AccountId: 011433970860
ContactId: b7fb4552-f2e6-4192-b84d-e4b8ebefdb41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 609169 ms
Total Talk Time (AGENT): 229138 ms
Total Talk Time (CUSTOMER): 272765 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/b7fb4552-f2e6-4192-b84d-e4b8ebefdb41_20250303T18:56_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][NEUTRAL] Good [PII], I have a question. I got a couple claims here. I received some that uh were showing it's paid, but I still have two that you guys are asking for the EOB and I just wanna make sure that I send you the right stuff and where I send it.
[AGENT][NEUTRAL] OK, who am I speaking who am I speaking with?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] You, you're speaking, you're speaking, you're speaking with the patient with the insured [PII].
[AGENT][NEUTRAL] OK, and your
[AGENT][NEUTRAL] And what's your policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number is 025.
[CUSTOMER][NEUTRAL] 12982.
[AGENT][NEUTRAL] And could you provide a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, give me one moment, let me pull up your file.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And if you could verify your date of birth, your mailing address and email address, Mr. [PII].
[CUSTOMER][NEUTRAL] Sure, uh, [PII].
[CUSTOMER][NEUTRAL] Address is [PII] and email is [PII].
[AGENT][NEUTRAL] And is that [PII]?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] Oh [PII]. You're right. [PII] OK, in [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] OK, thank you so much and um you were you were calling regarding which claims?
[CUSTOMER][NEUTRAL] So, so there's, I, I've received, I've received 4 envelopes, uh, 2 were showed as paid and then I have 2 that are not showed as paid that you're asking that they're asking requesting the EOB, uh, claim number.
[CUSTOMER][NEUTRAL] 35
[CUSTOMER][NEUTRAL] 50755
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And claim number.
[CUSTOMER][NEUTRAL] 3551558
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they both say ACA Florida Woodmont Hospital inpatient and outpatient expense.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Now I, I received two that were for uh infectious disease specialists and those were shown as paid for inpatient services. So who are these for?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So these are claims um.
[AGENT][NEUTRAL] The one ending in 1558 is from HC Florida Woodmount Hospital. This looks like an emergency room visit on [PII].
[CUSTOMER][NEUTRAL] Yep, so I'm sorry, so this, so this is the one for the hospital, so bear with me so I'm trying to write this down.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, OK. OK.
[CUSTOMER][NEUTRAL] So 3
[CUSTOMER][NEUTRAL] So the one ending in 558 is the hospital and this is emergency ER room, is that what it is?
[AGENT][NEUTRAL] Yeah, this is the hospital bill for the ER visit.
[CUSTOMER][NEUTRAL] Yeah, A C A E R.
[AGENT][NEUTRAL] And did did you get the data service?
[CUSTOMER][NEUTRAL] Uh, yes, just give me the data service for this one again.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So this one is for [PII], OK.
[AGENT][NEUTRAL] Uh huh, and then the other one is for data service [PII] 24.
[CUSTOMER][NEUTRAL] Same thing HC HCA uh Woodmont ER.
[AGENT][NEUTRAL] Or well, Woodmont Hospital is what this one says, and so this is for an inpatient stay.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So it looked like you were admitted through the emergency room, basically, I believe.
[CUSTOMER][NEUTRAL] I, I, I, I, I, I was OK, so the one ending in in 755 is, is for the inpatient stay, not for the hos not for the ER visit.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct, correct.
[CUSTOMER][NEUTRAL] N P
[CUSTOMER][NEGATIVE] Shit
[CUSTOMER][NEUTRAL] Stay
[CUSTOMER][NEUTRAL] And this state of service is what?
[AGENT][NEUTRAL] [PII] to [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] To [PII].
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so they've done it that, OK, so I, I'm not sure what they've done it like this, but um.
[CUSTOMER][NEUTRAL] So they've done the inpatient through the [PII] and the [PII] and then they're doing the ER room visit.
[CUSTOMER][NEUTRAL] On the [PII] you said?
[AGENT][NEUTRAL] Right, did they, did they, yeah, the, the outpatient claim, it shows from [PII] through [PII].
[CUSTOMER][NEUTRAL] For the other flight?
[CUSTOMER][POSITIVE] Uh-huh, that, that is correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the providers.
[CUSTOMER][NEUTRAL] So what, what do you want to see? Go ahead.
[AGENT][NEUTRAL] So the provider submitted these claims separately. There's two separate claims, and we're needing a copy of your, uh, major medical carrier's explanation of benefits.
[AGENT][NEUTRAL] Because we're
[CUSTOMER][NEUTRAL] Oh, OK, I, I do, I do, I do have those. I, I just, I, I wasn't sure where to send them. Uh, hey, can I email them, upload them to a [PII], or or how do I get them to you?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You can upload them
[AGENT][NEUTRAL] To, um, [PII].
[CUSTOMER][NEUTRAL] OK, so if I go on the website it'll show I'll basically show me how to create a log in and all that and then I can upload the documents in there.
[AGENT][POSITIVE] Correct and
[AGENT][POSITIVE] Right, and I can assist you creating the log in if you need if you need, you know, assistance.
[CUSTOMER][NEUTRAL] OK, uh, what should I need? It's just I'm at work right now and I'm waiting for an inspector, so, um.
[AGENT][NEUTRAL] Oh, OK, the, the website that you're gonna go to is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And then through there I should be able to follow the prompts to create a create an account, a log in.
[AGENT][NEUTRAL] Right, once you get to that log in because you have not created an account, there's two tabs to the right. One is that it's a login button, the other one is a new user tab, click the new user tab.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And then it's gonna ask you pretty much the same security questions that I did, so what you enter has to match what we have in our system, which you've already verified. That would be your email. um, now it's gonna ask you for, um, you're gonna enter your social security number when it asks you for your social or, um, I think it says a member ID or something like that. Enter the your social security number and I'm showing that as [PII] just so I know it'll match.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That is, that is correct.
[AGENT][NEUTRAL] OK, and then it will also ask you for your zip code which you verified uh [PII].
[AGENT][NEUTRAL] And then it'll ask you for your email. You have [PII].
[AGENT][NEUTRAL] And uh let me look it up it's one other thing and once you enter that information it's going to take you to the next screen which is allowing you to create your own username and password.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, it's asking you for your date of birth as well.
[CUSTOMER][NEUTRAL] OK, alright, and then I can, I can go ahead.
[AGENT][NEUTRAL] Oh, and then
[AGENT][NEUTRAL] And then you can then you could proceed and it's gonna ask you, the first box is gonna ask you which role best describes you and you're an individual with an APL insurance policy.
[CUSTOMER][POSITIVE] Got you. OK, excellent. All right, I'll do this this evening and uh and I'll, and I'll get those uh documents uploaded.
[AGENT][POSITIVE] OK, very good. Any other questions I can help you out with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, no, so you, that's, that's, that's all at at this point, um.
[AGENT][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] Now, uh, bear with me because actually you know what I, the only other question that I do have is I, I did pay.
[CUSTOMER][NEUTRAL] I didn't pay the hospital, but I did pay the doctor.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I did, I did pay, I did pay the hospital doctor, um.
[CUSTOMER][NEUTRAL] For one of those visits.
[CUSTOMER][NEGATIVE] Out of pocket already.
[AGENT][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah, they sent, they sent me a bill and I, and I, and I paid and then I was like, oh, you know what, but anyways, I, I already paid it. I didn't pay the hospital, but I paid the, the, uh, the attending physician.
[AGENT][NEUTRAL] You said
[AGENT][NEUTRAL] What's the uh data service of that one?
[CUSTOMER][NEUTRAL] Uh, 1010 27, 1028.
[CUSTOMER][NEUTRAL] And it was like $94.80 and plus the other fee ended up being like $286 and change.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] That was for for H2 Hospital Associates.
[CUSTOMER][NEUTRAL] So it was for the attending position. It wasn't, it wasn't for HCA itself.
[AGENT][NEUTRAL] OK, Mr. [PII], so under this particular policy, the physician visit fee or the office visit fee is not covered.
[CUSTOMER][NEUTRAL] Got you. OK. Alright, so if I paid it, I, I, I, I shouldn't have an issue because then it still would have been my responsibility if I'm understanding you correctly.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It would have been your responsibility, correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][POSITIVE] OK, if that's the case, if that's the case, then we're good. Uh, no, thank you so much, [PII]. Any other questions I'll call back after I upload the documents.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] OK, sounds good. And thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Alright thank you bye bye.
[CUSTOMER][NEUTRAL] Yes.