AccountId: 011433970860
ContactId: 0b1ed56d-c53d-4701-9f73-15d84a3d9881
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 582119 ms
Total Talk Time (AGENT): 332222 ms
Total Talk Time (CUSTOMER): 218160 ms
Interruptions: 4
Overall Sentiment: AGENT=1.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/0b1ed56d-c53d-4701-9f73-15d84a3d9881_20250207T13:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, [PII]. Um, I wanted to go over a, uh, two claims that I have in the system.
[CUSTOMER][NEUTRAL] Um, because I received the text that says, uh, your claims were processed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, I look at them and it doesn't give me any other information, so I wanted to, to go over them and be good. Mm.
[AGENT][NEUTRAL] Yes, ma'am. So you're the insured and these claims are for yourself, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Can you please spell your last name, [PII] or [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. OK, thank you. And Miss [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] And the policy number is 025.
[CUSTOMER][NEUTRAL] 16,770
[AGENT][NEUTRAL] OK, thank you. So one moment please while I get your information pulled up and then once I do, Mrs. [PII], I will have to verify several things with you first for security and also any information that I provide for you will be a verification of benefits and not a guarantee of payment. Now you said the claims are for yourself?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, it's for my son.
[AGENT][NEUTRAL] And your son's name and date of birth?
[CUSTOMER][NEUTRAL] His name is [PII] His date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and so first off, if you could please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct? Thank you. OK, thank you. And lastly, your email address, please.
[CUSTOMER][NEUTRAL] Yes, that's my cell phone.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. Thank you so much for verifying your information. So do you have the specific claim numbers that you would like to discuss, Mrs. [PII]?
[CUSTOMER][NEUTRAL] Excuse me?
[AGENT][NEUTRAL] Do you have the claim number? or do you have the claim numbers? Uh huh.
[CUSTOMER][NEUTRAL] The specific claim? Yeah.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] Yes, 3560.
[CUSTOMER][NEUTRAL] 537.
[AGENT][NEUTRAL] OK, and
[CUSTOMER][POSITIVE] And the other one is, I'm sorry.
[AGENT][NEUTRAL] Uh-huh. You can go ahead. No, ma'am, you can go ahead and give it to me.
[CUSTOMER][NEUTRAL] 356-053-4
[AGENT][NEUTRAL] OK, thank you very much. OK, so both of these claims were denied for the same reason and the reason, excuse me for my voice, the the reason on the denial states to please provide copies of your explanation of benefits from your primary insurance carrier.
[AGENT][NEUTRAL] On this, on this supplemental policy, Mr. [PII], we will always have to have a copy of the primary insurance company's explanation of benefits when reviewing claims. And you can just you can upload those into your portal just like you did these two claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How do I do that? Because when, when these claims are like that, I, I have to like click.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so you're not going to be able to add to these existing claim numbers you will just do it like if you were submitting a new claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And our system will know that that to tie that together as a missing, you know, because we were missing that piece of information to complete the review so yes ma'am just upload it like a new claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Now, I have another question. I have another claim that was also shown as process before that ties up to this one. Because what happened is one of these claims was in regards to a radiology process, OK? And, but in the radiology process that was done at the hospital, the hospital charged one thing, and the radiologist that reviewed the radiology also charged.
[AGENT][POSITIVE] Correct. OK.
[CUSTOMER][NEUTRAL] And so, the, the one came before, and, you know, and that one was under
[CUSTOMER][NEUTRAL] Uh, and visual Services that is on [PII] and uh it had the remarks, it's under 3531548.
[AGENT][NEUTRAL] Mhm. OK, so on this.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] It has the remarks, yeah, it has the remarks 2 and 3.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So in this one also, if I wanna
[CUSTOMER][NEUTRAL] Add to this one, I will have to do the same, just upload another one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so on this claim, yes, ma'am, that was we, OK, give me just one second. So a couple of the denial codes on that particular claim number were due to office visits are not covered under the policy, right, and then there, I do see there was one that we were in need of the explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah, I'm not, I'm not talking about those.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, and then there it also stated for 11:15 that we were um that we need a diagnosis code for this data service. This information may be obtained from your physician. So, yes, ma'am, once you have those documents, yes, ma'am, just upload them into your portal.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Like you
[CUSTOMER][NEUTRAL] OK, one more question, I'm sorry. Explanation of benefits is one document in general for for all of this.
[AGENT][NEUTRAL] Well, the
[CUSTOMER][NEUTRAL] Or is it separate per visit.
[AGENT][NEUTRAL] It, it would be separate for each because as the claims are filed right with your now depending on how your primary insurance company provides their explanation of benefits, you know, they may, and like if you have a portal with them, it may show multiple dates of service and you could just mark the ones. OK, so you could just.
[CUSTOMER][NEUTRAL] It will be separate for each?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It does, so I, I just have to download those.
[AGENT][NEUTRAL] Yes, ma'am, and then mark on there the dates of service, you know, whether you highlight them or whatever said it will, we'll know what you're submitting that for if it's multiple. Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it refers to this one.
[CUSTOMER][POSITIVE] Yes, OK, excellent.
[AGENT][NEUTRAL] Either mark out what you're not wanting us to review, you know, or highlight or indicate that these are the, you know, dates of service that you're wanting us to review the information on.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. OK, perfect. Now I understood how I need to do this. OK.
[AGENT][NEUTRAL] And 2 just for future reference um on our because I can see you know you submitted all of these on the Medin claim form.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] The first page at the top has some instructions for completing the claim form and it also gives you exactly tells you which documents need to be submitted for the review so in the future just you know use that as your checklist and that way you can.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Make sure you have everything the first time, but if for some reason we're missing something, you know, like in this case, you can still get that information and upload it for us to review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Perfect. Thank you so much, [PII].
[AGENT][POSITIVE] Well, you are certainly very welcome.
[CUSTOMER][POSITIVE] Very, very informative. Now I know what to do.
[AGENT][POSITIVE] Oh, well, you're very welcome and it was my pleasure. So is there anything else this morning that I could help you with?
[CUSTOMER][NEUTRAL] No, that would be, you clear, clarify everything, so I'm just gonna go ahead and download the documents from my page and then just put them, attach them to this one and, and then we go from there.
[AGENT][POSITIVE] OK. Well, that will be fine then. And uh is there, if that's all then at the moment, at least what I can help you with? Thank you very much again for calling APL and I hope you have a very nice weekend.
[CUSTOMER][POSITIVE] You too. Thank you so much, [PII].
[AGENT][POSITIVE] Yes, ma'am. You're certainly welcome.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.