AccountId: 011433970860
ContactId: 1172a4cf-e804-492c-8803-ba3ad248443b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 681289 ms
Total Talk Time (AGENT): 337419 ms
Total Talk Time (CUSTOMER): 139180 ms
Interruptions: 2
Overall Sentiment: AGENT=1.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/1172a4cf-e804-492c-8803-ba3ad248443b_20250115T18:30_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII], and I'm checking on the payments for the labs on my annual wellness check.
[CUSTOMER][NEGATIVE] Um, it's quite a while back and there's still nothing been paid.
[CUSTOMER][NEUTRAL] So I don't know they didn't file right or something.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, [PII], I'd love to take a look at that with you. Do you have um your policy number handy?
[CUSTOMER][NEUTRAL] Get it
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Sort number [PII].
[AGENT][NEUTRAL] Alright, give me a moment to pull that one up for you while I'm getting that policy loaded, would you mind if I also snagged a good call back number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. I appreciate that.
[AGENT][NEUTRAL] And [PII], would you be able to verify for me, please, your last name and your date of birth?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I do just need to verify some additional information with you, your mailing address if you can.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the, just the email on file if you can as well, please.
[CUSTOMER][NEUTRAL] Should be [PII].
[AGENT][POSITIVE] Wonderful. Thank you so much. And
[AGENT][NEUTRAL] One second while I look into this for you, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, I do see.
[AGENT][NEUTRAL] Was this claim submitted under yourself, [PII]?
[CUSTOMER][NEUTRAL] Under myself? What do you mean?
[AGENT][NEUTRAL] Yeah, like was it um.
[AGENT][NEUTRAL] Was it a claim for yourself or would it be for like a dependent?
[CUSTOMER][NEUTRAL] No, it's for me.
[AGENT][NEUTRAL] For you, OK, so I do see that we received one back in.
[AGENT][NEUTRAL] December
[AGENT][NEUTRAL] Um, and it would have been from Access Medical Clinic as the provider. Does that sound right?
[CUSTOMER][NEUTRAL] No, that sounds like my wife's baby.
[CUSTOMER][NEUTRAL] She has one as well.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] He is like 700 something.
[AGENT][NEUTRAL] Would there be, would it be like exact science laboratories uh back in [PII] is when you would have been?
[CUSTOMER][NEUTRAL] That was sounds like for Board.
[CUSTOMER][NEUTRAL] The preventive check for that this is from Quest Diagnostics.
[AGENT][NEUTRAL] OK, I don't have any claim on file um from Quest Diagnostics for you.
[AGENT][NEUTRAL] Oh hold on, you know what, let me check something else, [PII], one second, hang tight.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I just realized we're under your hospital indemnity policy. Let me see.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so under that wellness and diagnostic benefit for you [PII], I'm only seeing that we had that one claim that came through and it did pay out for you under that one claim, but it was not from Quest Diagnostics it was the claim we had from Exact Science Laboratories, um, so we might just need that claim to be resubmitted to be able to process for it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That's something that.
[CUSTOMER][NEUTRAL] I need to do and then so now and then just for the.
[CUSTOMER][NEUTRAL] I can check with the lab if they've already submitted it's my PCP that.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Absolutely so if you would like to, you're, you are more than welcome to submit it if you submit the claim any benefits payable will go to you, but if the provider submits the claim any benefits payable will go to them, um, but if you end up submitting it, you're just gonna wanna make sure you have an itemized bill that has your diagnosis code as well as the procedure code on it, um, that gets submitted to us and then.
[AGENT][NEUTRAL] Um, if I, but I would strongly encourage you to have the provider resubmit if they can, just because they have access to all the right forms and everything they need and sometimes it's kind of a pain, um, to, well, I mean, unfortunately it's a pain to get those forms on your part where they pay someone to do that job. So you might just reach out to them and see if they can submit that, um, again on your behalf because I don't have it on file here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I'll check with.
[CUSTOMER][NEUTRAL] Check with both of them I guess.
[CUSTOMER][NEUTRAL] Because.
[CUSTOMER][NEGATIVE] Not clear
[AGENT][POSITIVE] Yeah, I'm really sorry about that.
[CUSTOMER][NEUTRAL] I don't know that my PCP is going to submit for the lab.
[AGENT][NEUTRAL] And sometimes those labs will bill separately too, especially if like they have to send your lab work out, um, those labs will just create their own bills instead, not all the time, but sometimes, so.
[CUSTOMER][NEGATIVE] So makes it confusing.
[CUSTOMER][NEUTRAL] Right, but then they should file the claim.
[AGENT][NEUTRAL] Uh, yes, ideally they should file the claim.
[CUSTOMER][NEUTRAL] OK, what's
[AGENT][NEUTRAL] I would certainly reach out, especially if they're sending you a bill, I would reach out and say like, hey, I need you to file a claim with us before, you know, I, before I make a payment on anything.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah, there's no diagnosis, it's just an annual wellness check.
[CUSTOMER][NEUTRAL] Prevent it
[AGENT][NEUTRAL] OK. Yeah, I know on our claim forms we do have to have a diagnosis code, um.
[AGENT][NEUTRAL] So you might even.
[CUSTOMER][NEUTRAL] Well then there should be a code.
[AGENT][NEUTRAL] Yeah, so you might reach out and see if you can get some paperwork that has that code on it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] File with myself because of a ticagnosis.
[CUSTOMER][NEUTRAL] Whatever, how do I go about that?
[AGENT][NEUTRAL] Yeah, absolutely, if you want, um, I have your email on file and I could go ahead and email you out um a copy of our um hospital indemnity claim form.
[AGENT][POSITIVE] And then that would be like a really good starting point as far as
[CUSTOMER][NEUTRAL] That you
[AGENT][NEUTRAL] Um, getting that form filled out, it's gonna tell you exactly what information they need on that form, and then if you.
[AGENT][NEUTRAL] Um, once you get that filled out, you would just attach any supporting documents and you can either submit it through the online service center if you use that, um, you can fax it or you can mail it to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect I'm assuming that information will be on that email as well.
[AGENT][NEUTRAL] Yeah if you want um so what I'm gonna do is I'll get that email together I will attach that hospital indemnity claim form for you and then what I'll do is I'll also attach the user guide for our um.
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][NEUTRAL] For our online service center and it will talk you through not only how to create your account online but then all of the features and how to submit claims, how to check claims, and it will have all that information on there for you to help you um navigate through the portal um but then yeah you can just like fill out the claim form on your computer instead of printing it attach your documents and upload it straight through there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good.
[AGENT][POSITIVE] Perfect and I'm working on getting that email.
[CUSTOMER][NEUTRAL] Um, uh, try to get them to do it first.
[AGENT][POSITIVE] Put together, yes, abs I highly, highly recommend it. Um, I mean, it is just tremendously easier on their part to put together a claim than it is for you to get all that documentation. I wish it was as easy for you too, but it will be easier to have them do it if you can.
[CUSTOMER][NEUTRAL] If they should filed to you.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, they can send that claim to us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright and then um the claim remittance information if they need it like if you don't um but it will be included in the information on the email I'm sending you as well OK? um so if they don't have like our claims address or fax it will be on that claim form I sent you so you'll have access to it as well there.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][POSITIVE] Awesome and then alright I did hit send on that email for you um is there anything else I can do to help you, my friend?
[CUSTOMER][POSITIVE] No, I think that's it thank you so much.
[AGENT][POSITIVE] Hey, yeah, it's my pleasure thank you so much for giving us a call at APL. If you have any other questions or you need help along the way, don't hesitate to reach out to us and we'll do our best to take care of you, OK?
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] My pleasure. You take care.
[CUSTOMER][POSITIVE] Take care bye bye
[AGENT][POSITIVE] Thanks bye bye.