AccountId: 011433970860
ContactId: ff8fdfa2-7437-403c-b7f2-a66096577cd6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351220 ms
Total Talk Time (AGENT): 118138 ms
Total Talk Time (CUSTOMER): 114638 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/ff8fdfa2-7437-403c-b7f2-a66096577cd6_20250613T13:32_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. My name, my name's [PII] and I wanted to check on uh a claim for my gap.
[AGENT][NEUTRAL] I can verify
[CUSTOMER][NEUTRAL] Um, for my knee replacement surgery, yeah.
[AGENT][NEUTRAL] I can verify claim status. May I have your policy number?
[CUSTOMER][NEUTRAL] Um, let me see here.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, here, hold on a second, um.
[CUSTOMER][NEUTRAL] Policy number 2549537.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] Sure, uh, [PII], [PII], and it's [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised verification of coverage does not guarantee the payment of a claim. And do you have a data service?
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] I was in the hospital a couple of days for my knee replacement.
[AGENT][NEUTRAL] OK, so it looks like we're requesting the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] I sent it
[AGENT][NEUTRAL] OK, let me pull this up. It looks like the providers submitted some other claims in which we asked for the primary EOB as well.
[AGENT][NEUTRAL] Let me get this pulled up one moment.
[AGENT][NEUTRAL] OK, there's 39 pages, one moment.
[AGENT][NEUTRAL] scan through and see if I see the EOB.
[AGENT][NEGATIVE] OK. I'm going through these pages and there is no primary EOB attached. I do see the doctor's notes. I do see your diagnosiscope, but there's no major medical explanation or benefit attached to these 39 pages.
[CUSTOMER][NEGATIVE] Who is, is that just pardon my ignorance, is that from?
[CUSTOMER][NEUTRAL] Florida blue or from Mount Sinai?
[AGENT][NEUTRAL] This right here is from the hospital. So what we need will come from
[CUSTOMER][NEUTRAL] But no, no, I know, but I mean the explanation of benefits is is from the insurance company, right? Not the hospital.
[AGENT][POSITIVE] Correct, that is correct.
[CUSTOMER][NEGATIVE] OK, alright, and then my second question is how come when I log in I get all these text messages that my claim is being processed and all this kind of stuff I log in and I can't even see these claims. I only the only claims that I see are from [PII].
[AGENT][NEUTRAL] So you're not seeing anything from 25?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] No ma'am.
[AGENT][NEUTRAL] I'm not showing any claims actually processed for 25 other than the denied for major medical EOB, but you should be able to see those claims as well.
[CUSTOMER][NEUTRAL] Uh-huh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'll make a note so that someone can check that out as well.
[AGENT][NEUTRAL] Because you should be able to see anything that's processed on your account.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And once you get the uh the explanation of benefits I'm gonna request that from Blue Cross um once you get that uh like back in [PII] I had my other knee replaced and you guys paid like uh basically the deductible or whatever I had it was I think it was like $2000 is that still the like the maximum payout now?
[AGENT][NEUTRAL] Oh, let's see.
[CUSTOMER][NEUTRAL] If it's approved
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Inpatient allows 2000, yes.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] OK, alright, so that hasn't changed. Alright, let me work on that other and I'll upload it, uh, once I get it I'll upload it in the portal.
[AGENT][NEUTRAL] OK. And that's all we need to verify what your copays, co-insurance and or deductible was and we can get that claim processed.
[CUSTOMER][POSITIVE] All right thank you so much I appreciate it have a great weekend.
[AGENT][POSITIVE] You're so welcome, [PII], and thank you for calling American Public Life. Have a great weekend. Bye-bye.
[CUSTOMER][POSITIVE] Great thank you bye bye.