AccountId: 011433970860
ContactId: c0b1950e-0b35-469f-84c0-6d741d2e0ef2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 445339 ms
Total Talk Time (AGENT): 147307 ms
Total Talk Time (CUSTOMER): 141295 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/c0b1950e-0b35-469f-84c0-6d741d2e0ef2_20250527T17:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name's [PII], and I just had a knee replacement surgery and last week.
[CUSTOMER][NEUTRAL] Uh, I thought I had uploaded the documents for a claim, but I'm looking in the portal and I don't have a claim number, so I don't think I did it the right way. Can you help me with that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, I can assist you. May I have your policy number?
[CUSTOMER][NEUTRAL] Uh, policy, um, group, group number effective plan, would it be in hospital benefits certificate certificate number?
[AGENT][NEUTRAL] Yes, do you have an outpatient?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have outpatient and inpatient so let me give you in in hospital because that's what the one I'm I'm applying for 025.
[CUSTOMER][NEUTRAL] 49
[CUSTOMER][NEUTRAL] 537 M as in Mike L as in Lima and the number 7.
[AGENT][POSITIVE] Thank you, and [PII], may I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] [PII] and my new address is [PII].
[CUSTOMER][NEUTRAL] I don't know if it's updated, but I could give you my old address too.
[AGENT][NEUTRAL] No, it's updated.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] And your email address?
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] Let me see which one I have in here. It's either uh [PII] or.
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] OK, my work one and mana.
[CUSTOMER][NEUTRAL] At midway [PII].
[AGENT][POSITIVE] That is correct and thank you for verifying that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me get this pulled up and it looks like that we did receive a claim on [PII] and it is in line for processing.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Let me get it pulled up.
[CUSTOMER][NEUTRAL] OK, I just wanna make sure I did it right.
[AGENT][NEUTRAL] I'm gonna get it pulled up and make sure that we don't need any additional information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So it was 39 pages.
[AGENT][NEUTRAL] Just scan through here real quick to see if we have the information to process.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I downloaded that from my chart which had all the discharge information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was submitted on the [PII] and then I got out on [PII].
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] I do apologize, our system is slow.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK. I do see the diagnosis code.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Looking for your primary insurance explanation of benefits. That's what I'm looking for.
[AGENT][NEUTRAL] I just see your notes.
[AGENT][NEUTRAL] I see aftercare instructions, but I'm not seeing.
[AGENT][NEUTRAL] Your primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] You mean from Florida Blue?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Where would I get that? Because this is what the hospital provided me.
[AGENT][NEUTRAL] That will come from, normally they would have a website that matches your inpatient stay and it tells us what was applied to your co-pays, co-insurance, and or deductibles.
[CUSTOMER][NEUTRAL] OK, hold on, I'm logging into Florida Blue. Let me just see if there's something there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, 31301.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Would I look under their claims or?
[AGENT][NEUTRAL] Does it, is it um a patient portal? Do you have a patient portal for yourself?
[CUSTOMER][NEUTRAL] Yeah, yeah, I'm in the patient portal.
[AGENT][NEUTRAL] And then look for your data service.
[CUSTOMER][NEUTRAL] Yeah let me see here.
[CUSTOMER][NEUTRAL] Well, I don't, it's there's nothing there yet apparently they haven't a a file for it.
[AGENT][NEUTRAL] Oh, OK. So maybe, maybe the provider.
[CUSTOMER][NEUTRAL] Because the latest I have is uh 520, huh?
[AGENT][NEUTRAL] Maybe the provider has not submitted it over yet?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So what is it that you guys need? Do you guys need my insurance card so you can see my deductible $750 for the year.
[AGENT][NEUTRAL] No, when we, when the insured submits a claim, we need 3 items to process the claim. We would need your itemized bill from your provider.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] We would need your primary insurance explanation of benefits, and we would need the claim form.
[AGENT][NEUTRAL] So since we already have this from the provider, it does show us the diagnosis code. We would only need the EOB going with this.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And what's the EOB again explanation of benefits from Florida Blue?
[AGENT][POSITIVE] Explanation of benefit. Correct.
[CUSTOMER][POSITIVE] Perfect. Alright, and then I could just uploaded here in the portal?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] OK, all right, you've been a great help thank you so much appreciate it.
[AGENT][POSITIVE] You're so welcome, [PII], and thank you for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] Thank you alright bye bye.
[AGENT][NEUTRAL] Bye bye.