AccountId: 011433970860
ContactId: ff12374b-cebf-4368-9d02-91adbffa9866
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1034790 ms
Total Talk Time (AGENT): 507192 ms
Total Talk Time (CUSTOMER): 570327 ms
Interruptions: 13
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/ff12374b-cebf-4368-9d02-91adbffa9866_20250117T14:40_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] Good morning, Ms. [PII]. This is [PII] in customer service.
[AGENT][NEUTRAL] Hey, [PII].
[CUSTOMER][NEUTRAL] I have an insured on the line, um, new to the online service center who is requesting um assistance with a claim, uh, how to file a claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Her name is [PII] and um her policy number is
[CUSTOMER][NEUTRAL] 14
[CUSTOMER][NEUTRAL] 800.
[CUSTOMER][NEUTRAL] 77.
[AGENT][POSITIVE] All right. I can certainly help, Ms. [PII] with how to file a claim. Not a problem at all. I would be happy to.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] And her callback number is on file?
[CUSTOMER][NEUTRAL] Um, yes, it is the one that we have in um the system, the one ending in [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] Perfect. Thank you, [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you, sweetie. Take care.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] Good morning, Ms. [PII]. My name is [PII]. Uh, how are you doing?
[CUSTOMER][NEUTRAL] Hi, I'm, I'm well and you?
[AGENT][POSITIVE] I'm doing well, thank you for asking. I'm in the care team and it was Ms. [PII] said you were needing help in filing a claim.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Alright, I can help you with that. Now there's two options if you have not paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the services.
[CUSTOMER][NEGATIVE] Uh huh I have not paid.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, let, let me explain and maybe you'll be able to tell me then what my, what I need to do. I had an outpatient procedure done. I gave them my insurance card. I paid a copay and then I just got a bill in the mail, uh, yesterday from the outpatient center for, um, it looks like anesthesia.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And did um.
[AGENT][NEUTRAL] Did the does the is that coming from the facility or from the anesthesiologist?
[CUSTOMER][NEUTRAL] Um, uh, well, it's addressed on here it says Jupiter Outpatient Surgery Center.
[CUSTOMER][NEUTRAL] There is a billing code on here.
[AGENT][NEUTRAL] Let me just check something on your claim history, bear with me just one second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Do you know what that data service was?
[CUSTOMER][NEUTRAL] The date of service would be [PII].
[AGENT][NEUTRAL] OK, so we have not received any claims for that data service.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, there's there's not been anything filed because I they didn't have my gap insurance card so I now have this bill and I'm like, oh wait a minute, um, I wasn't aware that I was gonna get it actually does say on here now that I'm looking at the back of it it it has like a um you can detach the area to mail in a check and on the on that um slip it does say Bethesda anesthesia associates so I guess maybe it is going to the anesthesiologist and not the outpatient but it's coming from.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know the outpatient center.
[AGENT][NEUTRAL] The facility, yeah, so what I would suggest is to actually to call them.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And give them your make sure that they have your APL information on file.
[CUSTOMER][NEUTRAL] OK, because what if they reject it like I mean would it be easier for me to file the claim through y'all to try to.
[AGENT][NEUTRAL] And you certainly can. Yeah, you, you can. What we're gonna need is an itemized bill from the facility or the anesthesiologist.
[CUSTOMER][NEUTRAL] Um, see if that's covered, OK, OK.
[AGENT][NEUTRAL] With the diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let me just say itemized.
[CUSTOMER][NEUTRAL] Bill
[CUSTOMER][NEUTRAL] With diagnosis codes and procedure codes.
[AGENT][NEUTRAL] And procedure codes, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we're also going to need, who's your primary insurance with?
[CUSTOMER][NEUTRAL] It's um it's blue um options.
[AGENT][NEUTRAL] Is it Florida Blue?
[CUSTOMER][NEUTRAL] Yeah it's um yeah it's I think it's Florida Blue Blue options I think it's called.
[AGENT][NEUTRAL] Let me check something and see what we have on file for you.
[CUSTOMER][NEUTRAL] Oh come on, let me see.
[AGENT][NEUTRAL] Florida Blue.
[CUSTOMER][NEUTRAL] Yeah it's it's Florida Blue Blue options yeah that's what it's called it's called.
[AGENT][POSITIVE] OK, so that's a good thing because actually with Florida Blue, if you can submit the health statement, that's H [PII] A [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Health statement for that data service?
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Florida Blue is wonderful in the fact that they do put all the codes needed that.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] On their health statement.
[AGENT][NEUTRAL] And you can just submit that help statement for that data service.
[CUSTOMER][NEUTRAL] So I would call what you're saying is I would call Florida Blue and ask them for a health statement for that that data service.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK, and then they'll send that to me and then I have to submit that with the this this bill?
[AGENT][NEUTRAL] Uh, you can submit the bill now we can't pay from a bill because it's not gonna have your codes on it. You can just submit the health statement.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, just submit that OK um.
[AGENT][POSITIVE] Yeah, you, you are one of the lucky ones because Florida Blue is wonderful in that fact. That would be the only dot. I mean, we can process from the health statement.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, OK, that's helpful and then when I'm because I'm on y'all's website now I'm logged in I just got my log in created and I'm on a it's like my coverage page and then I see it says my claims and it says upload documents and there's a green box that says upload files. Do I just need to go there when I get that and basically upload it and then like what do I need to do after that?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is exactly right. So you're gonna go and upload the document you'll get a confirmation that it was successfully uploaded.
[AGENT][NEUTRAL] And once it's processed, it will have a claim number attached. Now there's also an option to sign up for text messaging.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That text messaging um we would.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, text you once the claim is processed. Now you may not be able to see it online for up to 24 hours.
[AGENT][NEUTRAL] It has to go through imaging and overnight processing.
[CUSTOMER][NEUTRAL] OK, that's that's OK.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Um, then you can click the claim number and view the claim status or the claim decision.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now there's also an option for direct deposit.
[AGENT][NEUTRAL] You can choose to have benefits sent directly to your bank account.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or we can mail a check to you. If you file the claim, all benefits would come to you. If the provider files the claims, then we pay the provider direct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, um, OK, that's helpful, um, and then like say there's something like if I have, um, paid like because I had to pay for like a a CAT scan like I had given them my insurance and then I still had to pay like a big copay for a CAT scan after the fact, would I be able to like upload the receipt for that, the receipts and see if that's something that would have that should have been covered?
[AGENT][NEUTRAL] Well, there again, we can't, we can't pay from a receipt, but we can from the health statement. So your policy is
[CUSTOMER][NEUTRAL] So everything kind of is always health statement then um this is so new to me. I've never done it before.
[AGENT][NEUTRAL] Yeah, uh, a look, and insurance is just a whole another creature in itself, right?
[CUSTOMER][NEGATIVE] I am so lost. I have no idea what I'm doing.
[AGENT][POSITIVE] Well, thanks why I'm here. And it's not a problem. You ask, please ask questions. I love, I love to help people understand because I'm the same way. I've got to talk it through and I've got to hear it. I can't just look at it and go, oh, you know, that's what it is.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, it's, it's all foreign to me. I have not, I have not done this before, so I, OK, so then if I had paid on like, like for instance like a co-pay for a CAT scan or whatever, um, and I would then need to go through my insurance and to ask them for a health statement for that particular incident or whatever and they would send yeah and then they would send me again like the the statement needed on that OK, so that seems to be the way to go about it.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Data service, yeah.
[AGENT][NEUTRAL] Yeah, if you're gonna file the claims, that's the easiest thing to do. I tell you, are you on the portal right now? Have you got just a minute?
[CUSTOMER][NEUTRAL] I'm on, yes, mhm.
[AGENT][NEUTRAL] OK, if you will click on your policy number.
[AGENT][NEUTRAL] Under where you see my coverage and it says policy number.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, uh huh, yeah, let me click on that.
[AGENT][NEUTRAL] You can click on that and view your policy benefits because we don't want you to miss any of your benefits and you've had your policy since [PII].
[AGENT][NEUTRAL] So any of these services that you had that are covered, you can file a claim for reimbursement.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK, that's good to know.
[AGENT][NEUTRAL] There's no time frame, but if you look on your policy, if you download that policy document on there's within the document there's a page called a schedule of benefits.
[CUSTOMER][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Schedule of benefits that's gonna be towards the bottom.
[AGENT][NEUTRAL] Yeah, I was trying to get mine.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Schedule schedule of benefits OK.
[AGENT][NEUTRAL] I have to.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] So you see
[AGENT][NEUTRAL] What is covered
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, so it's like outpatient benefits like hospital surgery outpatient da da da da da da da. OK, so um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Diagnostic testing in hospital outpatient facility outpatient treatment now I.
[CUSTOMER][NEUTRAL] Uh, so here would be a question because I, I maybe I'm not narrowing it down enough. If I had gone to an imaging center for the CT scan, does that fall under uh outpatient facility or MRI facility?
[AGENT][NEUTRAL] It does. Now, your policy also has what's called the office treatment writer.
[CUSTOMER][NEUTRAL] OK yeah I see that.
[AGENT][NEUTRAL] Which does cover procedures or treatments in a doctor's office, including diagnostic testing.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEGATIVE] Um, I mean, I feel like that would fall under all that.
[AGENT][POSITIVE] It, yeah, that should be, you should be good whether that was done in a doctor's office or outpatient facility.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, OK, um, OK, that's definitely helpful. I, yeah, I like never use it because I haven't really been in any, you know, I haven't praise God I haven't had to, I haven't had to use it and then I had like a health scare in November and I had to have all these tests done and uh lo and behold they had kind of misdiagnosed me. They told me I, you know, something in my colon and um ended up being a ovarian cyst, so that was scary.
[AGENT][NEUTRAL] Uh,
[AGENT][NEGATIVE] Oh my goodness. Yes, that is scary.
[CUSTOMER][NEUTRAL] So I'm like I'm like walking around for a couple of days thinking I have some kind of mass in my colon and um you know like oh my god.
[AGENT][NEUTRAL] Oh bless your heart. That is so scary. I, I've been there before too. And, in fact, they did a bunch and it was an ovarian cyst and I had a hysterectomy and everything's fine, you know.
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh Lord, yeah, I'm like I hope I don't have to go that route, but I at least I know there's not anything too, too crazy going on with my colon, so, but, um, you know, they had to have do do all these tests and a colonoscopy and all this stuff, yeah, so I was just like hit with everything, but um I was smart enough when I went to the because I had gone to the ER and I had given them my gap card when I was there.
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] Oh, it's so scary. Yeah.
[CUSTOMER][NEGATIVE] And they were kind of like what is this? and I had to tell him it's like you know a supplemental or whatever and luckily I have not gotten a bill from the ER yet so I'm hoping that that was just covered and they figured it out um but the you know the outpatient procedure I had now I'm getting this other bill so that's why I'm like, OK, um.
[AGENT][NEUTRAL] Oh right.
[CUSTOMER][POSITIVE] I like this is a lot of money so um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I will um I'll call my insurance provider and get that health statement and upload that and then I guess if I have any issues or questions I'll call you all back but um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You've been very helpful, so I have a starting point now.
[AGENT][NEUTRAL] Yeah, and I'll tell you what the what you may wanna do is just go back to your Florida blue um do you have a portal that you can view all the claims?
[CUSTOMER][NEUTRAL] Uh, yes, I think I do, yeah, I think I do have a log in with them.
[AGENT][NEUTRAL] That have been submitted.
[AGENT][NEUTRAL] OK, so you may just wanna go back and just review the claims that they've processed with since let me give you your effective date. I mean there's no reason for you not to get these benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, your policy became active on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now this policy pays towards sickness or injury, which means that like wellness is not covered.
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] OK, so your annuals, things like that is not covered, but you may want to go back to your Blue Cross website and just review the claims that they processed since [PII] if they're available online and see if there's anything that is covered under your GAP policy that you can just, you know, hit that health statement and upload it on your policy. We'll be happy to review it for benefits, you know, if it's covered, then we'll be happy, you know, to provide those benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if not, it'll just be denied as non-covered. So if you think there's something.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just go ahead and submit it.
[CUSTOMER][NEUTRAL] Yeah, OK, OK, and each one is obviously a separate claim that I'm submitting each time.
[AGENT][NEUTRAL] Yeah, um, you, that's right, because it'll be under, you know, the outpatient benefit. And just remember you've got that independent lab facility writer too. So if they did any blood work during those testing, that can be um benefit, you have those benefits as well, if they send it off to Quest or Labor, that kind of thing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Different
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Mhm OK that's good to know, wonderful. OK, that's that's good to know um OK I will get to work on that and um I appreciate your help.
[AGENT][NEUTRAL] You've got that also.
[AGENT][NEUTRAL] And then the other thing, Ms. [PII], it's always show your APL card with your primary insurance.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] When you go for medical.
[CUSTOMER][NEUTRAL] Yeah, the, uh, lesson lesson learned, yeah, I, um, I will be doing that moving forward because I'm just like I don't know if they, you know, I am like I don't know what's covered and what's not, but it, it, it might as well take the chance to just give it to them and they can say, well, it's not or whatever, yeah, so that's that's your.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Exactly. Exactly. And then they've got it on file if there is something that's covered, you know.
[CUSTOMER][POSITIVE] Yeah, yeah, of course, yeah, so that's a lesson learned for me all right well thank you.
[AGENT][POSITIVE] Well, I learn lessons every day.
[CUSTOMER][MIXED] I know it's a it's an expensive lesson that I'm learning at this point, very expensive, but if I can get some of that money back then, hey, that's that's definitely worth it because that's, you know, I spent like $1000 on a week on health stuff, so I'm like I don't have that kind of money.
[AGENT][NEUTRAL] It is, it is.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][POSITIVE] It's crazy what they charge exactly.
[CUSTOMER][NEUTRAL] I know, especially after insurance you're like you're not expecting like, you know, a 400 copay here, 400 co-pay there, a 400 copay. I'm like I, I just, uh, it's crazy, so yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Exactly. Exactly. And you know what, I was just looking at your claims. Now, just be aware that we have not received a claim from the hospital in November.
[CUSTOMER][NEUTRAL] That's weird, OK.
[AGENT][NEUTRAL] So if they bill you, you call them and say, look, you've got my gap policy on file, please file with GAP.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah yeah OK good to know because I, yeah, it's been, you know, it's been over a month now I would have figured something would have been sent to me or what I don't know how long they take to do their billing there but um.
[AGENT][NEUTRAL] Yeah, and sometimes it takes the insurance a while to process and then, you know, they have to wait for your, for Florida Blue to process and then get that back and then they file with us so sometimes it could take a while, I suppose.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, alright, well that's good to know. OK, um, I'll have to get that submitted to you then.
[CUSTOMER][POSITIVE] Alright, OK, I will do that. I appreciate you.
[AGENT][POSITIVE] Oh it's been my pleasure to assist you and anytime you have any questions or concerns, uh, no matter what the question is, you call us and ask us.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] I, I will do that. I will do that. Thank you so much.
[AGENT][POSITIVE] Well, it's much easier for you to get the full benefits of the policy if you understand and know what to file for so, and that's our desire for you to get the full benefits. My pleasure. Anything else?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, like that.
[CUSTOMER][POSITIVE] Thank you. Yeah, absolutely. Thank you so much. You have a good. No, that's it for now.
[AGENT][POSITIVE] All right. Well, Ms. [PII], thank you for calling APL. It's been such a pleasure to assist you. Hope you have a wonderful weekend and get you feeling better.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Pleasure.
[CUSTOMER][POSITIVE] Thank you, appreciate it.
[AGENT][POSITIVE] Thank you. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.