AccountId: 011433970860
ContactId: 08f50bd9-350a-4fc8-b3b9-20391cd20ac3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 433019 ms
Total Talk Time (AGENT): 243073 ms
Total Talk Time (CUSTOMER): 173279 ms
Interruptions: 3
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/08f50bd9-350a-4fc8-b3b9-20391cd20ac3_20250429T15:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, yes, uh, good morning. I'm calling because I saw an answer to a claim that I filed.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I have some questions regarding the comments. Do you want the policy number or the, oh, I'm sorry, go ahead.
[AGENT][NEUTRAL] Sure, yeah, I could take a look at that claim.
[AGENT][POSITIVE] Oh no, no, you're perfectly fine. I can definitely help you out with that. um, first, uh, what was your name please?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][POSITIVE] And then can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then, yes, if you've got that policy number, please.
[CUSTOMER][NEUTRAL] Uh yes, it says 02069775.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK, and then just gonna verify some information really quick. [PII], uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you. uh, looks like it's a Gmail account.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Awesome thank you for verifying all of that. OK, uh, did you have that claim number?
[CUSTOMER][NEUTRAL] Yes, the document says 35948997.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you one moment, let's take a look at that.
[AGENT][NEUTRAL] OK. So looks like we might just be missing some information. Uh, there is one item um for prescription drugs that is simply not covered under this policy. As for everything else, I am showing, excuse me, oh my goodness, I'm so sorry. Um, we are needing an itemized statement that shows a diagnosis code.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] And then a more detailed copy of the primary EOB. So it looks like we did receive a primary EOB, but as this is a secondary medical policy, it does have to show uh the amounts paid towards uh deductible, co-pay or co-insurance as that's what this policy is supposed to help with.
[CUSTOMER][NEUTRAL] Um, OK, I'm trying to follow cause the, the EOB that I got from my United, like that was it, when they processed the claim for the MRI. So am I supposed to call them back and like they told me that was the EOB that they had for that claim.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, that's perfectly fine. Um, what I would do instead, uh, what I've noticed to be more, um, for the information that we need is to go instead through the actual provider. So where you went for treatment, they will have that more detailed EOB that shows what was contributed to those, uh, deductible copay and co-insurance.
[AGENT][NEUTRAL] And you also get uh that uh statement that diagnosis codes from them as well, yes.
[CUSTOMER][NEUTRAL] Hold on, hello? hello? Hello? You hear me, hun? Sorry, the call started breaking up when you were explaining about going to the provider.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] me?
[AGENT][NEUTRAL] 0000, I'm sorry, um, OK, yeah, so the provider will have all of this information, so the more detailed EOB and then they'll also have of course that itemized statement that shows the diagnosis code as well.
[CUSTOMER][NEUTRAL] Um, all right, I guess I'll try contacting them cause when I had called a couple of weeks ago when I first filed my like urgent care claim, I had also asked what other things were covered in my policy due to the injury and um they, I had asked about an MRI and they go, yeah, when you get it, just have the receipts and your EOB from your health insurance and send it to us. So that's what I did. But now I gotta get more stuff.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, I know it's very confusing. I apologize for that. So primary EOB that does specifically have to show the amounts paid towards, you know, deductible co-pay coinsurance, um, and then the, I don't like saying the bills because most of the time that doesn't show we also need those codes, so an itemized statement that shows the diagnosis codes and they will have all that if there's any.
[CUSTOMER][NEUTRAL] OK, and I'm gonna go to the diagnosis diagnostic center that I got the procedure done.
[AGENT][POSITIVE] Yes, from, yes, the pro uh provider where you went for treatment and if there's any confusion or if they have questions for us, they're more than welcome to give us a call as well, [PII]. We do talk to providers all the time. You just give them the same phone number and try to clear up any confusion if there's any.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] All right, I'm gonna try to get the stuff from them. Um, all right, and then I had another question. I'm not ready yet cause I'm still getting physical therapy, but it's my understanding that due to the injury that I may potentially be able to claim for all the payments that I have made for physical therapy. With that b[PII] said, do I need to get the same thing and I can add my statement from the provider and also the EOB from United Healthcare?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] [PII]es, and now most of the time, and I'm not familiar with how a lot of these uh major medical companies like United, I'm not sure how they work, I would say for the sake of ease, um, so you're not having to do this again where it might be insufficient information. I would ask for the primary EOB from your provider because they will have that and but it will also include those amounts that are paid towards those things that we need.
[CUSTOMER][NEUTRAL] Um, OK. I'm still doing it. I think I have a couple more visits, so I figured to do it when I was at the end of it, and I have a list of everything I paid.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Oh yeah, that's perfectly fine.
[AGENT][NEUTRAL] Yeah, sure.
[CUSTOMER][NEGATIVE] Um, but I'm just asking cause I just feel like just when I think I'm submitting everything that I need, you got, and I know it's not you, I don't want you to think that I'm taking this out on you. I get another letter for asking me for, you know, just when I thought I was checking all the boxes off, I get another letter asking me for another piece of document that I'm like, I don't know, I just got hurt and I'm using my insurance.
[AGENT][POSITIVE] No, I understand it is trust me.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I understand.
[AGENT][NEGATIVE] Yeah, it is extremely confusing, yes.
[AGENT][NEUTRAL] Well, and especially for this kind since it's secondary medical it's just that much more information that we need um but that's why I always try to say just to make it easier the provider wherever you went for treatment, they will have all of the information that we need so you shouldn't have to jump through too many hoops. It's gonna be that primary EOB and then the itemized statement that shows those codes.
[CUSTOMER][POSITIVE] All right. All right, I'll try to get it.
[AGENT][NEUTRAL] All right, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] No, I think that's it for now. Thank you so much.
[AGENT][POSITIVE] OK, well, thanks for giving us a call. Yeah, have a great rest of your day.
[CUSTOMER][POSITIVE] You too, thanks.
[AGENT][POSITIVE] Thank you. Bye-bye.