII].
[AGENT][NEGATIVE] No, no.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, OK. All right. Well, the reason I ask is that I am showing your policy is no longer active. Um, it looks like it did terminate, uh, [PII]. So if that's the case then that you're definitely active during that time. So let me take a look here.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct. Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Oh goodness, let's see. What was the name? Uh, you said it was Miami uh University Hospital, is that right?
[CUSTOMER][NEUTRAL] Yeah, the name of the thing. Let me see if I found it.
[CUSTOMER][NEUTRAL] You have University of Miami Healthcare.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Miami health system.
[AGENT][NEUTRAL] All right. Bear with me just a moment.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Probably what that happens is they received the claim in December.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] 00, OK.
[AGENT][NEUTRAL] That makes sense to see.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I the
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] But you don't know the exact date of service [PII] just said it was in October? Oh, OK, yeah, what was that exact date?
[CUSTOMER][POSITIVE] Yes, I do.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, that helps. Give me just a moment.
[CUSTOMER][NEGATIVE] And then another one, they, for this one they charged me $50. The other one was [PII], they charged me $42.50 dollars.
[AGENT][NEUTRAL] OK, let's take a look at this one first just to make sure we did receive it.
[AGENT][NEUTRAL] I see one from Miami medicine.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I was gonna this one states it's for $114. We did not pay a benefit, so let me check and make sure this is correct. OK, well this might be the same for all of them then, um, so the denial reason for this one is that your outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] For how much?
[AGENT][NEUTRAL] That might be why they were unable to.
[CUSTOMER][NEUTRAL] Oh, that can be.
[CUSTOMER][NEUTRAL] How much was my benefit? For how much?
[AGENT][NEUTRAL] Let's see. Give me just a moment, let me get back here.
[AGENT][NEUTRAL] So it looks like that outpatient benefit was $6000 per calendar year. So let me take a look. I'm gonna go back through these claims.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't remember going to the doctor that many times for 6000.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] OK, so there's a big hefty one that we paid that was [PII], um, was that date of service we paid $3,307.94.
[CUSTOMER][NEUTRAL] For what?
[AGENT][NEUTRAL] And it let's see, there's oh there's several for [PII], let's see.
[AGENT][NEUTRAL] There was another one for $1,075 214 dollars.
[AGENT][NEUTRAL] Another for 214. Let me take a look, um, because this was all [PII], so let me, let me look at these.
[CUSTOMER][NEUTRAL] For who?
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] This one does state that was uh UMHC so I imagine that's University of Miami um I could get that exact information but this one is stand alone one that was $3,307.94 and let me take a look at these others.
[CUSTOMER][NEUTRAL] 33,300.
[AGENT][NEUTRAL] Mhm, yes ma'am, let's see.
[AGENT][NEUTRAL] And there's another one that's uh you Miami Medicine um that was again still uh [PII] and this one we paid $1,075.62.
[AGENT][NEUTRAL] And there are two separate um claims that we paid $214.20 on that or each of those.
[AGENT][NEUTRAL] Let me see who that is from.
[CUSTOMER][POSITIVE] Oh wow.
[AGENT][NEUTRAL] That's also, OK, that's you Miami medicine and that says, I think that's anesthesiology for those.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] Let me verify them.
[AGENT][NEUTRAL] Yeah, both of those were for anesthesiology, um, and then we've got another from [PII] that was $634.89.
[AGENT][NEUTRAL] With another of $34.50 I could check that one too let's see.
[CUSTOMER][NEUTRAL] For who?
[AGENT][NEUTRAL] OK, this one says it's for Elite imaging LLC.
[CUSTOMER][NEUTRAL] But they don't say what?
[AGENT][NEUTRAL] Oh, I could take a look to see if you want to see exactly what it was, let's see.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, so this states.
[AGENT][NEUTRAL] Magnetic resonance. I'm sorry that this is not my strong suit reading this in geography.
[AGENT][NEUTRAL] Neck with uh so yeah so essentially an imaging so that would be like an MRI or a CT scan um that was looks like it was around the neck area.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so that was that one I could go back further if you'd like, but this does appear to be accurate from there I do see a few in July and April that were payments of $75 194 dollars 42 cents, $50.39 dollars 45 cents, so I do believe that that is accurate.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] For that, uh, for the neck, a CAT scan from the neck, how much did you pay?
[AGENT][NEUTRAL] Uh, that 10 my goodness, I could go back. Let me see. I think that was about over $600.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Yeah, this this month is definitely um correct.
[AGENT][NEUTRAL] Yeah, that was $634.89 well sorry.
[AGENT][NEUTRAL] $668 sorry about that.
[CUSTOMER][NEUTRAL] But that was only for my neck, right? Because I had another CAT scan to be done, and they never did, and I wonder if they charged for.
[AGENT][NEUTRAL] And this was for [PII] and that's the only thing instance that I see for that um for that medical imaging test or magnetic imaging test.
[CUSTOMER][NEUTRAL] And they, and they say that the CAT scan from the neck.
[AGENT][NEUTRAL] Yeah, that was from [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] All right, I thank you.
[AGENT][NEUTRAL] Of course, yeah, did you have any other questions for me, [PII]?
[CUSTOMER][NEUTRAL] No, I think I have to pay my bill.
[AGENT][POSITIVE] All right, sorry about that. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Yeah, me too. Bye bye, thank you.
[AGENT][POSITIVE] Of course thank you bye