AccountId: 011433970860
ContactId: a86b3a1d-8bc5-4afb-9210-c19a16e5bcd6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 399399 ms
Total Talk Time (AGENT): 184543 ms
Total Talk Time (CUSTOMER): 180570 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/a86b3a1d-8bc5-4afb-9210-c19a16e5bcd6_20250122T15:34_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEGATIVE] Hi [PII], so all of a sudden my claims are being denied and I don't understand why. Can you help me with that?
[AGENT][NEUTRAL] Yeah, I can help you look at those claims. um, do you mind if I get your name and a good callback number real quick?
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] and my, my hos my outpatient benefit number, I have a number here is 02564534 ML8.
[AGENT][NEUTRAL] All right, and Ms. [PII], do you mind if I also get a good call back number in case we get disconnected please?
[CUSTOMER][NEUTRAL] Of course not. Let me give you my desk number because that's easy. [PII], and [PII] is the cardholder.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] She's a policy holder.
[CUSTOMER][NEGATIVE] And all along, everything has been paid for all the time and all of a sudden, um, it started to be denied, so I don't know what happened.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, yeah, I'll look at that with you, Ms. [PII]. Could you verify for me, please, your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful. And if you could also verify for me, oh, I'm so sorry. Hold on, I have to go back one screen.
[CUSTOMER][POSITIVE] It's OK to give you barber's too if you need that.
[AGENT][NEUTRAL] No, that's OK, but I do need to verify with you just the mailing address on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful and then if you could verify the phone number on file for me please.
[CUSTOMER][NEUTRAL] Mm that I'm gonna try her number [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] So my number might be on file as well, um, but not the one I gave you my cell which is [PII].
[CUSTOMER][NEUTRAL] [PII]. I keep forgetting my number today twice I just blanked on it that weird?
[AGENT][NEUTRAL] That's OK. I feel like, I don't know, I don't feel like I have to say my phone number that often, so.
[CUSTOMER][NEGATIVE] I know today I was trying to get somebody to call me back for an appointment and I couldn't do it. I'm just like I can't do it, so I'm gonna have to call you back.
[AGENT][NEUTRAL] Alright, so let's take a look at this. I have 2 claims on file for you, [PII], and
[CUSTOMER][NEGATIVE] I just can't do it.
[AGENT][NEUTRAL] It looks like.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Um, I just wanna look into them a little further.
[CUSTOMER][NEUTRAL] Yeah, I have like 3 claims here that have been denied um from Boca Raton Regional Hospital.
[AGENT][NEUTRAL] OK, do you know the claim numbers?
[AGENT][NEUTRAL] Um, off the top of your head or do you have them on those papers?
[CUSTOMER][NEUTRAL] I have them in front of me here, so claim numbers is that the same as account number?
[AGENT][NEUTRAL] OK, what is the claim number?
[AGENT][NEUTRAL] Um, no, it, it, well, it shouldn't be. It should start with maybe a 35 or a 34.
[CUSTOMER][NEUTRAL] No, I have the bills from the hospital, but APL didn't send me anything to tell me they were denied, but these people told me that they also sent it into APL that they sent to Blue Cross and um.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And APO.
[AGENT][NEUTRAL] OK, so let me take a look.
[AGENT][NEUTRAL] And they were for yourself, correct?
[CUSTOMER][NEUTRAL] Yeah, oh, it does say here primary insurance Blue Cross and secondary APL.
[CUSTOMER][NEUTRAL] But it just says insurance payments like 216. It doesn't say like how much each, you know what I mean, it doesn't break it down.
[AGENT][NEUTRAL] OK, so I actually like I don't have any claims on file for you.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEGATIVE] Like I don't show that they've submitted any claims and we've denied them. I do have like two sets on here, but they're not attached to any claims. They're just like error messages. I'm just saying that the mail number was given an error and then when I open it up there's nothing attached, so I'm not seeing any claims that were submitted on your behalf.
[CUSTOMER][NEUTRAL] So what should I do? Should I send these claims in or should I have them send them?
[AGENT][POSITIVE] Um, I would, if you can, I would highly encourage you to get them to submit claims. Like I would say, hey, you know, my secondary insurance doesn't have any denied claim information. You know, I need you to submit with them before I pay, um, but if you have to, like if they give you a hard time, you can submit that to us. Um, but they have access to all the paperwork, all the information they need to submit a claim, and they pay somebody to do it. So I would really encourage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know it's ridiculous. The funny thing is I work in [PII], so I do that for the hospital here. So I actually work in [PII] too, so I knew that they were lying, but you know I need a verification. I knew it. I said to her, you couldn't have it doesn't say it anyway, and also APL would have sent me that they deny the claim that she said, right, so she says to me, no, that's not true, and I said, OK, but I work in you are so I know it's true, but whatever, I'll take your bullshit, you know.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, an explanation of benefits.
[AGENT][POSITIVE] Yeah, I, I didn't see anything on file, so I'd really, I mean, you are very fortunate in the fact that you have the knowledge of, you know, what sort of things are needed to submit a claim, but I'm a big believer in putting that back on the provider.
[CUSTOMER][NEUTRAL] Whatever.
[CUSTOMER][NEGATIVE] Yeah, I'm gonna try to make them do it, but if I have to do it because they're really ridiculous, I send it to [PII].
[AGENT][NEUTRAL] Yeah, you can, um, or if um [PII] has the online account, she can set it up and you can just like upload them like in PDF form, um, your, your stuff and get everything done that way. Um, all we need is the itemized bill. I'm I'm sure you know this, but I'll just say it to say it, um, itemized bill with the procedure codes, um, something with your diagnosis code, um, and then your EOB from your major medical.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Got it. I'm gonna call them right now and yell at them and see if I could get them to submit it. Thanks so much for your help. I really appreciate it.
[AGENT][POSITIVE] Hey, it's my pleasure. Thanks for calling APL and you have a great day. Good luck out there. I appreciate you. My pleasure. Bye bye.
[CUSTOMER][POSITIVE] Thanks [PII] take care bye.