AccountId: 011433970860
ContactId: bd2789a5-bbb9-4353-b85e-be37c046c709
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436239 ms
Total Talk Time (AGENT): 161322 ms
Total Talk Time (CUSTOMER): 173881 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/bd2789a5-bbb9-4353-b85e-be37c046c709_20250305T22:55_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, uh, this is [PII]. Um, I'm calling regarding an ambulance invoice, um.
[CUSTOMER][NEUTRAL] By the City of Miami Fire rescue and uh I have an I'm an APL uh member and and so I'm trying to understand if you received the invoice and if if you're gonna cover part of the invoice so uh let me know what other information you need from my end please.
[AGENT][NEUTRAL] Oh, what's your policy? Excuse me, I'm sorry, I, what's your policy number?
[CUSTOMER][NEUTRAL] Sure, um.
[CUSTOMER][NEUTRAL] So my group number is 23,110 and my payer ID is 60801.
[AGENT][NEUTRAL] No, sir. What's your policy number? It may say policy certificate number or in-hospital outpatient benefit certificate number.
[CUSTOMER][NEUTRAL] Yes, in hospital benefit certificate number is 02462877 M as in Mary L as in Laura 7.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] The callback number is [PII] during business hours.
[AGENT][NEUTRAL] OK, and verify your date of birth, mailing address and email address, please.
[CUSTOMER][NEUTRAL] Uh, [PII], um, I think my, I'm using my work email for this which is [PII] so.
[CUSTOMER][NEUTRAL] At [PII] and then the city of [PII], so [PII], so that's my email.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service?
[CUSTOMER][NEUTRAL] So the date of service was.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] So I guess that's [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, uh, don't show we received the claim, and you said [PII], I mean.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I don't show we received the claim, but you do have an ambulance benefit under the plan and it could be covered as outpatient. Um, you can either file the claim or you can give the information to the provider, uh, and they can submit a claim.
[CUSTOMER][NEGATIVE] Yeah, I, I, I'm trying to give it to you because the provider, um, I've, I sent it a couple times and the provider just doesn't respond.
[AGENT][NEUTRAL] OK, so you can submit the claim. Uh, what we will need is the itemized bill showing diagnosis and procedure codes and the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] OK, so, um, where should I send this information? I, I have the bill.
[AGENT][NEUTRAL] Uh, we will also need a primary EOB since this policy is the secondary.
[AGENT][NEUTRAL] So you can contact your major medical insurance and request the EOB for that data service.
[CUSTOMER][NEUTRAL] OK, I have it.
[AGENT][NEUTRAL] OK, and you can either fax it, mail it, or if you set up on our online service center, you can upload it into the system.
[CUSTOMER][NEUTRAL] OK, and what's the online service center?
[AGENT][NEUTRAL] Uh, it's at [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEGATIVE] That website doesn't appear.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh and [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when you go to the site, you will select new user and then individual, and they'll ask for your name, date of birth, social, zip code and email address, and from there you can uh set up a username and password. Once you've set up a username and password, uh you can uh submit a claim via the online service center.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] OK, it appears I I already have a user.
[AGENT][NEUTRAL] Uh, let me see. Give me one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm gonna find my password.
[AGENT][NEUTRAL] Yeah, it looks like you have and then the password expires. So, do you have your username? If not, I can give that to you.
[CUSTOMER][NEUTRAL] Sure, please give it to me.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then uh you can put in your username and then just forget password or reset password and they'll send an email to the email address you gave that we have in our system to where you can reset your password.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] And then I can set up a claim.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, you then I can use this website to to send the explanation of benefits and the bill.
[AGENT][NEUTRAL] Yes, sir. Once you've uh reset your password, you can upload the claim. Yes, sir. You should receive a confirmation when it's been uploaded.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] OK, you're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye.