AccountId: 011433970860
ContactId: c7e11245-2114-47d3-8776-e1f48370e4e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 667119 ms
Total Talk Time (AGENT): 288551 ms
Total Talk Time (CUSTOMER): 259254 ms
Interruptions: 7
Overall Sentiment: AGENT=0.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/c7e11245-2114-47d3-8776-e1f48370e4e1_20250626T14:59_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Um, yes, I have a couple questions about a claim and a policy. I'm hoping you can answer for me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. Go ahead and give me your name and the member's policy number, please.
[CUSTOMER][NEUTRAL] Um, my name is [PII], and what's the other information you asked for?
[AGENT][NEUTRAL] The member's policy number?
[CUSTOMER][NEUTRAL] Store 02478752 ML.
[AGENT][NEUTRAL] Alright, thank you for that, [PII]. And while I am pulling this up, go ahead and give me a good return telephone call number, please, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alrighty, Ms. [PII], thank you for that information. Are you the insured on this medical supplemental plan, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, I am.
[AGENT][NEUTRAL] Alrighty, go ahead and verify your date of birth and address for me, please.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Alrighty, thank you for that. Now let's go ahead and make sure we got your correct email address, please, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am, we do. And thank you for all that information, Ms. [PII]. Now, who is the patient on this claim that you want to check status on?
[CUSTOMER][NEUTRAL] Um, well, the first one is me, myself, [PII], and it's for services on [PII].
[CUSTOMER][NEUTRAL] For Palm Beach Institute of Sports Medicine.
[AGENT][NEUTRAL] Alright, let me pull up, let's see you said 42, let me get that date pulled up first.
[AGENT][NEUTRAL] Alrighty, it looks like you're submitting these claims in for physical therapy. Is that correct?
[CUSTOMER][NEUTRAL] Yes, and it looks like 42 was paid even though the other day they told me that it wasn't gonna be paid because I didn't have an out of pocket, but I did. So I just wanted to make sure I'm understanding that correctly that it was paid.
[CUSTOMER][NEUTRAL] 42 but not 44.
[AGENT][NEUTRAL] Well, it
[AGENT][NEUTRAL] 42. I'm looking at 42. Let me see about 44, yeah, because I'm showing there was no deductible, no copay, for there was no deductible, no copay and no co-insurance looks like taken so oh let me go. I'm gonna have to look at this claim, so bear with me. I'm gonna have to pull your claim up. Let's see. Alright, let me go and see. Yes ma'am, give me just a moment. I'm gonna have to pull up that claim and look at it.
[CUSTOMER][NEUTRAL] Do you see 42?
[CUSTOMER][POSITIVE] Yeah, yeah, there was. OK. No problem.
[AGENT][NEUTRAL] To see if I can figure out what is going on.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, bear with me. My computer is kinda moving a little slow today, so bear with me.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][POSITIVE] No problem at all.
[AGENT][NEUTRAL] I might have to look at both of them too, so let's see.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 4
[AGENT][NEUTRAL] No, oh.
[AGENT][NEUTRAL] OK, let's see 4244.
[AGENT][NEUTRAL] All right. I'm looking at your ledger. Uh, that's not your EOB, so let me keep looking on down.
[AGENT][NEUTRAL] Let me go to this other claim, let's see.
[AGENT][NEUTRAL] Yeah, because that's not nothing but a ledger. Let me go look at this other climb up. Let's see.
[AGENT][NEUTRAL] 52825493.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] D E.
[AGENT][NEUTRAL] All right, let's see.
[AGENT][POSITIVE] Like this.
[AGENT][NEUTRAL] Family.
[AGENT][NEUTRAL] Yeah, I see a $20 copay. This is on 44. I do see a $20 copay. So yes ma'am, I do see what you're talking about. So I will go back. No ma'am, no ma'am, we, I'm gonna send this over for reprocessing, yes ma'am, I do see that co-pay so we looks like we just overlooked that in error, so we're sorry for that, but I will send this claim over to get reprocessed today.
[CUSTOMER][NEUTRAL] So do I need to resend the EOB or can you just do it?
[CUSTOMER][POSITIVE] Oh, thank you.
[CUSTOMER][NEUTRAL] And 62 looks like it was processed. Can you confirm? I mean 4242.
[AGENT][NEUTRAL] 4242 is not been paid on but I'm gonna send it over as well. I'm gonna send 42 and 44 over.
[AGENT][NEUTRAL] Yeah, looks like they were just denied do, so yes ma'am. Yes ma'am. Is there anything else I can help you with? Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK. And here's my next, yes, there, there is. My next question is my husband has to have major surgery um in 2 weeks.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is she coming? OK, can you hold one second for me?
[AGENT][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] OK, but it's that's fine. Wait, what time? wait, wait, I have to see who's already scheduled though.
[CUSTOMER][NEUTRAL] Um, I have people at [PII]. You have to be here right at [PII] though, and I can do it in 15 minutes, OK? And you're both gonna have come prepared. Do I need to unlock your partner? Oh yes, yes, she, she definitely is she's staying a patient now? She is, yes, but she's locked. Oh well, yeah, she's not the provider. She's assisting right now.
[CUSTOMER][NEUTRAL] I see OK she she needs the, the provider. So was she able to prepare her paperwork? She, she said that she is still needing to finish a little bit more. OK, so I need to unlock her. For yes, yes, and what's her name? Um, her name is [PII]. OK, I will unlock her and I'll see you guys at [PII]. OK, thank you for arranging that. I'll unlock her now. OK.
[CUSTOMER][NEUTRAL] I'm sorry. Um, so the question about the surgery, you have our policy number?
[AGENT][NEUTRAL] Yes, ma'am. He's he's a dependent under yours. Uh-huh.
[CUSTOMER][NEUTRAL] Hello? Yes.
[CUSTOMER][NEUTRAL] Yes, and so, um, his surgery is at [PII], and then he has to stay overnight and he's wondering how that deductible thing works. Does he have to be in 18 hours or 24 hours, and when does that start? How does that work? Do you know?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, well, um, we're just gonna coordinate with your primary insurance carrier, so it has to be, um, for sickness and injury and whatever is applied towards your deductible copay or co-insurance. Now here at APL, but probably not at your primary, we consider over 18 hours inpatient, but it, it, yeah, so it just depends on the exact time that the doctor documents the exact time that he's.
[AGENT][NEUTRAL] Entered into the hospital and released.
[AGENT][NEUTRAL] So that that would strictly dependent.
[CUSTOMER][NEUTRAL] Does that mean entered into the hospital? Like he, he has to be there at [PII]?
[AGENT][NEUTRAL] Yeah, like whatever time he signs in.
[AGENT][NEUTRAL] That's probably what, that's probably when they're gonna sign him in, yeah.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] So when he signed in to go to his surgery, it doesn't matter when they assign him his room, it's when his procedure, when he has to be there for the procedure, like if he has to be there at [PII] and the surgery is at [PII], and they probably won't give him a room until [PII]. Is the 18 hours start when they give him the room and they check him inside to stay in the hospital, or is it when he has his surgery to check in? Do you know?
[AGENT][NEUTRAL] Well, it's gonna, it's gonna be whatever time that the hospital sends the claim in for. That's what we're gonna go back.
[AGENT][NEUTRAL] Because it's gonna tell the exact hours he was there, so we're not gonna know that until after the surgery is done, of course.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But is the exact hours start at the time he's there or do the hours for the inpatients start at the time he gets his room to stay overnight? That's what we're confused about.
[AGENT][NEUTRAL] That is, is you're gonna have to ask the hospital how they document it because I, I, I can't answer that. I can just tell you we're gonna go by what they file on the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it has to be 18 hours or more.
[AGENT][POSITIVE] For it to be impatient here, yes.
[CUSTOMER][NEUTRAL] For him to be inpatient 18 hours or more, but you don't know if that counts being for his surgery or once he's once he gets his room.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah, that's strictly up to the hospital billing department.
[CUSTOMER][NEUTRAL] OK, so we have to coordinate with them.
[AGENT][NEUTRAL] Yeah, because I'm just gonna go by what's on the, yeah, I'm just gonna go by what they bill.
[AGENT][NEUTRAL] That's, that's the only thing we're gonna go by, yeah, what, what is on their claim, yeah.
[CUSTOMER][NEUTRAL] What they bill OK.
[CUSTOMER][NEUTRAL] OK, but 18, it's 18, not 24 hours. Is that correct? OK.
[AGENT][POSITIVE] Yeah, that is correct. Here at APO it's 18 for inpatient. Yes, ma'am, that's correct.
[CUSTOMER][POSITIVE] OK. Very good. OK. Thank you.
[AGENT][NEUTRAL] All righty. Well, yes, ma'am. Is that all I can help you with, Ms. [PII]?
[CUSTOMER][POSITIVE] It is for now. Thank you so much.
[AGENT][POSITIVE] OK, yes, ma'am, and thanks for calling APO and you have a great rest of your day, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you, ma'am. Mhm, bye-bye.