AccountId: 011433970860
ContactId: da85018a-eab0-4c89-8e6f-2412a6df2bef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 652739 ms
Total Talk Time (AGENT): 206631 ms
Total Talk Time (CUSTOMER): 266301 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/da85018a-eab0-4c89-8e6f-2412a6df2bef_20250530T12:53_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII], and I am calling because I started a claim, um, when my first doctor told me to do an MRI. I have an issue on my knee. So I present information on the, on, on your website, and then I visit the orthopedic and they suggested some physical therapy, OK? So at the beginning I didn't give my APL card.
[CUSTOMER][NEUTRAL] But um both things are related. So I checked on the portal and I think you are requiring some information, MRI results, so you know, the therapy, whatever.
[CUSTOMER][NEUTRAL] My question is if the doctor that recommended the therapist submit that information, it will go with the actual claim that I have or I need to submit it separately, can you please guide me? How can I do that?
[AGENT][NEUTRAL] OK. Do you have a phone number in case we get disconnected, I can call you back?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And do you have your policy number?
[CUSTOMER][NEUTRAL] Uh I think so.
[CUSTOMER][NEUTRAL] 1776 8.
[AGENT][NEUTRAL] OK, that probably your group number. Do you have your policy certificate number?
[CUSTOMER][NEUTRAL] I it it's 02164502.
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And can I verify your date of birth?
[CUSTOMER][NEUTRAL] [PII] and I also would like to update my my address.
[AGENT][NEUTRAL] And can I
[AGENT][NEUTRAL] That's what I was supposed to ask you, you, can I verify your address and email address?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I think you have one that is uh [PII].
[CUSTOMER][NEUTRAL] And I need to update it.
[AGENT][NEUTRAL] OK. And what's your email address?
[CUSTOMER][NEUTRAL] [PII] or [PII]. I can't remember which one I put.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] What's your, uh, new address and I'll get that changed for you.
[CUSTOMER][POSITIVE] Thank you it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you spell that for me?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that was [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. I can get that changed for you. Thank you, Ms. [PII]. And you were calling about a claim that you had filed and the information we're needing?
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's the last one I checked that yesterday and I think you are requiring some test results.
[AGENT][NEUTRAL] OK, I can help you with that. Is that?
[AGENT][NEUTRAL] What date of service was that for?
[CUSTOMER][NEUTRAL] Oh, I don't have that on top of my mind, but definitely it was, I think it's, it was at the beginning of May, maybe.
[AGENT][NEUTRAL] OK, I can see.
[CUSTOMER][POSITIVE] That they did I got the results, mhm.
[AGENT][NEUTRAL] I can see that we have 2, we have one for 52 for a diagnostic test for 25601. We need your explanation of benefits from your primary insurance where they paid that claim.
[CUSTOMER][NEUTRAL] I provided that. I provided explanation of benefits.
[AGENT][NEUTRAL] And then.
[CUSTOMER][NEUTRAL] From my insurance.
[AGENT][NEUTRAL] Was there something on [PII] that hold on just a moment, let me pull up the claim.
[AGENT][NEUTRAL] It looks like on one of them, we're asking for the diagnosis code, but let me pull the claim up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment. I'm look at it for you.
[CUSTOMER][POSITIVE] Sure. Thank you.
[CUSTOMER][NEUTRAL] I think I put the order of the MRI and then you might need the result, right?
[AGENT][NEUTRAL] OK. On this one, all we received was, was the order rheumatology and in specialist of Palm Beach.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was a diagnostic test.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] October
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] Let's see, and that was, hold on, I'm sorry. I'm.
[CUSTOMER][POSITIVE] No, take your time. No problem.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And then we received the credit card receipt which we can't pay by that. So on that one we did not receive the EOB from your primary.
[AGENT][NEUTRAL] We just received a bill.
[AGENT][NEUTRAL] The imaging order.
[CUSTOMER][NEUTRAL] And, and what do you need?
[AGENT][NEUTRAL] Uh, who is your primary insurance?
[CUSTOMER][NEUTRAL] What and what
[CUSTOMER][NEUTRAL] Uh, Florida blue.
[AGENT][NEUTRAL] OK, you would call.
[CUSTOMER][NEUTRAL] Chill, but what happened is
[CUSTOMER][NEUTRAL] What happened is I, I didn't present the APL card when I did this.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Well, the, the place where I did the MRI, they told me.
[CUSTOMER][NEUTRAL] Just to pay the copayment so.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's, it's, I need, you're saying that I need to call the insurance and let and what should I tell them?
[AGENT][NEUTRAL] You, you would tell them that you need an exclamation of benefits for 52 of 25.
[CUSTOMER][NEUTRAL] Let me write it down.
[CUSTOMER][NEUTRAL] Explanation.
[AGENT][POSITIVE] A benefits.
[CUSTOMER][NEUTRAL] Explanation of benefits, OK? 4.
[AGENT][NEUTRAL] 452 of 25.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For TH TGH imaging.
[CUSTOMER][NEUTRAL] That's the MRI right?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that's for your diagnostic test, your.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] OK, so that.
[CUSTOMER][NEUTRAL] And then for the for the rehab, then um the center that is doing the rehab, they will present the the documents because I gave them my APL card, right? It's a different.
[AGENT][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] Right. They may send it in for you. I'm not sure.
[CUSTOMER][NEUTRAL] Yeah, I gave them the information, but I'm gonna follow up with them.
[AGENT][NEUTRAL] OK, when you call Florida Blue though and ask them for that explanation of benefits, just tell them.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You need one that shows what was applied to your copay.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me look at this other claim. Hold on just a second.
[CUSTOMER][NEUTRAL] Because I, I submit the, the benefits.
[CUSTOMER][NEUTRAL] I submit the benefits that I have.
[CUSTOMER][NEUTRAL] With them.
[AGENT][NEUTRAL] OK, yeah, we don't need that. We need the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you. OK, so I'm gonna call them.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, perfect. I appreciate your help thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that will be it. Thank you.
[AGENT][POSITIVE] Thank you, Ms. [PII], for calling APL. You have a good day and I'll get that address changed for you.
[CUSTOMER][POSITIVE] Thank you so much. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.