AccountId: 011433970860
ContactId: ed443c7b-6201-4bf2-8abd-b3705c71cc7a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 869099 ms
Total Talk Time (AGENT): 358531 ms
Total Talk Time (CUSTOMER): 450509 ms
Interruptions: 5
Overall Sentiment: AGENT=1.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/ed443c7b-6201-4bf2-8abd-b3705c71cc7a_20250324T15:17_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] Hi [PII], good morning, um, trying to look into a specific claim.
[CUSTOMER][NEGATIVE] On my account just I think the website's having some technical difficulties today, um.
[AGENT][POSITIVE] Well, I'll be happy to assist you. What is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And do you have your policy number available?
[CUSTOMER][NEUTRAL] Uh, let's see here I 212-3559.
[AGENT][NEUTRAL] And do you mind verifying your name and date of birth and current mailing address?
[CUSTOMER][NEUTRAL] I'm [PII], pretty good, [PII], uh [PII] address [PII].
[AGENT][POSITIVE] All right, thank you. And then finally, what is your Yahoo email address?
[CUSTOMER][NEUTRAL] Yeah, the [PII], I gotta update that, um.
[AGENT][POSITIVE] Yeah, I can update it. You wanna go ahead and update it?
[CUSTOMER][NEUTRAL] Shoot.
[CUSTOMER][NEUTRAL] Yeah, let me see if I can guess it first. Is it um [PII]?
[AGENT][POSITIVE] You did good. That was it.
[CUSTOMER][NEUTRAL] Yeah, it's been a, it's, it's been a while I get it's been a couple of years since that's why, um, but yeah, you can change it if you don't mind.
[AGENT][NEUTRAL] Well I can
[AGENT][NEUTRAL] Oh really, what's
[CUSTOMER][NEUTRAL] Cause I, it's very similar now.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] So now it's now it's just 9 now it's [PII].
[CUSTOMER][NEUTRAL] So I just flip them, you know what I mean, and then it's [PII].
[AGENT][NEUTRAL] Got you. So [PII]
[CUSTOMER][NEUTRAL] Yeah, because believe it or not, I tried to, yeah, when I went to Google or I went when I went to Gmail, I tried to do the [PII], but somebody already had it. I was like, darn. So I had to switch them.
[AGENT][POSITIVE] Isn't that amazing?
[CUSTOMER][NEUTRAL] Yeah, I just
[AGENT][NEUTRAL] You would think nobody else would have that, right?
[CUSTOMER][NEUTRAL] Yeah, I mean, like what are the odds, right?
[CUSTOMER][NEUTRAL] So, but yeah, [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right, and I do understand we are having some issues today um with the website and they are working to get that uh rectified as quickly as possible.
[AGENT][POSITIVE] But I can help you with.
[CUSTOMER][NEUTRAL] OK, well, maybe you can help me with.
[AGENT][POSITIVE] Sure, it would be my pleasure.
[CUSTOMER][NEUTRAL] One specific claim.
[AGENT][NEUTRAL] And who is it for?
[CUSTOMER][NEUTRAL] Um, so the claim number, oh, I'm sorry, it's for [PII].
[AGENT][NEUTRAL] OK, you got that claim number you said?
[CUSTOMER][NEUTRAL] It's 3576823.
[AGENT][NEUTRAL] OK, for Florida Women Care.
[CUSTOMER][NEUTRAL] Yeah, let me just give you my quick synopsis and then you can tell me if I did something wrong or, or if there's just something else needed or if it's just not gonna be paid. I just don't know. So like she, you know, for example, she went to obviously the, to the doctors and had some work done.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, but then, so the bills came back, you know, where we owe some money.
[CUSTOMER][NEGATIVE] But I didn't the original claim. I, it showed that I don't think you guys paid anything on it or maybe it didn't even go to you. I'm not sure so I personally submitted a claim and that's what this one is. That's why you could probably see like a few files that I put in there.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] So I just don't know if I did it right or if it's just something that's not gonna be covered. I, you know, I just don't know where I need, you know, what, what the status of it is basically because it looks like it's currently showing that nothing is paid.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Yeah, so there are some, uh, there is some information that we do need, and that is the diagnosis code for that data service 12924.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So that, uh, because your policy.
[CUSTOMER][NEUTRAL] The diagnosis, so is that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is that not on the Blue Cross Blue Shield one?
[AGENT][NEUTRAL] Let me check because if you have [PII] Blue, is it [PII] Blue?
[CUSTOMER][NEUTRAL] Um, just I think it's Blue Cross Blue Shield of [PII].
[AGENT][NEUTRAL] OK, yeah. So that's probably not going to be on that.
[CUSTOMER][NEUTRAL] The company is out of [PII].
[AGENT][NEUTRAL] Let me see, I'm checking a couple of things.
[CUSTOMER][NEUTRAL] So that's why I submitted the Blue Cross Blue Shield of [PII], you know, EOB.
[CUSTOMER][NEUTRAL] Says there's procedure code down here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, procedure codes are what was performed for that data service. Diagnosis code is the reason.
[AGENT][NEUTRAL] And because your policy pays towards sickness or injury, we have to have that diagnosis code in order um
[AGENT][NEUTRAL] To know that it is in fact for a sickness or an injury.
[AGENT][NEUTRAL] And that can be, that can be obtained from the provider. You can actually call Florida Women Care.
[CUSTOMER][POSITIVE] Got you OK.
[AGENT][NEUTRAL] And ask them for a.
[AGENT][NEUTRAL] Form, it's called a CMS 1500.
[CUSTOMER][NEUTRAL] Say that again, I'm sorry.
[AGENT][NEUTRAL] It's CMS and that's Charlie, Mike, Sam, 1500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For data service 129.
[AGENT][NEUTRAL] The [PII], let me check this, um.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Well, I wonder if she.
[CUSTOMER][NEUTRAL] Yeah, I'm wondering if she went in before that, like that's a hypothetical, maybe she went in on [PII] or [PII], right? And that's when they diagnosed her and then she went back on [PII] for the procedure. Is that possible?
[AGENT][NEUTRAL] That is very possible.
[CUSTOMER][NEUTRAL] Or do you think it would have all happened on the same day?
[CUSTOMER][NEUTRAL] I don't know, I'm just hypothetically.
[AGENT][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] But because those procedures were performed on [PII], yeah.
[CUSTOMER][NEUTRAL] So basically I just need to call [PII].
[AGENT][POSITIVE] That's what we need that.
[CUSTOMER][NEUTRAL] So basically I just need to call them and ask them for the CMS 1500 for the procedures that were performed on [PII].
[AGENT][NEUTRAL] Now that will come from [PII] Women Care.
[CUSTOMER][NEUTRAL] Because like they maybe.
[AGENT][NEUTRAL] That information will, yeah.
[CUSTOMER][NEUTRAL] Yeah, that's what I mean. Call [PII], right, that's what I mean, call [PII] Women Care and ask them for the CMS 1500 for the, for what they, the procedures that they performed on [PII] because they might have diagnosed it on [PII]. I don't know, you know what I mean? That's all, you know.
[AGENT][NEUTRAL] care.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's right. That's right. But because the procedure date.
[CUSTOMER][NEUTRAL] Right, I just wanna make sure I'm.
[AGENT][NEUTRAL] Yeah, you're right. And because that procedure date, let's see, did she go back, did she?
[AGENT][NEUTRAL] Well, there was something on [PII] as well.
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Well, that's kind of what I'm getting at because I think she's been there a few times because it was an, I mean it is a, a potential sickness thing, you know, she has, she has low iron, um, so.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I just, you know, I, that's all I just need to, trying to get you the right information, you know, because I know she did go there a few different times.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But the CMS 1500 should get you what you need, you think?
[AGENT][NEUTRAL] It should, yes, sir, because that's gonna give us the diagnosis codes, and we can't process a claim without those diagnosis codes because your policy pays towards sickness or injury. So we always have to have those diagnosis codes, and that will indicate if those services are for a sickness or an injury.
[CUSTOMER][NEUTRAL] Got you, or a potential sickness?
[AGENT][NEUTRAL] And then in the future.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Right, OK, OK, um, I'm sorry.
[AGENT][NEUTRAL] And then in the future um just if she goes back, tell her to be sure to give them that your APL card and they can file claims for you.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, she normally does, you know, I think she may have because if I, if you go back into the EOBs, you know, on the, on the APL on my account, I mean, I think you'll see some in there.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, like, well, yeah, there's, there's two of them in there from [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] It looks like nothing, or I'm sorry, um, you know, maybe one yeah it looks like there's one on [PII] that.
[CUSTOMER][NEUTRAL] Well, no, that came
[CUSTOMER][NEUTRAL] I don't know, it's hard to read their website, but yeah, maybe they didn't because I guess this is, this is showing the claims process in the last 24 months.
[CUSTOMER][NEUTRAL] And there's only the one that I did.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] And then there's another one that I didn't do.
[CUSTOMER][NEUTRAL] So like claim 33576885.
[AGENT][NEUTRAL] Mhm. I was just looking at that one also.
[CUSTOMER][NEUTRAL] Yeah, I can't. The website won't. The website won't let me open them. I'm sorry, I can't really help you with them, but that might be, so that might be the, that might be the one that got submitted to APL that I showed there was nothing paid. So then I went and tried to upload some documents. That's why there's, I think, showing two of them for the 12 [PII].
[AGENT][NEUTRAL] No, uh, you're fine. You're fine.
[AGENT][NEUTRAL] Mhm. Right.
[CUSTOMER][NEUTRAL] To see the ones giving me like a confirmation number where I, you know, I, I added files.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So if I get the CMS 1500, what should I do? Should I call you guys back or how does that work?
[AGENT][POSITIVE] So you can just upload it online uh hopefully they'll.
[AGENT][NEUTRAL] Resolved and they should shortly have that issue resolved, um, but you can just upload it online just like you would did the original claim. The adjusters will go back and review the history.
[AGENT][NEUTRAL] And they'll see that it is for this claim.
[CUSTOMER][NEUTRAL] OK, so that's all I won't have to resubmit anything other than just that CMS 1500 and the adjusters will know what to do with it basically.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, then I will work to get that CMS 1500.
[AGENT][POSITIVE] Yes sir is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] And it is
[CUSTOMER][NEUTRAL] Uh, I think that's it, so it's basically a diagnostic code.
[CUSTOMER][NEUTRAL] That's what the CMS 1500 is giving me.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] That's right, so they will give us the procedure codes and the charges listed as well, but they'll have all the diagnosis codes.
[AGENT][NEUTRAL] And when you look on that form when you get it, it's gonna be in about the middle of the page. It's gonna be under the ICD 10 codes. That way you can kind of see what a diagnosis code looks like. For example, it could be M54.92 or 092.30. That's, that's what a diagnosis code looks like.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I guess that makes sense what you're saying like, you know, you, you know, I'm telling you there was a procedure performed, but you don't know why that procedure was performed, so I get it.
[AGENT][NEUTRAL] Exactly, and because your policy pays only for sickness or injury, that's why we have to have that diagnosis code.
[CUSTOMER][NEUTRAL] I got it. OK, that makes sense. So I'm gonna get that and then submit it and go from there.
[AGENT][NEUTRAL] That's right. And let me check one other thing for you. Let's see.
[AGENT][NEUTRAL] We also have an option for direct deposit.
[AGENT][NEUTRAL] You can sign up for benefits to go directly to your bank account if you would prefer that option.
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] So once, so once the claim is.
[CUSTOMER][NEUTRAL] Or a check is that you in that um.
[AGENT][NEUTRAL] That's right. Right now, if the claim was paid, you'll be receiving a check by mail, but if you would prefer to have.
[AGENT][NEUTRAL] Uh, the benefits directly deposited deposited to your bank account, then you can choose that option. I think it's called uh under your portal under the update payment option.
[CUSTOMER][NEUTRAL] Um, let me see here.
[CUSTOMER][NEUTRAL] Payment preferences.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, set up payment preferences and it's, it's where I can put a routing number, the bank account number, that sort of thing.
[AGENT][NEUTRAL] That's it.
[AGENT][POSITIVE] Right, you got it.
[CUSTOMER][POSITIVE] Yeah, so don't wait your check. Get your benefit faster with the direct deposit. Yeah, yeah, OK, cool, cool.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Yeah, because, so on this one, once I get you the CMS 1500, everything goes perfect you guys will direct deposit the money into my account but then I, I would just go pay the bill on this one because it's kind of.
[CUSTOMER][NEGATIVE] At that point, right, the way this one, right, like you're not, you're not gonna pay the the provider direct on this one because it's already kind of in the system as being rejected and then now I'm just trying to get it corrected.
[AGENT][POSITIVE] That's right. That's right.
[AGENT][NEUTRAL] Well, we wouldn't um send the money to the provider because you filed the claim, so if you file the claim benefits go directly to you if the provider files the claims benefits would go directly to the provider.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Oh, so then I guess like in theory I could just go to the provider and say look you need to file a claim with ACL.
[AGENT][POSITIVE] You certainly could.
[CUSTOMER][NEUTRAL] OK, mm
[CUSTOMER][NEUTRAL] Alright, well I'm gonna try to get the CMS 1501st and see if, see if we can, um, yeah, go that route.
[AGENT][POSITIVE] Yeah, see if they'll provide that for you. Exactly, exactly.
[CUSTOMER][NEUTRAL] Since I've already started it.
[AGENT][NEUTRAL] And, um, just in the future.
[CUSTOMER][NEUTRAL] OK, and if that, if I can't get that, then I'll just call the provider and tell them to submit a claim with you guys.
[AGENT][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] And then I'm sure they would have the code and know exactly what they need to do so.
[AGENT][NEUTRAL] They do.
[CUSTOMER][POSITIVE] Yeah, OK, alright, well I appreciate your time.
[AGENT][NEUTRAL] They do.
[AGENT][POSITIVE] Oh, it's been my pleasure to assist you. Mr. [PII], is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it I appreciate it.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a wonderful day and please call us if we can be of further assistance to you.
[CUSTOMER][POSITIVE] OK will do thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.