AccountId: 011433970860
ContactId: 16beb0c5-ea6f-418a-ad1b-b8603b92a987
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 632820 ms
Total Talk Time (AGENT): 268525 ms
Total Talk Time (CUSTOMER): 148903 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/16beb0c5-ea6f-418a-ad1b-b8603b92a987_20250516T17:19_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, [PII], my name is [PII], and I'm calling about my husband's account, uh, [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], uh, and what's a good callback number for you, please?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you. And the policy number, please?
[CUSTOMER][NEUTRAL] Uh, his APL policy number is 01897865.
[AGENT][NEUTRAL] OK, thank you. While I'm pulling the policy up, um, Miss [PII], I will, before I do that, I will have to verify several things with you first for security, and then we can go from there, um.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] And how can I help you today while this information is pulling up for me?
[CUSTOMER][NEUTRAL] Um, well, um, I have a ques bill that I received in the mail that they said they submitted to you on [PII].
[CUSTOMER][NEUTRAL] And I'm not seeing it out on
[CUSTOMER][NEUTRAL] The website.
[AGENT][NEUTRAL] OK, so you're calling about a claim for Mr. [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so, uh, first off, let's verify his information. So first off, if you'll please verify his date of birth.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you and also his home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That the code.
[CUSTOMER][NEUTRAL] Pardon me?
[AGENT][NEUTRAL] The zip code?
[CUSTOMER][NEUTRAL] Oh, I'm sorry. Uh [PII].
[AGENT][NEUTRAL] What is the zip code?
[AGENT][NEUTRAL] Thank you. And his phone number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Now, Miss [PII], that's all the information I'll need to verify with you at the moment. Is Mr. [PII] available to authorize me to speak to you?
[AGENT][NEUTRAL] Because
[CUSTOMER][NEUTRAL] He's already submitted up.
[CUSTOMER][NEUTRAL] I have a I have a an email that says I can talk to you from you people.
[AGENT][NEUTRAL] OK, let me check something.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] Can you please read me that email?
[CUSTOMER][NEUTRAL] Well, let me.
[AGENT][NEUTRAL] And then tell me exactly who it's from.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Uh just a minute.
[CUSTOMER][NEGATIVE] I'm gonna put my phone down just for a second.
[AGENT][NEUTRAL] OK, you're fine.
[CUSTOMER][NEUTRAL] I believe, uh, here it was submitted on [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so give me just
[AGENT][NEUTRAL] Give me just one moment to locate that document, please.
[AGENT][POSITIVE] Thank you for your patience, Ms. [PII]. Just one moment, please.
[CUSTOMER][NEUTRAL] It was from the care team.
[AGENT][NEUTRAL] Yes, ma'am. I found it, but I just, I'm gonna have to send a request to have it added into the system. So just, that's why I couldn't see that. So just one moment, please.
[AGENT][NEUTRAL] OK, Ms. [PII], so I have located that um.
[AGENT][NEUTRAL] That document. So first off, any information provided will be a verification of benefits and not a guarantee of payment. So what is the date of service and total bill amount that you're calling about?
[AGENT][NEUTRAL] Again, you said it was [PII]?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] No, uh, they submitted it on [PII]. It's from 10-29-24.
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The total bill amount was what my primary paid already and adjusted so the the total was like 6 1952.
[CUSTOMER][NEUTRAL] And the adjusted amount was 570 41 and the insurance paid $15.99.
[CUSTOMER][NEUTRAL] And the open balance is $33.12.
[AGENT][NEUTRAL] OK, so APL does not have a claim on file for Mr. [PII] for data service 1029-2024 at all.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] What I wanna know is what do I need to do that they've submitted it to you but you don't have it so how do I get this submitted? Do I take a picture of it and create a claim?
[AGENT][NEUTRAL] OK, so you can go to our website to get the claim form that you will need to complete and the claim form also has all of the instructions on it for which documents you will also need to submit to us.
[AGENT][NEUTRAL] Because you're going to have to submit an itemized bill including the diagnosis code. And what is the facility name that says they have already submitted it?
[CUSTOMER][NEUTRAL] Uh, Quest Diagnostics.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yes, ma'am. You'll have to reach out to the provider that ordered his test to get the diagnosis code.
[AGENT][NEUTRAL] Again, the claim, don't try to write all that down, the claim form is the claim form has those instructions on there for you.
[CUSTOMER][NEUTRAL] Those are uh
[CUSTOMER][NEUTRAL] They're on my bill, so if I submit the bill, you should be fine, right?
[AGENT][NEUTRAL] If it has the diagnosis code, not just the procedure code.
[AGENT][NEUTRAL] The why they did it, not just what they did.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Along with the primary insurance amount, we will also need to include the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] But you can
[AGENT][NEUTRAL] Do you have something that you can write down the website or you could pull it up while we're talking and I can show you where to find that claim form?
[CUSTOMER][NEUTRAL] Um, well, I think I'm here.
[CUSTOMER][NEUTRAL] If I go to claim forms at the top or no?
[AGENT][NEUTRAL] Yeah, if you click on the word claims and forms on the [PII] main website.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] If you click on claims and forms, just scroll down the page.
[AGENT][NEUTRAL] A good ways and then you're gonna see where it says um you should see a little box that says filter by product.
[AGENT][NEUTRAL] And it has a little green arrow in it.
[AGENT][NEUTRAL] Drop down arrow.
[AGENT][NEUTRAL] Do you see that?
[CUSTOMER][NEUTRAL] Uh, check on [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so under claims and form again, you click claims and forms from the main page.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And you scroll all the scroll about middle ways down, you're gonna see a big black bold letters, claim forms, and policy change documents.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And right under that there's two boxes. One says filter by product, one says filter by form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Click on the filter by product.
[AGENT][NEUTRAL] And it gives you a list.
[AGENT][NEUTRAL] You're gonna select Medlink.
[AGENT][NEUTRAL] Just click on the word med link.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then out to the right now you should see a blue button that says download form and if you click on that Miss [PII], it will open up the claim form for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I fill that out?
[CUSTOMER][NEUTRAL] From there,
[AGENT][NEUTRAL] You will have to, he will have to sign that. Yes, ma'am. He's gonna have to sign that.
[CUSTOMER][NEUTRAL] Is
[AGENT][NEUTRAL] And then you will have to save that along with the other documents that we're needing on your computer to upload them.
[AGENT][NEUTRAL] For our review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Oh, is there anything else that I could help you with at the moment?
[CUSTOMER][NEUTRAL] Um, no, [PII], that's fine, that's everything.
[AGENT][POSITIVE] OK, Miss [PII], well thank you so much for calling APL and I hope that you have a very nice weekend.
[CUSTOMER][POSITIVE] I hope you do too. Thanks.
[AGENT][POSITIVE] Oh, yes, ma'am and thank you as well.
[AGENT][NEUTRAL] Bye bye