AccountId: 011433970860
ContactId: 9a086816-7f25-4954-b38c-644b5b194efe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346989 ms
Total Talk Time (AGENT): 136320 ms
Total Talk Time (CUSTOMER): 116911 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/9a086816-7f25-4954-b38c-644b5b194efe_20250225T16:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Hi, [PII]. I just called a few minutes ago and I was um told what I needed to do to be able to get me reimbursed my co-pay for urgent care. Um, however, I ended up calling urgent care and they told me they sent you guys a bill and you guys denied to pay it, which I don't know why.
[AGENT][NEUTRAL] OK, let's see if we have a claim on file. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. I have an outpatient one is 01369754 M like in Mary, L like in Larry, and the number 8.
[AGENT][POSITIVE] OK. Thank you for that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] All right. And then if I could get your first, last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then what is the address and email address we should have on file?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII]. Email is [PII].
[AGENT][POSITIVE] Thank you. All right, let me look.
[CUSTOMER][NEUTRAL] You're welcome. So they said they sent two bills. One you haven't denied yet, but the other one you did, and I paid them the $125 but they still billed you anyway, and they said they would have gave me the money back, but it seems to be a circle.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the recent one that was submitted, I didn't look at what was submitted. I can pull it up, but um the denial reads, um, unable to use receipts to process the claim. Please submit a fully itemized bill with diagnosis and procedure codes. We need the explanation of benefits from your primary also.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That's from what I sent, but they said they billed you directly um do now.
[CUSTOMER][NEUTRAL] They billed you.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEGATIVE] She's like well we'll go you know reimburse you, it's just a hot mess, I guess.
[AGENT][NEUTRAL] Let me see
[CUSTOMER][NEUTRAL] I mean I could send you all the other stuff anyway but but you know.
[AGENT][NEUTRAL] Yeah, let me see if I see another claim for that date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And then there's one before that, but they say you haven't done any of that one yet, but they haven't gotten any uh approval either that that they that they, um, I didn't pay anything.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] I don't see any other urgent care claims except for just that one.
[CUSTOMER][NEGATIVE] Which is weird. No, I went 4 days before that. They said they're waiting for you guys to respond.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] That was just not me.
[AGENT][NEUTRAL] Yeah, I mean, the only one that I see is just that one that we were just talking about. Um, I went through.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All your claims history.
[AGENT][NEUTRAL] I don't see anything else yet.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] They didn't give you like a claim number or anything?
[CUSTOMER][NEUTRAL] I didn't ask them for it. I didn't think I needed to.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, the only one that I see is just that one from the urgent care that was done online on the [PII] of this month. Um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The one before that.
[AGENT][NEUTRAL] The only other thing that I see that has a denial was from
[AGENT][NEUTRAL] Um, Broward Health Coral Springs, and that was the date of service of [PII].
[AGENT][NEUTRAL] I don't see any other denied claims.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, so let me see, I'll give it, I guess, give it a few days. Maybe you haven't received it yet. I don't know.
[AGENT][NEUTRAL] Yeah, maybe if they just send it, maybe give it a couple more days and then on the denied one online, if you just resubmit the explanation of benefits for that date and then um just the itemized with the diagnosis and procedure codes, we can reprocess that one.
[CUSTOMER][NEUTRAL] Yeah it's only gonna take like 24 hours for them to send it to me, so I have to wait.
[AGENT][NEUTRAL] OK, all right.
[CUSTOMER][POSITIVE] All right, thank you very much I appreciate your help.
[AGENT][POSITIVE] You're welcome, [PII]. Take care.
[CUSTOMER][NEUTRAL] You too, bye.