AccountId: 011433970860
ContactId: dab409fc-7567-40cc-a851-91f184e2f8db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384549 ms
Total Talk Time (AGENT): 170098 ms
Total Talk Time (CUSTOMER): 191048 ms
Interruptions: 6
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/dab409fc-7567-40cc-a851-91f184e2f8db_20250307T17:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I am calling to ask a question about a possible claim that was put in, um, from one of my family members, and I'm the insured.
[AGENT][NEUTRAL] OK, uh, I can take a look at that claim. What was your name?
[CUSTOMER][NEUTRAL] My name is [PII]. Last name [PII].
[AGENT][NEUTRAL] OK, and can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, um, area code [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, 1072145.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Alright, and I'm just gonna verify some information really quick. Can I get your date of birth please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] Um, I, let me try because we've moved, but the original one was [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, that is what we've got. Does that need to be updated?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what is that current address for you?
[CUSTOMER][NEUTRAL] [PII] that's [PII] and there's no apartment number.
[AGENT][NEUTRAL] Got it. OK, I will get that updated um last thing I need is the email address we've got on file for you. uh, looks like it's a [PII] account.
[CUSTOMER][NEUTRAL] Yes, it should be [PII].
[AGENT][POSITIVE] That's it. OK, thank you so much for verifying that information. Alrighty and uh which member was this claimed for?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So it's for my son [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK. Uh-huh.
[CUSTOMER][NEGATIVE] And the claim because I'm getting a bill from Broward Health Medical Center and I already called Florida Blue, which is our primary, and they told me what what supposedly they're telling me I owe is correct. I just didn't know if they put a claim in through APL as well.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, we can take a look.
[CUSTOMER][NEUTRAL] And um mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have that date of service?
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Yeah, they're telling me it's [PII].
[AGENT][NEUTRAL] [PII] of last year.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Give me just, let me see if I've got anything for that date.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And it was for an emergency room visit with X-rays, doctor visit. They're telling me the original amount was $3,022.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then after Florida Blue it was like $1,582 something like that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I think I've found it from Broward Health. Let's take a look.
[AGENT][NEUTRAL] OK, so we did receive this claim um it is stating that we were unable to pay a benefit as so the outpatient benefit amount uh the way your policy works, uh, operates on a per calendar, um, excuse me, per occurrence, uh, basis so essentially what that means is treatment for the same or related condition until that amount had been met and it had it had been pri met prior to uh this date of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] As a as a whole, like for the whole account, like my whole family.
[AGENT][NEUTRAL] Um, it is for individuals. So, um, for him, uh, specifically for whatever he went, um, to be treated for, um, it looks like, let me go back here and take a look.
[AGENT][NEUTRAL] Because we had gotten another claim.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] For yes, and it paid that um it was so it was a $500 maximum benefit amount per occurrence, yes.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] And so can you tell me when that was met because I I have a feeling these dates are not accurate because the incident happened the same day we went to the emergency room, so I don't know how it was met before then.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, it that that's the thing so we didn't receive this claim until November of last year, um, so [PII] was when this claim was received. Um, it looks like that if I'm this is the same, let me check. It looks like we got another for the date of service. Let me check this one give me just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Ah, got you.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So he did go into surgery for this incident, but um through an orthopedic surgeon at a um a different facility for his shoulder to be repaired um at the end of June.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was that on [PII] by chance? Yeah, OK, so that's where that went, yes.
[CUSTOMER][NEGATIVE] Yes, correct, so that's where they applied it. OK, all right, well, I was, I was wondering why Broward Health took so long. They literally just sent me a statement at the end of, of, of January and then they sent it to my old address on top of it. So then they called me and I said, What are you talking about? I thought I paid for everything because this is like old news to me now. It's almost a year later.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Yeah, definitely.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Right. Oh my gosh.
[AGENT][POSITIVE] Exactly, right, yeah.
[CUSTOMER][NEUTRAL] So, OK, so I do owe that. OK, darn.
[AGENT][NEUTRAL] No, it's, and I'm sorry, I know it's very confusing and yeah, I don't know why they just filed the claim there in November, but yeah, it does work with whoever files it first, you know, they'll get that.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Mhm, yep, yep, no problem, thank you so much for clearing it up.
[AGENT][POSITIVE] Alright, did you have any other questions for me? Of course, absolutely.
[CUSTOMER][POSITIVE] Yes, that's it thanks have a good weekend.
[AGENT][POSITIVE] Alright, yeah, thanks you too bye bye.
[CUSTOMER][POSITIVE] Thanks bye bye.