AccountId: 011433970860
ContactId: fc7372a6-6e0a-4b19-9758-9d5828b7bded
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 470619 ms
Total Talk Time (AGENT): 205385 ms
Total Talk Time (CUSTOMER): 197908 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/fc7372a6-6e0a-4b19-9758-9d5828b7bded_20250312T18:20_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, good afternoon, [PII]. My name is [PII]. How are you?
[AGENT][POSITIVE] I'm doing well how are you?
[CUSTOMER][NEUTRAL] I'm good, good, thank you. I wanted to ask you real quick. I did, um, submit a claim, uh, it's the first time that I actually do it myself. It's typically all all of our claims typically are, they're typically are submitted by, you know, the, the medical offices, whatever, right? So I just want to make sure, you know, uh, if you guys need something else from my end, and it has to do with the claim of um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The doctor's office. Mhm.
[CUSTOMER][NEUTRAL] I had a procedure that was supposed to be outpatient, so then there was a certain amount that was uh covered, but it ended up that I had to stay um overnight on the on the on the hotel I was gonna stay at the hospital. And um so I wanted to know, you know, if, if, if everything that I submitted is what you guys need or something else is is also required.
[AGENT][NEUTRAL] OK, well, I can definitely take a look at the documents um and see what's been received. Uh, I can let you know if I see anything that might be missing, um, but it, it, we won't really know until the examiner uh processes everything, but I can certainly take a look for you. And, um, [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] Sure, my contact is [PII].
[AGENT][POSITIVE] Thank you and the.
[CUSTOMER][NEUTRAL] And the policy
[CUSTOMER][NEUTRAL] Uh-huh. The policy is 2,331,550.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And I just need you to verify your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] And the address is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And hold on one moment. Let me take a look at the claim. It looks like it's actually um already finished processing. um this is for Doctor [PII].
[CUSTOMER][NEUTRAL] No, no, this is the Doctor [PII] is my husband. Uh, it's under, I do have a confirmation number here. I don't know if that will help.
[AGENT][NEUTRAL] Do something different.
[AGENT][NEUTRAL] This is for you, this is a claim for you?
[AGENT][NEUTRAL] You said it was a procedure for you, OK. Hold on one second.
[CUSTOMER][POSITIVE] So correct. It's for myself.
[AGENT][NEUTRAL] Oh, I see, it didn't go to the 2nd 1, it stayed on your husband. OK, sorry about that. Hold on one second.
[CUSTOMER][NEUTRAL] Right. Mhm.
[AGENT][NEUTRAL] OK, let me see if I can access the documents. I do see it came in on the [PII].
[AGENT][NEUTRAL] Um, does the confirmation end in 91471?
[CUSTOMER][NEUTRAL] No, I, the confirmation that I have here says 94731.
[AGENT][NEUTRAL] Right, and then the colon and then the 91471?
[CUSTOMER][NEUTRAL] I don't see that number here.
[AGENT][NEUTRAL] Oh, you just had the front part. OK, it's OK. This is the same thing, and this is the only claim.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Under my name, yeah.
[AGENT][NEUTRAL] Yes, ma'am. OK, so this is it. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm just looking to see if I can access the documents that um you submitted.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it's coming up now. So it looks like it was like 7 pages looks like.
[CUSTOMER][NEUTRAL] I do let me see, I can do the file here.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] I just submitted 2 documents.
[CUSTOMER][NEUTRAL] Let's see, one is 3 pages, which is the discharge summary from the hospital.
[CUSTOMER][NEUTRAL] And the other one.
[CUSTOMER][NEUTRAL] It's a picture of the receipt of the uh amount that I did pay when I was admitted at the hospital for $6000.
[AGENT][NEUTRAL] OK, so this is what you're gonna have to do.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Anytime you submit a claim, you're going to need the Mein claim form, which can be found on our website.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're gonna need the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Explanation of benefits, OK, from the primary, OK.
[AGENT][NEUTRAL] Uh-huh. And then you're gonna need the itemized bill from Baptist Health. They may call it a universal bill, but it needs to have the diagnosis code.
[AGENT][NEUTRAL] The procedure codes?
[CUSTOMER][NEUTRAL] OK, hold on, I'm picking up diagnosis, procedure code.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Any surgery codes and all the charges.
[CUSTOMER][NEUTRAL] Surgery and charges. OK. I saw that on the Baptist website, so I could probably just download it from there.
[AGENT][NEUTRAL] No, you, you won't be able to find what we're asking for. This is the hospital's billing, um, it's where your bills come from.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Got you. OK. So I need to call them and request that?
[AGENT][NEUTRAL] Yes, um, they may call it an itemized bill or a universal bill, but if it has all of those, the codes and the charges, um, you should be fine and then the explanation of benefits and um the claim form.
[CUSTOMER][NEUTRAL] So the explanation of benefits that I get from the primary insurance. And is that something that's available there in the systems or I need to also to call?
[AGENT][NEUTRAL] For the explanation of benefits, um, you may be, if you have access to Florida Blue's uh portal, you may be able to access the explanation of benefits and print it off there. Um, if not, you that member services number and they'll be able to, they usually email it.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Got you. Alright. OK, I'll do that. Alright, so I'll take care of putting all this together and then I'll just submit it at the same portal here in in APR.
[AGENT][NEUTRAL] Yes, now this claim here may be denied for a few reasons, but it's OK. Um, you're gonna submit, you're gonna submit what they're going to be asking for, so hopefully, um,
[AGENT][NEUTRAL] Once they finish processing this, the documents will be in there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so then I would say then then this one is gonna be submitted, should I then submit a new claim or or they will just update the information?
[AGENT][NEUTRAL] No, anytime you submit a claim on the online service center, it's gonna give you a new confirmation number and it'll, once it's processing or once it has processed, it'll generate a new claim number. So it'll it'll be a different entry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. OK. So then basically when I when I gather all this information, it will kind of be like a new claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, OK, right. So let me work with this and then I'll, I'll do, I'll do this and if anything, I'll call you.
[AGENT][NEUTRAL] Alrighty. Well, was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, you've been very helpful. I really appreciate your help.
[AGENT][POSITIVE] Well, you're very welcome. I'm glad I can help you and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye bye.