AccountId: 011433970860
ContactId: 97f652ee-fdb3-4ad6-be7a-33ec8c5b50a0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 759440 ms
Total Talk Time (AGENT): 358845 ms
Total Talk Time (CUSTOMER): 193431 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/97f652ee-fdb3-4ad6-be7a-33ec8c5b50a0_20250328T18:42_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] Um, yes, hi, I have a question. Um, I have, I'm receiving bills for a claim that was submitted, um, for a colonoscopy that I did back in [PII], um, and APL always covers the, the those balances, but they keep billing me so I wanted to know before I call them if they ever sent you or APL a copy of that claim or the claim to be paid.
[AGENT][NEUTRAL] OK. So you're the insured and you're wanting to see if we have received a claim for you for a, a colonoscopy that you said you had in [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Yes, ma'am, I can help you with that.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][NEUTRAL] OK. You're welcome. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, and your policy number please?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Sorry, my policy number.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] There's a group number then there's an in in hospitals and outpatient, the one that.
[AGENT][NEUTRAL] You can get the outpatient number. Mhm, you can give me the outpatient number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02035268 M as in Mary L 8 again.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and [PII], I will need to verify several things with you first for security and then also any information that I provide for you today would be a verification of benefits and not a guarantee of payment. So first off you please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And also
[AGENT][NEUTRAL] Your home mailing address please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same. I I'm sorry, it is not the same as what you gave me. What is another phone number that we could have had have on file for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, is it still a valid phone number for you?
[CUSTOMER][NEUTRAL] Yeah, that's my cell number. I thought you had asked for a callback number, so I just gave you my home number because that's where I am right now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, yeah, no, that's, that's fine. Yes, I did initially ask for that, but this phone number that we had on file was different, so we do have your cell number is the one on file. So what is your email address?
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, it should be [PII] or it could be [PII]. OK, I have two emails.
[AGENT][NEUTRAL] OK, thank you. Let me.
[AGENT][NEUTRAL] Yeah, that that is the one that we have now, um, one question before I pull up to see if we received that claim, have you ever set up your profile, [PII], in our online service center so that you can have access to your ID cards, policy information, and claims information online?
[CUSTOMER][NEUTRAL] I don't think that I have for APL. I did for United Healthcare, but not for APL, I don't think.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well I have a user guide that explains how to set up the portal and also gives you some information on the different things you can do within the portal and I'll be happy to email that to you when we get off of our call so that you can set that up.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK, so let me see, you did say it was for [PII], is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Do you have a total bill amount for that particular data service?
[CUSTOMER][NEUTRAL] Um, yeah, they're billing me $884.50 from Broward Specialty Surgery Center.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] OK, we do have several claims on file for you specifically for I'm just gonna, it's gonna take me a moment to look through them to see if we've received one.
[AGENT][NEUTRAL] Um, for them, so give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, um, now we received, uh, of course I can't, I don't see anything that shows 88,450, right? $884.50. Now we did receive a claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, let me keep looking. I need to look at a couple more things.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so no, we have not received we did receive one claim from the facility.
[AGENT][NEUTRAL] Now the total bill amount on the claim that we received was $14,144.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm, I, I see that here.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, 32.
[CUSTOMER][NEUTRAL] And then it says there was an adjustment.
[CUSTOMER][NEUTRAL] For 1,237,550.
[AGENT][NEUTRAL] OK, so on here, let me just look at the remarks on this particular claim for you, just one second please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To get that pulled back up.
[AGENT][NEUTRAL] OK, so we received that claim and that's for our specialty surgical. OK, we did deny the claim when it was received.
[AGENT][NEUTRAL] And the reason for the denial on here states.
[AGENT][NEUTRAL] Receipt of the reference claim is acknowledged, however, in order for us to process this claim, we need the explanation of benefits that matches the claim information.
[AGENT][NEGATIVE] The explanation with benefits we received did not match the claim information, but we, we have never received that from them as of now.
[CUSTOMER][NEUTRAL] Mm, OK, when was it built? when did you receive that claim? Was it back then or recently?
[AGENT][NEUTRAL] No, it was back then. Let me go back to that. I can tell you.
[AGENT][NEUTRAL] This claim was received [PII] and we processed it on [PII].
[CUSTOMER][NEUTRAL] [PII] you said?
[AGENT][NEUTRAL] Uh-huh, was when we processed it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the next one.
[CUSTOMER][NEGATIVE] And then after that you never received anything else?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] We didn't.
[CUSTOMER][NEUTRAL] OK, so is it.
[AGENT][NEUTRAL] Now the portal will go only go back 24 months, so you should be able to see that explanation of benefits in there and the remark that I just read to you is on page 2.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So if, you know, if you're
[CUSTOMER][NEUTRAL] It will only go back how many? 2 years?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So then that has expired for me to see right? because we're already in March of.
[AGENT][NEUTRAL] Probably. Mhm. Yes. So,
[CUSTOMER][NEUTRAL] But can they, are they still able to send the claim now for payment or that time period has elapsed?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, we don't have a timely filing. We just need again they, the explanation of benefits that they sent to us with the claim that it did not match the claim and the EOB did not match, so we ask for the correct explanation of benefits, but we just haven't received that as of now. They can still submit that I can give you the fax number if you would like if that can be sent to [PII].
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] So our claims fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me, 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] And just attention claims.
[CUSTOMER][NEUTRAL] What was the number before 65 I'm sorry, the 1st 3.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] So 877.
[CUSTOMER][NEUTRAL] 0 365943 mhm.
[AGENT][NEUTRAL] Mhm. I'll just repeat it one more time. 877.
[AGENT][NEUTRAL] 3659423
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Um, and then you said the, the explanation of benefits have to match the claim for that service? Is that the wording?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, if you would like I can read you the remark again, the specific remark.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you
[AGENT][NEUTRAL] If you want me to.
[CUSTOMER][NEUTRAL] It's OK. I just wrote denied denied claim in order to process any EOB that matches the claim for that service, yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That is correct, needed the explanation of benefits that matches the claims information.
[CUSTOMER][POSITIVE] OK alright perfect so I'll call them now and let him know alright thank you very much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome and I'll
[CUSTOMER][POSITIVE] For your help I really appreciate it.
[AGENT][POSITIVE] Oh it was my pleasure and again I'm gonna send you that email I was talking about in just a moment and that email that I'm gonna send to you will come from care team at [PII] and I will put APL in the subject line for you so that that's easy to recognize.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome. And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][POSITIVE] No, that's all thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][POSITIVE] Thanks you too thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] OK bye.