AccountId: 011433970860
ContactId: ca986851-a168-4c60-93bd-124d833efce3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 645090 ms
Total Talk Time (AGENT): 319696 ms
Total Talk Time (CUSTOMER): 294770 ms
Interruptions: 7
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/ca986851-a168-4c60-93bd-124d833efce3_20250219T17:46_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hi, this is [PII] calling. Um, what information do you need from me, um, to check my records?
[AGENT][NEUTRAL] OK, so you have a question on your policy, is that correct?
[CUSTOMER][NEUTRAL] I have a question regarding um an explanation of benefits that I receive in the mail.
[AGENT][POSITIVE] OK, yes ma'am. I am so sorry if you could please give me your name again?
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII]
[AGENT][POSITIVE] Thank you. And Ms. [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. So you have a question regarding an explanation of benefits for a claim that we reviewed, is that correct, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And what is your policy number?
[CUSTOMER][NEUTRAL] 02419334.
[AGENT][NEUTRAL] OK, thank you. So if you will give me a moment to get your information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hey Ms. [PII], any information that I do provide you today would be a verification of benefits and not a guarantee of payment. I will need to verify several things with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Also your home mailing address.
[CUSTOMER][NEGATIVE] Listen, I'm working. I don't have too much time. I have called several times here and they still keep sending me the wrong thing.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] So I don't have too much time to be on the phone.
[AGENT][NEUTRAL] OK, so Ms. [PII], before I can further assist you with providing any information, I will have to verify this, these things with you for security.
[CUSTOMER][NEUTRAL] OK, ma'am, continue asking questions and I will answer you and go someplace else because I'm working. I cannot um do this here where I work.
[AGENT][NEUTRAL] Now, Ms. [PII], if you would like, we are open Monday through Friday from [PII] to Central.
[CUSTOMER][NEGATIVE] Uh, I work every day. I work every day and every time I receive this paper, I called, and every time I I keep on receiving the same thing.
[AGENT][NEUTRAL] OK. So again, I'll be very happy to look at the information. I'll be very happy, but you will have to verify your information with me first. Otherwise,
[CUSTOMER][NEGATIVE] If you don't, if you don't do the right thing, you won't.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, ask, ask, and I will answer you fast.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have for you is the same as the one you gave me, so that is your best contact number. Is that correct?
[CUSTOMER][POSITIVE] I know, yes, it is. Everything is correct. I have called several times and every time I call they ask the same questions.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Ms. [PII], I have to verify that, yes, ma'am, that this is taking longer because I just, we need to verify the information and we can get to the reason for your call. So, what is your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and the claim number that you're calling about?
[CUSTOMER][NEUTRAL] The claim number.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 356-23999
[AGENT][NEUTRAL] OK, thank you. One moment. OK, so yes ma'am. How can I help you with that claim today?
[CUSTOMER][NEUTRAL] OK, now you're gonna listen to me.
[CUSTOMER][NEGATIVE] I keep on receiving this from APL and they keep on asking for the, it says please provide copies of your explanation of benefits from your primary insurance carrier. I don't know how many times I have sent the explanation of benefits from my primary insurance company, and that's why I am so upset because I keep on sending the information and they keep on asking the same thing.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEGATIVE] I don't understand.
[AGENT][NEUTRAL] This is for data service 511 2024, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so just a moment, let me see what we have received.
[AGENT][NEUTRAL] OK, so Ms. [PII], you had submitted one claim, but then your, the facility submitted a claim. So you received that explanation of benefits because they did not include the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, but I faxed the, the, the explanation of benefits from the primary insurance company. I have, uh, I have faxed it before and I keep on receiving, you know, the same paper asking for that.
[AGENT][NEUTRAL] OK, so you have multiple claims for that same data service. This one is from.
[CUSTOMER][NEGATIVE] I know, and I, and I have problem with, I have problem with all the claims because they haven't done the right thing.
[AGENT][NEUTRAL] OK, the provider that filed this claim.
[AGENT][NEUTRAL] That is why, because when they file a claim, you will also get an explanation of benefits from us.
[AGENT][POSITIVE] In addition to them receiving an explanation of benefits for us.
[CUSTOMER][NEUTRAL] OK, let me, let me tell you that HCA Florida, Kendall Hospital, which is the place where I went, they don't know what they're doing.
[AGENT][NEUTRAL] I do not show that we have.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They are not doing, I, the first time I went there, I told them I have Asmet as primary insurance and APL a secondary insurance. You need to do both.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know what they did? They built Medicare, which I didn't have.
[CUSTOMER][NEGATIVE] You know, this is, these people, these people, they don't know what and then I call them and I say, I don't have Medicare. You have to bill Ahmed and APL and they did bill Medicare again.
[AGENT][POSITIVE] Oh goodness. I'm sorry. Yes, ma'am.
[CUSTOMER][NEGATIVE] And I told them, you know what, you will never get paid if you don't do the right thing.
[CUSTOMER][NEUTRAL] Now APL is asking for the.
[CUSTOMER][NEUTRAL] The explanation benefits from your primary insurance card. I have the explanation of benefit here from my primary insurance. Where do I have to send this to you?
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] And that is for the total.
[AGENT][NEUTRAL] OK, and, and I just want to make sure since you do have multiple claims, Ms. [PII] for that data service that this is for the $7,486.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, so you may fax that or you may upload it directly into the online service center portal if you have set up your profile.
[CUSTOMER][NEUTRAL] Give me the fax. Give me the fax number please.
[AGENT][NEUTRAL] [PII] attention claims.
[CUSTOMER][NEUTRAL] [PII] I mean [PII].
[AGENT][POSITIVE] That is correct, yes, ma'am.
[CUSTOMER][NEUTRAL] That's the fax number. OK, I'm gonna fax this attention claims. OK, I'm gonna fax this right now and uh and let's see if we can get, yes.
[AGENT][NEUTRAL] Attention claims.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] OK, and just please allow up to 24 hours for the claim to be processed and put into the system, I mean the documents, because with faxing it it does take a little longer. I know that I have spoken to you before, Ms. [PII]. Did you ever set up your profile in our portal?
[AGENT][NEUTRAL] Where you could actually just upload it directly into your portal.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, I, uh, I haven't done that and uh I'm about to retire next week, so I, I think it's a little bit too late to do this. Thank you. Now is that I'm gonna have Medicare.
[AGENT][POSITIVE] 00, well, congratulations on that.
[AGENT][POSITIVE] Oh, well, congratulations.
[AGENT][NEUTRAL] Uh, now, you'll actually have Medicare.
[CUSTOMER][NEUTRAL] But not before.
[AGENT][POSITIVE] Oh goodness.
[CUSTOMER][NEUTRAL] You know, the thing is that they see, they see my age and immediately they think I have Medicare.
[CUSTOMER][NEUTRAL] And I was still working, because they, I'm an old person, they think that I, I have Medicare.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Mm, I'm so sorry for the frustration. I know that that's a lot to deal with, but, um, if you will send us this explanation of benefits for that bill amount, uh, yes, ma'am, we can review it again if you're faxing it though, you will need to, it takes about 24 hours for us to be able to have that, you know, in the system and on your profile. So if you want to.
[CUSTOMER][NEUTRAL] I'm gonna start it right now and I'm sorry about, you know, being so upset but you know I keep on receiving the same thing and I'm, you know, I, I, I don't know what to do anymore.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Yes ma'am, I know that we have sent you other things and again, that is all because we have multiple claims for the same data service so any time there's something that's missing, those are going to go out in order to give you or the provider the opportunity to provide that information to us so that we can review and process your claim fully.
[AGENT][NEUTRAL] So, you know, but I understand it's OK. I did not take that personal, but I do hope you understand that we have certain things that legally we have to do for security purposes to verify that we are indeed speaking to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I know, but the thing is that I have sent, I have sent this before.
[AGENT][NEUTRAL] OK, so we don't show.
[CUSTOMER][NEUTRAL] I have sent this before to you guys.
[AGENT][NEUTRAL] What did your insurance company pay on that?
[CUSTOMER][NEUTRAL] They paid, it says here um uh let me see.
[AGENT][NEUTRAL] Because I'm not
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It says amount bill 7,000486 amount allowed 2,17094 applied to deductible 1000.
[CUSTOMER][NEUTRAL] Uh, 17094. They haven't paid anything.
[AGENT][NEUTRAL] Yes, so I don't see where, I don't see where we've received that explanation of benefits. I don't know, maybe something, if you've sent it, it was a fax, something happened with the fax transmission, um, but I don't see that we have a claim on file reflecting those numbers for that 5-112024 data service for you.
[CUSTOMER][NEUTRAL] OK, I'm gonna fax it right now.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with at the moment?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's it, ma'am thank you. I, I will send it over and see if we can get this clear.
[AGENT][NEUTRAL] OK. Well, that'll be fine then. If you have any other questions, just give us a call, OK?
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] All right. Well, yes, ma'am, and thank you again for calling APL. Have a nice afternoon.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Bye-bye.