AccountId: 011433970860
ContactId: 00a001a3-1308-4171-92e9-56db9be1061b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1987900 ms
Total Talk Time (AGENT): 440606 ms
Total Talk Time (CUSTOMER): 614504 ms
Interruptions: 11
Overall Sentiment: AGENT=1.6, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/00a001a3-1308-4171-92e9-56db9be1061b_20250410T15:37_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] Yeah.
[CUSTOMER][NEUTRAL] Hi [PII], how are you? Um, I'm calling because I have a bunch of claims that I need to upload into the portal.
[CUSTOMER][NEUTRAL] From a quest and I just wanna make sure because I don't see the diagnostic code. What I do see my quest bill is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A CPT code, so I don't know if that works for you guys. I uploaded one bill, um, and I wanted to see if you guys can look at it to see if like you have everything you need before I go in and manually input one by one because there's a lot of them that I have to input.
[AGENT][POSITIVE] OK, well, it would be my pleasure to assist you. What is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And what is your policy number, please? Oh, I hear something precious.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let, let me grab it really quick. Yeah, I have both my boys here.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Hold on a second.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, you need the payer ID or the group number?
[AGENT][NEUTRAL] At the bottom of the card, do you see the outpatient benefit certificate number?
[CUSTOMER][POSITIVE] Yes I do.
[AGENT][NEUTRAL] Yeah, that's it.
[CUSTOMER][NEUTRAL] It is 025117189 M as in Mary, [PII] as in Larry [PII].
[AGENT][NEUTRAL] Thank you. And what is your name and date of birth please, ma'am?
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let me just check something.
[AGENT][NEUTRAL] I'm gonna pull up that document. What's your current mailing address, Miss [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I'm gonna get that document pull. I'm gonna try to pull up that document, so bear with me just one second. Now, I will tell you that we'll also need the primary insurance EOB with each.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Data service. Now that EOB stands for explanation of benefits, and you have AvMed as your primary insurance.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, so we will need the
[CUSTOMER][NEUTRAL] OK, so you, I have to go in then, OK, and upload the EOB?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's right. And
[CUSTOMER][NEUTRAL] OK, hold on one second. I'm gonna log on. Would the patient diagnostic code be in the EOB or in the document that I just uploaded from Quest?
[AGENT][NEUTRAL] So, unfortunately, asthma does not include the diagnosis codes listed on their EOBs.
[AGENT][NEUTRAL] And I am checking the quest.
[CUSTOMER][POSITIVE] OK, so then what I need to see, OK, you're gonna check perfect.
[AGENT][NEUTRAL] Yeah, I'm checking on it for you. So I am looking at that bill. Now, the CPT code is the procedure code that tells us what they did. So we actually need, still need the diagnostic code.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And that
[CUSTOMER][NEUTRAL] Which is not on there.
[AGENT][NEGATIVE] It's not on there, unfortunately. I wish they would put those on there.
[CUSTOMER][NEUTRAL] Oh my God, it's been such a mission dealing with Quest.
[AGENT][NEGATIVE] Quest is not easy for some reason.
[CUSTOMER][NEUTRAL] And it's so many bills I guess I'll call back and see.
[AGENT][NEUTRAL] I do not know why.
[CUSTOMER][NEUTRAL] No, it's not, and I'm just, I'm trying to rush to do this just because my gap, I, I'm, my coverage is done at the end of the month, so I'm trying to get it all in.
[AGENT][POSITIVE] Oh well I'll tell you, you, you don't have it it's OK as long as your policy was active for the data service, there's no time frame to submit the claims if that helps you. Sounds like you got your hands full anyway.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] OK, perfect. OK, good, that makes me feel better.
[AGENT][NEUTRAL] And I tell you what.
[CUSTOMER][NEUTRAL] Yes, I do. I have my [PII] and a, a [PII].
[AGENT][NEUTRAL] Oh, you do have your hands full.
[AGENT][NEUTRAL] Well, there
[CUSTOMER][NEUTRAL] Oh yeah, big time, big time.
[AGENT][NEUTRAL] There is an option, Ms. [PII]. We can call uh Quest together, do a three-way call, and I can advise them that we don't have these claims on file and see if they will file the claims for you, or they, they will need to provide you with a diagnosis.
[CUSTOMER][POSITIVE] Oh, that would be great.
[CUSTOMER][NEUTRAL] Well, so funny that you say that, funny that you say that, because last week on Friday, the gentleman that I spoke to from Quest filed the claims for me and when I called APL on Monday this past Monday, the woman that I spoke to told me that she didn't see any of it on her side.
[AGENT][NEUTRAL] No, we don't, and it'll depend on how they filed it if they faxed it or if they mailed it, you know, we'll need to check that as well and I'll be.
[CUSTOMER][NEUTRAL] Oh, you know what? You know what? They did ask me, they did ask me for the PO box, so maybe they mailed it.
[AGENT][NEUTRAL] What's that?
[AGENT][NEUTRAL] Yeah, I wish they would fax it directly to our claims department.
[AGENT][NEUTRAL] Cause that would be quicker.
[CUSTOMER][POSITIVE] Yeah, that would be OK, so can we do a 3 way call? That would be great.
[AGENT][POSITIVE] Sure, you wanna try to get him on the line and just add me to the call or would you prefer? OK, I don't mind at all.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Unless, unless you have a direct line that you know you can get to them quicker than I could.
[AGENT][NEGATIVE] I don't have a direct line with Quest, unfortunately.
[CUSTOMER][NEUTRAL] If not, I don't mind doing it. You don't, OK, don't worry. OK, let me, let me.
[AGENT][NEUTRAL] All right, I
[AGENT][NEUTRAL] So when you get that representative on the call just tell him that you have an APL representative that you need to add to the call.
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] OK perfect so let me, let me go ahead, let me just grab that number really quick, um.
[AGENT][POSITIVE] OK. Take your time.
[CUSTOMER][POSITIVE] And then, OK, great, thank you so much, [PII].
[AGENT][POSITIVE] Oh, it's my pleasure.
[CUSTOMER][NEUTRAL] Question, OK.
[CUSTOMER][NEUTRAL] All right, I'll be right back. Let me add them to the call.
[AGENT][NEUTRAL] That'll be fine. All right.
[CUSTOMER][NEUTRAL] 80488.
[CUSTOMER][NEUTRAL] 8890
[CUSTOMER][NEUTRAL] [PII], I'm still on hold. I, I haven't forgot about you.
[AGENT][NEUTRAL] That's fine. I'm just sitting here waiting. I was like, I wish I had a way to.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][POSITIVE] Talk to her. You can just leave me on the line and hopefully somebody will answer.
[CUSTOMER][POSITIVE] I know, no worries, I'll, I'll add you, I'll merge the, I'll merge the call when they answer.
[AGENT][POSITIVE] All right, thank you for letting me know.
[CUSTOMER][POSITIVE] Thank you. Thanks.
[AGENT][POSITIVE] Take care.
[CUSTOMER][NEUTRAL] [PII], are you there?
[AGENT][NEUTRAL] I'm here.
[CUSTOMER][NEUTRAL] OK perfect I have Quest on the line so what they're mentioning to me is that they don't provide diagnostic codes with their bills.
[CUSTOMER][NEUTRAL] Only the doctor does.
[CUSTOMER][NEUTRAL] The doc the doctor provides the diagnosis codes, not quest.
[AGENT][NEUTRAL] So if you were to pro um may I ask your name at Quest please?
[CUSTOMER][NEUTRAL] We just
[CUSTOMER][NEUTRAL] Sure. This is [PII]
[AGENT][NEUTRAL] Thank you, [PII]. So we do not have those claims on file. Is there any way that y'all can file those claims?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, for Miss [PII] and
[CUSTOMER][NEUTRAL] OK. What, what is the uh
[CUSTOMER][NEUTRAL] Yeah, what's the bill number?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] There's lots of bill numbers. OK, so let me just give you one just to see, and then I can give you the rest. Um, the first bill number is 8329886324.
[CUSTOMER][NEUTRAL] Uh, patient's name? [PII], date of birth [PII] and the address? [PII]. And your phone number please? [PII].
[CUSTOMER][NEUTRAL] OK, so this one's from [PII]. Do you have this claim?
[AGENT][NEUTRAL] We do not. We have no claims on file from Quest.
[CUSTOMER][NEUTRAL] Like the APL they don't.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Uh, APL does not have any claims from Quest.
[AGENT][NEGATIVE] We've not received any of those.
[CUSTOMER][NEUTRAL] OK, so this is from
[CUSTOMER][NEUTRAL] OK. So you're referring, uh, who's APL? Is that your primary or secondary? It's the secondary insurance. OK, let me see here.
[CUSTOMER][NEUTRAL] And what is the member ID for uh APL?
[CUSTOMER][NEUTRAL] Um, let me get that really quick. Is it the payer ID that you need? OK, perfect, thank you, [PII].
[AGENT][POSITIVE] I can, I can get that for you, [PII]. No, I can get it.
[AGENT][NEUTRAL] Policy number is 251-7189.
[CUSTOMER][NEUTRAL] OK, that's the policy. What about the member ID?
[AGENT][NEUTRAL] That's the member ID.
[AGENT][NEUTRAL] Same thing.
[CUSTOMER][NEUTRAL] OK. So, um, we had 80084. So that's not the policy number or the member ID?
[AGENT][NEUTRAL] 80084 is what you have?
[AGENT][NEUTRAL] That is the group number. That's not the policy, the member ID, that's the group number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So that's the group number. OK. And what is the address to send medical claims to?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] Those can also be faxed directly to our claims department.
[AGENT][NEUTRAL] And because for 2nd day.
[CUSTOMER][NEUTRAL] And I'm sorry I didn't capture your name. What is your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can fax those claims to us or we also have a payer ID.
[CUSTOMER][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] OK. What is the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] And who's the primary policy holder?
[AGENT][NEUTRAL] It is Miss [PII].
[CUSTOMER][NEUTRAL] Yeah. OK.
[CUSTOMER][NEUTRAL] And this is the secondary insurance.
[AGENT][NEUTRAL] So we'll need the primary EOB.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII], so now that you have that information for that bill, you need me from AMed to get the EOB correct?
[AGENT][NEUTRAL] Well, we're still gonna need the um diagnosis code, but if [PII]'s gonna send those claims to us.
[AGENT][NEUTRAL] Um, [PII], will y'all put a hold on her account since y'all are now filing with us?
[CUSTOMER][NEUTRAL] Uh yes, uh, we're gonna go ahead and put a hold while it's pending with the secondary. One moment.
[AGENT][NEUTRAL] OK. So, Miss, Miss [PII], you might just wanna wait and see if they send that in. That way you won't have to continue trying to get the diagnosis codes for that bill.
[CUSTOMER][NEUTRAL] S BBC.
[AGENT][NEUTRAL] But it's whatever you need, but we will need.
[CUSTOMER][NEUTRAL] OK. And my other question is,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My other question is, so there's that bill I hadn't paid yet. What about all the other bills that I've paid that I wanna to process through?
[AGENT][NEUTRAL] So if you have paid for those services you will need to file for reimbursement. Just make sure that you have the EOB from AMed for each data service and then contact the um [PII] said you need to contact your doctor for the diagnosis code.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] Let me see if you have any other bills here with us that are still open because, so there's another one from the [PII], so I'm gonna go ahead and send that one as well. Um, you also had, um, the same insurance on the same date of service December of this year of last year.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then [PII], my other question is the other bills that are closed already that I've already paid.
[CUSTOMER][NEUTRAL] Can you guys go ahead and process that, or is that separate [PII] since I already paid them?
[AGENT][NEUTRAL] Yeah, they're probably not gonna and [PII] can correct me, but they're probably not gonna file for those if they've been paid and closed, so you would need to file for reimbursement, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's correct. OK, and [PII], is it the same process as how I've always processed the other claims?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes ma'am, you can just upload it on the portal with your um itemized bill, explanation of benefits from Admet and diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And diagnostic code. OK, perfect.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, let me see which are the bills I'm working on those so there's one here.
[CUSTOMER][NEUTRAL] OK, so there were 2 open, um, I went and submitted. I went ahead and submitted those 2.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Um, is there a way that you can check, [PII]? So my son is also on my insurance and I think that he, we may have one bill that's open.
[CUSTOMER][POSITIVE] Oh yeah, one moment. Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] So I'm working on the ones that are open with Quest. OK, one moment. Thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So the member ID is 251-7189.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The group number is 80084 and the payer ID is 60801.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All righty. So yours have been uh updated.
[CUSTOMER][NEUTRAL] And uh let's see here.
[CUSTOMER][NEUTRAL] What is your uh son's um do you have a bill number for him or no? I don't.
[CUSTOMER][NEUTRAL] What's the last name? [PII]
[CUSTOMER][NEUTRAL] Uh, first name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] His date of birth? [PII].
[CUSTOMER][NEUTRAL] Uh, address?
[CUSTOMER][NEUTRAL] [PII]. OK, yeah, there are no open bills for him. No? OK, perfect. All right, um.
[CUSTOMER][POSITIVE] Sounds good. Thank you so much for your help, [PII]. You're welcome.
[AGENT][NEUTRAL] But
[AGENT][POSITIVE] Yes, thank you, [PII]. We appreciate your help.
[CUSTOMER][NEUTRAL] [PII], do you mind staying on the
[AGENT][NEUTRAL] I was gonna ask you the same.
[CUSTOMER][NEUTRAL] [PII], do you mind staying on because I have another question.
[AGENT][POSITIVE] Yes, that would be great. Thank you. Thank you, [PII].
[CUSTOMER][POSITIVE] OK, you both have a great day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um bye bye.
[CUSTOMER][POSITIVE] Thank you for participating in this brief 3 question survey. Rate your satisfaction with the agent who helped you today. Press 5 for extremely satisfied. Rate your overall satisfaction with your most. How easy was it to use? Thank you for your time. We value your feedback. Have a nice day. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Perfect. [PII]. OK, so is that, OK, at least I have some clarification now. Now my question is, now I'm on the, I'm on AvMed and I just found like one bill for Quest, um.
[AGENT][NEUTRAL] Oh right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it's telling me here, oh look, I have I do have diagnosis codes here.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Would it, would tell me that code. Let's make sure that's the diagnosis code. I just wanna, that would be awesome.
[CUSTOMER][NEUTRAL] LL 2929.9 Z34.90
[AGENT][POSITIVE] Oh, thank goodness.
[CUSTOMER][NEUTRAL] They give me a procedure code and a diagnosis code.
[AGENT][POSITIVE] Yay.
[CUSTOMER][POSITIVE] Oh good. OK, good. I was thinking I'm gonna now have to call the doctor. It's gonna take forever. OK, perfect. OK, now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. So make sure on that EOB that it shows what was applied to your deductible co-pay or co-insurance for that.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] So the service. Perfect. Oh, that's wonderful.
[CUSTOMER][POSITIVE] Yes, it does.
[CUSTOMER][POSITIVE] Perfect. Now the other thing that I was gonna tell you is I don't know how I can match the press bill number now to the AMed.
[CUSTOMER][NEUTRAL] To the AMed like uh EOB or do I not have to upload anything of Quest? I just have to upload what AMed has here.
[AGENT][NEUTRAL] If, if you have that diagnosis code and procedure code from AvMed, we should be able to process just from that if it has all that information on it.
[CUSTOMER][POSITIVE] Oh perfect, OK.
[AGENT][POSITIVE] Yeah, we're doing good. I like this.
[CUSTOMER][POSITIVE] Perfect. OK, so.
[CUSTOMER][POSITIVE] Awesome. OK, so now what I'm gonna do is I'm gonna download all of these that I have on my portal and I'm gonna submit them into APL.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That'll be great.
[CUSTOMER][POSITIVE] Perfect awesome. All right, OK, I think I know what I'm doing now.
[AGENT][NEUTRAL] Now there is one other option for you. I was just checking if you would prefer benefits go to go directly to your bank account. There is a payment option as well online if you would prefer that versus coming by check.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It doesn't matter. I don't mind the the mailing of the checks is fine.
[AGENT][NEUTRAL] OK, just wanted to make sure you knew that option that you were aware.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Perfect. Uh, I, I, I didn't know about that option, so thank you for letting me know.
[AGENT][POSITIVE] Mhm. Well, it has been such a pleasure to assist you, Miss [PII]. What else can we help you with today?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] I know, thank you. You were such, you were such great help. You don't understand. It's so lovely dealing with people who know and can actually help me, so thank you very much. I greatly appreciate it.
[AGENT][POSITIVE] Well, we've all gotta help each other. We just gotta get all this over all this other stuff and just stop and help each other. So, you know, we just, and I love working for APL because they afford us the time to assist any way we can, so.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Definitely.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] OK, great. Thank you so much for all your help.
[AGENT][NEUTRAL] We
[AGENT][POSITIVE] Well, it has been such a pleasure and I've enjoyed listening to that new little angel of yours.
[CUSTOMER][POSITIVE] Oh thank you, thank you so much.
[AGENT][POSITIVE] I hope you all have a great day, Miss [PII] and keep an eye out on the portal.
[CUSTOMER][POSITIVE] You too, thank you.
[AGENT][POSITIVE] You can see when we receive claims and if you need any further assistance, never hesitate to give us a call.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Great awesome thank you so much have a great day. Thank you, bye bye.
[AGENT][POSITIVE] My pleasure. Thank you, Miss [PII]. You have a wonderful day as well. Bye-bye.
[CUSTOMER][POSITIVE] Thank you you too.