AccountId: 011433970860
ContactId: b5a4b632-3178-4098-b43e-edcad5595c47
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 698849 ms
Total Talk Time (AGENT): 296437 ms
Total Talk Time (CUSTOMER): 187652 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/b5a4b632-3178-4098-b43e-edcad5595c47_20250328T15:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], my name is [PII]. Um, I may have a battery going dead on this phone, but anyway, um, uh, policy number or reference number?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Policy number, please.
[CUSTOMER][NEUTRAL] Policy number 02559295.
[AGENT][NEUTRAL] OK, Mr. [PII], let me pull up that policy real quick.
[AGENT][NEUTRAL] OK, can you please verify your date of birth for me, sir?
[CUSTOMER][NEUTRAL] [PII] every year.
[AGENT][NEUTRAL] And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Should be [PII], and the phone number, um, damn, uh, my work phone is [PII].
[AGENT][NEUTRAL] OK, thank you, sir. And if we get disconnected, is your work email or your cell phone number the best number to call you back on?
[CUSTOMER][NEUTRAL] Uh, probably the work cell phone.
[AGENT][NEUTRAL] OK, let me go ahead and get that one more time so that I can update that phone number to that number.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then one last verification, can you please give me your email address?
[CUSTOMER][NEUTRAL] Should be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, sir. I appreciate you verifying your policy for me. How can I help you today?
[CUSTOMER][NEGATIVE] I got this statement in the mail and it looks like nothing was actually covered, uh, but the date.
[CUSTOMER][NEUTRAL] Says something about Florida hospital physical.
[CUSTOMER][NEGATIVE] And the date I've got nothing there.
[CUSTOMER][NEUTRAL] So I don't know what this whole statement is all about.
[AGENT][NEUTRAL] OK, so is it a claim that you received a um notice on, is that correct?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Explanation of benefits.
[AGENT][NEUTRAL] Are you there sir?
[CUSTOMER][NEUTRAL] Yeah, um, I'm about ready to drop. Hold on, let me grab another phone.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh no, yes sir, uh can you please give me the claim number that's on the letter?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Where's the other phone?
[CUSTOMER][NEUTRAL] do
[CUSTOMER][NEUTRAL] OK, can you hear me here?
[AGENT][NEUTRAL] I can hear you. Yes, sir.
[CUSTOMER][NEUTRAL] I can hear you, yes. OK, got the other phone.
[CUSTOMER][NEUTRAL] Do do do do do do.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you see a claim number on the letter?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim number 3577565.
[AGENT][NEUTRAL] OK, let me look that claim number up real quick.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Give me just a second.
[AGENT][NEUTRAL] OK, so I do show that there was a claim sent in from Florida Hospital physicians Group for date of service of [PII].
[CUSTOMER][NEUTRAL] Do you have a doctor's name with that?
[AGENT][NEUTRAL] Um, let me see if there's any doctor's name.
[AGENT][NEUTRAL] Let me try to pull up the EOB and see if that.
[CUSTOMER][NEUTRAL] Because the only thing that I show was I did have something but it was a doctor with the AdventHealth.
[CUSTOMER][NEUTRAL] And this is not them.
[AGENT][NEUTRAL] Look, I'm trying to pull in the EOB now to see if I can see anything.
[AGENT][NEUTRAL] Additional to what's on our computer screen.
[AGENT][NEUTRAL] It's gonna be just a second while it pulls up.
[AGENT][NEUTRAL] And it's loading.
[AGENT][NEUTRAL] It's always a process.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see if I can pull up some procedure codes here.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Looks like you had an outpatient office visit um.
[AGENT][NEUTRAL] And glucose blood, glucose monitoring?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Collection of capillary blood specimen.
[CUSTOMER][NEUTRAL] That sounds like it's something to do with the blood work up from Quest.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes. That's what it looks like is um like blood work. Um, so far, that's the only codes that I'm getting are all dealing with blood work.
[AGENT][NEUTRAL] Uh, blood pressure taken, uh, most recent systolic blood pressure.
[AGENT][NEUTRAL] Um, let me see, anything else? 307.
[CUSTOMER][NEUTRAL] I know there's been problems with a quest diagnostics data of service was 78 of 24.
[CUSTOMER][NEGATIVE] And they're trying to bill me $570.06 not the same amount.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And that's through Quest.
[AGENT][NEUTRAL] OK. Let me look and see if we have anything from that facility on that date.
[AGENT][NEUTRAL] There's not been a claim sent in for you on that date of service.
[CUSTOMER][NEUTRAL] OK, was.
[AGENT][NEUTRAL] To us anyway.
[CUSTOMER][NEUTRAL] Was coverage with you at that date.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] OK, so your policy started on [PII]?
[AGENT][NEUTRAL] That's your effective date.
[CUSTOMER][NEUTRAL] OK, this was, this was before that.
[AGENT][NEUTRAL] OK, so we wouldn't have anything on file for that.
[AGENT][NEUTRAL] Because it was before the, yes.
[CUSTOMER][NEUTRAL] That that makes sense. OK.
[CUSTOMER][NEGATIVE] So what the hell is this other one?
[AGENT][NEUTRAL] It shows that um.
[AGENT][NEUTRAL] On this explanation of benefits, it's showing that nothing was actually
[AGENT][NEUTRAL] Well, I take that total bill charges was 554.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And nothing was paid. Now, I can um email you a copy of this explanation of benefits if you would like to take it to the facility and find out what it is.
[CUSTOMER][NEUTRAL] I don't know what facility that is.
[AGENT][NEUTRAL] Florida hospital physicians.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That would be doing blood work up for me.
[AGENT][NEUTRAL] And it just says Florida Hospital physician Group.
[AGENT][NEUTRAL] That's what's on the
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can you send me a copy of that?
[AGENT][NEUTRAL] Yes, I can send you a copy of this, um, let me go ahead and email it to you.
[AGENT][NEUTRAL] I'm gonna do that while we're on the phone together, sir.
[CUSTOMER][NEUTRAL] Well, I brought that up and it comes up with AdventHealth.
[AGENT][NEUTRAL] So sometimes they have.
[AGENT][NEUTRAL] Under groups like that they will have subsidiary groups that fall underneath it.
[AGENT][NEUTRAL] And they're all the same just like insurance companies may have a corporate office but many different insurance, smaller companies underneath it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] That that they're all a part of the same group.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] That's beginning to make more sense.
[AGENT][POSITIVE] Good, good deal. Let me, let me get this it'll be.
[CUSTOMER][NEUTRAL] So they tell me that it was not with them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] And why am I being charged $554?
[AGENT][NEUTRAL] OK, let me look at this claim and see if there's any remarks on the claim.
[AGENT][NEUTRAL] OK, we've got several remarks on the claim that explain.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] One is your policy does not cover office visits.
[AGENT][NEUTRAL] Uh, the insurance, primary insurance provided full benefits.
[AGENT][NEUTRAL] And then some of the
[AGENT][NEUTRAL] Procedures were there was no charge, so this policy does not provide a benefit for service in which no charges were incurred.
[CUSTOMER][NEUTRAL] Makes sense.
[AGENT][NEUTRAL] And, and those were that that's the remarks that we had on the claim.
[CUSTOMER][NEUTRAL] OK. I
[CUSTOMER][NEUTRAL] Would you normally cover
[CUSTOMER][NEUTRAL] Yeah like from Quest blood work up.
[AGENT][NEUTRAL] It has to be since office visits are not covered under your policy, it would have to be done in an ER urgent care center or an ambulatory center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, send me what you got.
[CUSTOMER][NEUTRAL] And I'll see if I can't put the puzzle pieces together and figure it out.
[AGENT][NEUTRAL] Yes, sir. I'm getting that email on its way to you right now. I've just sent it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I appreciate it. Thank you. Have a good Friday.
[AGENT][POSITIVE] It's no problem Mr. [PII]. You have a good Friday too and a wonderful weekend. We appreciate you calling APL today.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye, sir.
[CUSTOMER][NEUTRAL] Bye.