AccountId: 011433970860
ContactId: ccce6e20-3bd9-4cbb-a5fb-062dce20c4cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 679599 ms
Total Talk Time (AGENT): 208742 ms
Total Talk Time (CUSTOMER): 165322 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/ccce6e20-3bd9-4cbb-a5fb-062dce20c4cd_20250516T13:06_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII], my name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] But it's actually every year.
[AGENT][NEUTRAL] And how may I assist you today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, I am so confused. I've got a couple of pending claims that I think I've been pro or trying to process.
[CUSTOMER][NEGATIVE] What the hell do you actually cover for me?
[AGENT][NEUTRAL] Um, let me take a look at your policy. May I have your um policy number and a good contact number?
[CUSTOMER][NEUTRAL] OK, contact number [PII].
[CUSTOMER][NEUTRAL] And the policy number I'm showing is 02559295.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, now I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Uh, date of birth is still [PII].
[AGENT][NEUTRAL] I'm sorry, I forgot you told me that already. Oh my apologies.
[CUSTOMER][NEUTRAL] And um email should be [PII].
[AGENT][NEUTRAL] And the mailing address?
[CUSTOMER][NEUTRAL] Uh, home address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So this is your secondary policy. Um, let me pull up your benefits.
[AGENT][NEUTRAL] So your, your secondary policy pays for both inpatient and outpatient. Inpatient is when you're admitted to the hospital, outpatient is everything else. Um, so, urgent cares, emergency rooms, um, therapies, um, diagnostic testing, outpatient surgeries, um, those are all.
[CUSTOMER][NEUTRAL] OK, diagnostic testing, would that be um for like quest diagnostics?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, no, those are labs, but, um, you have a lab benefit also.
[CUSTOMER][NEUTRAL] With whom?
[AGENT][NEUTRAL] The lab benefit covers facilities like Quest Diagnostic or Labor.
[CUSTOMER][NEUTRAL] OK, is that through this APL card that I'm looking at?
[AGENT][NEUTRAL] Yes, that's your policy here with us.
[CUSTOMER][NEUTRAL] OK. Do you have any pending claims for me with Quest Diagnostics?
[AGENT][NEUTRAL] Um, hold on one moment, let's see.
[AGENT][NEUTRAL] No, we only have 3 claims here for you and they're all from Florida Hospital physician Group.
[CUSTOMER][NEUTRAL] Would that be
[CUSTOMER][NEUTRAL] Advent Medical.
[AGENT][NEUTRAL] Um, let me look at the documents and see if I can see exactly what this is for. Hold on one moment.
[AGENT][NEUTRAL] Just waiting for the documents to populate here. So this one is for.
[AGENT][NEUTRAL] Yeah, AdventHealth Medical Group. Oh, Florida Hospital is their billing. OK, so it's for AdventHealth, the 3 claims that we've received.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Do you have reference as to the doctors for these claims?
[AGENT][NEUTRAL] Yes, let's see. The first one.
[AGENT][NEUTRAL] Uh, I, OK, so I guess the D referred you, so this one is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That was for the 1st 1 we received. Let me see if the 2nd or 3rd changes. Hold on one second.
[AGENT][NEUTRAL] The 2nd 1 is also [PII], and I'm looking for the 3rd 1 now.
[AGENT][NEUTRAL] OK, the 3rd 1 is from [PII] also.
[CUSTOMER][NEUTRAL] OK. Is there any?
[CUSTOMER][NEUTRAL] How shall I say, delay or something with pain, um.
[CUSTOMER][NEUTRAL] With getting the claim uh paid.
[CUSTOMER][NEUTRAL] Or is there something that I need to address with [PII] [PII]?
[AGENT][NEUTRAL] Um, well, let me take a look at the claims. They've been processed. Um, let me see what's going on with them. Do you mind if I place you on a brief hold?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Huh?
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, thank you so much for holding. I apologize for the wait. Um, so it's 3 lines here, but it's only 2 claims. So the first claim we received, um,
[AGENT][NEUTRAL] [PII] of this year, office visits aren't covered and primary for the other codes, their primary didn't apply anything, but if you do have something showing that they did apply to this claim, um, the explanation of benefits can just be submitted and we can reprocess.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] The second one we received on [PII]. Office visits aren't covered.
[AGENT][NEUTRAL] Um, on this one, primary insurance provided full benefits and then also some of the codes did not have a charge there, so we can't pay out if there's no charge listed.
[CUSTOMER][NEUTRAL] OK. Um, I'm thinking that should have been covered under the primary, which I believe is Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] Is that possible true statement?
[AGENT][NEUTRAL] You think what should have been covered?
[CUSTOMER][NEUTRAL] The office visit
[AGENT][NEUTRAL] So your primary policy has its own benefits and your secondary has its own benefits. So it could, office visits could be covered and most likely are covered under your major, but for your secondary policy, they are not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will check with them.
[CUSTOMER][NEUTRAL] And see if there's anything that needs to be cleared up there and.
[CUSTOMER][NEUTRAL] So, now, let me back up, uh, this Quest Diagnostics, is this gonna be solely covered by APL?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or does that need to be processed through Blue Cross Blue Shield first?
[AGENT][NEUTRAL] We're 2nd, so everything has to go through Blue Cross Blue Shield first.
[CUSTOMER][NEUTRAL] OK, well,
[CUSTOMER][NEGATIVE] I'll have to beat them up too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, I believe that's helpful.
[AGENT][NEUTRAL] All right, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] And that was document but.
[CUSTOMER][NEUTRAL] Um, you got the winning lottery numbers.
[AGENT][NEUTRAL] I wish I did.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Have a good day.
[AGENT][POSITIVE] Thank you, sir. You also thanks for calling APL. Have a great weekend.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][POSITIVE] You're welcome. Bye bye.