AccountId: 011433970860
ContactId: ed419ed9-a99a-403a-b929-a74c1b54bcce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414799 ms
Total Talk Time (AGENT): 131496 ms
Total Talk Time (CUSTOMER): 187132 ms
Interruptions: 1
Overall Sentiment: AGENT=2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/ed419ed9-a99a-403a-b929-a74c1b54bcce_20250407T18:34_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I am just calling in regards to an explanation of benefits I received.
[AGENT][NEUTRAL] OK, is it for yourself or are you with the provider?
[CUSTOMER][NEUTRAL] It's for me.
[AGENT][NEUTRAL] OK. Um, can I get your name and your policy number?
[CUSTOMER][NEUTRAL] Sure. My name is [PII] and then let me get my policy.
[CUSTOMER][NEUTRAL] I have my member ID here, is that what you're looking for?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK, it's 972-0.
[CUSTOMER][NEUTRAL] 31166
[CUSTOMER][NEGATIVE] Oh, I'm sorry, that's the wrong.
[CUSTOMER][NEGATIVE] That is the wrong policy. Give me just a sec.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEGATIVE] I grabbed the wrong card.
[CUSTOMER][NEUTRAL] I was like, wait, this is not the right one. policy number here. OK, it's on my explanation of benefits. Um, it's 025.
[AGENT][NEUTRAL] No
[CUSTOMER][NEUTRAL] 84025
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Sorry about that.
[AGENT][NEUTRAL] Oh, no worries. Um, just need to verify a few pieces of information. Um, can I get a good callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure [PII].
[AGENT][NEUTRAL] And then what is your birth date?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then lastly your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And we were, what were we checking on a claim status, is that correct?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, so I received a few, I've had a little bit of issues with this claim. I had just started my COR, um, and they had ran it under my non-COR insurance, so we had to run it again under COR, and then I think I just got an explanation of explanation of benefits for my COR, but I'm not sure what any of this means.
[AGENT][NEUTRAL] Does it have a claim number on it by chance?
[CUSTOMER][NEUTRAL] It sure does. Let me grab that for you. It is 3582192.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and was that for University of Florida Jacksonville ER?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, yes, it was the opposite.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] There's a couple of different claims here.
[AGENT][NEUTRAL] So it looks like it was for [PII]. Is that correct?
[CUSTOMER][POSITIVE] Mhm that is correct.
[AGENT][NEUTRAL] It looks like, OK, so for this policy, it's a hospital indemnity plan, so it looks like it pays out.
[AGENT][NEUTRAL] $50 for an ER visit.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me pull up something.
[AGENT][NEUTRAL] It looks like we received a claim from the provider and then we paid that to the provider $50.
[CUSTOMER][NEUTRAL] OK, so that's all it covers.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so that's, but for all the stuff that I got from the hospital that day, that's all it will cover.
[AGENT][POSITIVE] It's $50 for an ER visit. Yes, that's correct.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] OK. And like all the tests and stuff that I got that day and all that, it'll just be that much money that they pay out.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That would explain why it says that the maximum for the state of service has been met, I'm assuming.
[AGENT][POSITIVE] Yes, exactly.
[CUSTOMER][NEUTRAL] The benefit maximum.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, alright, that would make sense. Alright, yeah, I have, I have a ton of them that say like different things, so I was so confused. Alright, so it's already paid out what they, what they will pay then the rest is my responsibility.
[AGENT][NEUTRAL] Um, yeah, we don't determine patient responsibility, but we just, the $50 is the max that we can pay you.
[CUSTOMER][NEUTRAL] Yeah. Sure.
[CUSTOMER][NEUTRAL] That you'll pay covering anything in the hospital.
[AGENT][NEUTRAL] Before that date of service, yes.
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] For that, for that hospital visit.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, so what insurance is willing to pay out, they've already paid out.
[CUSTOMER][NEUTRAL] Not that.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] No, just that just didn't know if everything went through and what it does cover, what it doesn't cover.
[CUSTOMER][NEUTRAL] Things like that, so that should be all set.
[AGENT][NEUTRAL] Um, do you have access to your policy certificate on our online portal?
[CUSTOMER][NEUTRAL] Oh, I don't, I don't know. It's a good question.
[AGENT][NEUTRAL] Um, just in case.
[CUSTOMER][NEUTRAL] I don't even know where that.
[AGENT][NEUTRAL] Yeah, so if you're interested, um you can go to [PII], click the new user, and then you can get your account set up that will give you access to upload anything online. You can look at your policy certificate which outlines exactly what's covered, etc. um.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just keep in mind if you do go set that up for the member ID or social security number it will only take the social so it'll ask for your last name.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, so, OK.
[AGENT][POSITIVE] Yeah, so, but that's a great website if you, if you like, yeah, so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So put in my social.
[CUSTOMER][POSITIVE] OK, oh awesome, here I am right.
[CUSTOMER][NEUTRAL] So that'll kind of show me what it covers and what it doesn't cover.
[AGENT][POSITIVE] Yes, you'll be able to pull up the entirety of that policy certificate, which will give you a breakdown.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, awesome thank you so much.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thanks, you too. Bye-bye.
[AGENT][NEUTRAL] Bye.