AccountId: 011433970860
ContactId: f6705831-4822-4e0f-8254-c50c60853239
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329739 ms
Total Talk Time (AGENT): 135313 ms
Total Talk Time (CUSTOMER): 164919 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/f6705831-4822-4e0f-8254-c50c60853239_20250320T12:10_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, you need, you need the, the, the card number how it goes?
[AGENT][NEUTRAL] Let me get your first name first and then the policy number.
[CUSTOMER][NEUTRAL] So I'm registered. I'm the spouse of my wife. The insurance is on my wife, so you need to pull up her name or my name?
[AGENT][NEUTRAL] I need your name because you're the caller.
[CUSTOMER][NEUTRAL] Yes, my name is [PII], last name [PII]
[AGENT][NEUTRAL] And now the policy number?
[CUSTOMER][NEUTRAL] So I'm looking at the card, it says group number.
[AGENT][NEUTRAL] Uh, it'll be the
[CUSTOMER][NEUTRAL] And then in only hospital.
[AGENT][NEUTRAL] Uh huh the outpatient or inpatient policy certain numbers what I need either or.
[CUSTOMER][NEUTRAL] It it will be what?
[CUSTOMER][NEUTRAL] OK, you want, OK, so let's go with the outpatient. 023.
[CUSTOMER][NEUTRAL] 00504 ML 8.
[AGENT][NEUTRAL] OK, what's a good uh callback number you're on I can use in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. Let me pull up this policy. Are you on the policy?
[CUSTOMER][NEUTRAL] Yes, at least I was on the date of the billing. I, I don't know if I'm currently now, but uh I was when, you know, in the summer.
[AGENT][NEUTRAL] OK. Verify
[AGENT][NEUTRAL] What's your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your spouse's name and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII], and that's [PII].
[AGENT][POSITIVE] OK. And how can I help you today?
[CUSTOMER][NEUTRAL] OK. So, uh, on the date on, uh, [PII], uh, I did some treatment in South Broad and endo endoscopy.
[CUSTOMER][NEGATIVE] And supposedly they build something maybe for the difference or whatever and you guys denied it completely.
[AGENT][NEUTRAL] OK, is this year [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the claim is for your spouse or is it for you?
[CUSTOMER][NEUTRAL] For me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me the name of the provider.
[CUSTOMER][NEUTRAL] The provider name is South Broward endo endoscopy.
[AGENT][NEUTRAL] OK, I don't show a claim from South Broward endoscopy for that day. I have the anesthesiologist charge that we paid, but it appears that we have not received the claim yet, so we didn't deny anything regarding the South Broward.
[AGENT][NEUTRAL] Claim.
[CUSTOMER][NEUTRAL] So you got from whom?
[AGENT][NEUTRAL] Uh, Galloway Anesthesia Associates. So you had a surgery?
[CUSTOMER][NEUTRAL] On the day, on the same day?
[AGENT][NEUTRAL] Did you have a surgery on [PII]?
[CUSTOMER][NEUTRAL] I didn't
[CUSTOMER][NEUTRAL] Uh, yeah, it's, it's a colonoscopy, I guess so. I, I guess it has to do, it's not a surgery, but, uh, but it will colonoscopy involve, uh, involve the, the treatment you just mentioned, yeah.
[AGENT][NEUTRAL] OK. OK. It is considered a surgery. The only claim that we've received for that date of service is from the anesthesiologist's office.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and, and.
[AGENT][NEGATIVE] I don't show anything received from the.
[AGENT][NEUTRAL] Endocrinology facility.
[CUSTOMER][NEUTRAL] OK, and how much is that?
[CUSTOMER][NEUTRAL] So that.
[AGENT][NEUTRAL] How much is the bill or how much was paid?
[CUSTOMER][NEUTRAL] How much is the bill? How much was paid?
[AGENT][NEUTRAL] We paid $368.11.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And that looks looks to be your responsibility. The total charge was 2610.
[CUSTOMER][NEUTRAL] OK, so you paid the, OK, all right.
[CUSTOMER][NEUTRAL] OK. I, I understand.
[AGENT][NEUTRAL] OK. Do you have.
[CUSTOMER][NEUTRAL] And, and I still have money in the account to pay more, or no?
[AGENT][NEUTRAL] Right, so let me look at your outpatient benefit.
[CUSTOMER][NEUTRAL] Handicap.
[CUSTOMER][NEUTRAL] So, so that was from the, uh, how do you define it? who's who charged the bill on that, the 368, uh, and, and to all of this?
[AGENT][NEUTRAL] Anesthesia, the anesthesiologist office.
[CUSTOMER][NEUTRAL] And and this
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So your outpatient benefit is up to $2250 per calendar year. So yes, there is uh moneys available for that for [PII].
[AGENT][NEUTRAL] For the South Broward Endoscopy Center to send their claim in to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. So I in between that and Cigna, it should be covered. OK.
[CUSTOMER][POSITIVE] All right. OK. I will speak with them. Thank you so much.
[AGENT][NEUTRAL] OK, any other questions, [PII]?
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] That's it. Thank you so much. Bye-bye.
[AGENT][POSITIVE] Alright, and any information provided has been it's just verification, not a guarantee and if no other questions, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] So, so again, again, if I, if I have leftover money that I need to pay with that endo endoscopy, they can call you guys and it should be covered under my current here, correct?
[AGENT][NEUTRAL] Correct, there there are remaining benefits for last year, so yes they can call us, verify your benefits and submit the claim for review of payment.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Thanks so much.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK bye bye bye.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too.