AccountId: 011433970860
ContactId: 19101880-7152-4b86-a449-490aed778371
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 483179 ms
Total Talk Time (AGENT): 233791 ms
Total Talk Time (CUSTOMER): 266164 ms
Interruptions: 9
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/19101880-7152-4b86-a449-490aed778371_20250225T16:02_UTC.wav
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[AGENT][NEUTRAL] Good Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling because I submitted a receipt of a payment that I had to make to the urgent care because um they had an issue with you guys with the um trying to accept the secondary insurance for myself and uh for some reason I got a letter, um, something about.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Um, needing more info, but
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I don't know what to do because I sent the receipt in. I even called you guys when I was at the urgent care when I had the issue and the girl represented me on the phone.
[CUSTOMER][NEUTRAL] So can you assist?
[AGENT][NEUTRAL] OK, sure, yes, um, usually receipts are not enough, um, but I can go ahead and check and see what happened. May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, absolutely. It's [PII], call back number is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I have a group num. Which one do you want? The in hospital outpatient? OK, alright, it.
[AGENT][NEUTRAL] The
[AGENT][NEGATIVE] Outpatients hurt. Mhm.
[CUSTOMER][NEUTRAL] 01369754
[CUSTOMER][NEUTRAL] ML and the number 8.
[AGENT][NEUTRAL] Thank you. May I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, date of birth [PII]. Address is [PII]. What's the next email [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] So I think I originally went on um
[CUSTOMER][NEUTRAL] Uh, [PII], I think [PII] or [PII], and they took the secondary insurance at the at the MD and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I was still sick a couple of days later and they, I needed antibiotics. And when I went back, they gave me an issue that they wouldn't take the secondary insurance, which is, I don't know why they said yeah they one day na did the other, they just, you know, they're not the very smart. So anyway, um, I called APL when I was there and I couldn't figure out why, and the lady said that there was like no code to give when I spoke to one of the rats.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] And she said, well, just get the receipt and I spoke to her. She, I get the receipt. She sent me the claim form by email and just submit it and we'll reimburse you the $125 and I did that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so she sent you the claim form.
[CUSTOMER][NEUTRAL] And I got a text you the receipt.
[CUSTOMER][NEUTRAL] Yeah, she did. She sent me the claim form and I filled it out and sent it back with the receipt.
[AGENT][NEUTRAL] OK, so more than likely she just did not explain the claim form, um, but I do apologize for that. So the claim form on the first page, there's instructions. Um, and the instructions indicates that we need two documents, which is the itemized bill with the diagnosis code and the explanation of benefits from the primary insurance. Those two documents are must for completion of a claim. Um, if we have those two doc.
[CUSTOMER][NEUTRAL] Well, what she told was just to send the receipt. So how do you want an itemized bill? Do you want me to go to urgent care and get an itemized bill from them? Is that what you're telling me?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Either you can go or you can call to see how they can send you an itemized bill. The itemized bill is gonna have the diagnosis code and it's gonna have the charge amounts. We need that diagnosis code to determine benefit.
[CUSTOMER][NEUTRAL] OK, itemized bill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Diagnosis code, huh.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Mhm. And then we need the copy of the explanation and benefits from the primary insurance indicating how much they apply towards the deductible co-payment and co-insurance.
[CUSTOMER][NEUTRAL] Do you guys always do with the urgent care. I mean, it's just not the first time. And yeah, I have Cigna as my primary. You guys know that also. We did it, this is not the first time.
[AGENT][NEUTRAL] Yes, we're, we're not, we're not asking for the documents indicating what you have with or what insurance you have. It's more like for that date of service when you went to the urgent care, they gave you a discount, they apply some to the deductible co-payment and co-insurance, and they say that this you owe. That document we need because we need to know exactly how much we need to pay.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's just something we ask like whenever they send it I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] OK, so if I log in to signal.
[CUSTOMER][NEUTRAL] Mhm. Go ahead. It's just that I'm trying to figure it out because back in the past, I mean we've been with you guys forever. All I had to do is send out a receipt, and I'm like, I, when the lady told me just submit a receipt, fill out the claim. I'm like, OK, I can do. I said when like right now I will have to actually search for the damn claim form to see, um, so I need to resubmit that. I don't even know what I do. Do I need to resubmit a receipt because I don't even know what to do with it because I sent it to you guys.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You, we don't need the receipt. We don't need the receipt. Uh, all we need is the itemized bill and the explanation of benefits. You don't have to send the claim form again. You already send the claim form, so we don't need the claim form. Um, we just need the itemized bill and we need the copy of the explanation of benefits from the primary insurance. So those are the two. The primary insurance explanation of benefits, if you have um the website, if you can go to your account, you can probably get it like that.
[CUSTOMER][NEUTRAL] You don't, OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] More than likely you can get a copy like that.
[CUSTOMER][NEUTRAL] So what I should do is go to the day of the service and tell you the what they have for the day of the service. Is that what you need? What you need explanation of benefits?
[AGENT][NEUTRAL] It's a document is the explanation of benefits. It's gonna be the copy of the explanation of benefits for that date of service.
[CUSTOMER][NEUTRAL] Uh, copy of explanation.
[CUSTOMER][NEUTRAL] What the.
[CUSTOMER][NEGATIVE] Of service, I mean, I don't know why the, why the urgent care gave me such a problem when, you know, normally they would just call you guys and I wouldn't have an issue with, with this has been. So who, who, what number or who do I send this information to?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, um.
[AGENT][NEUTRAL] OK, you have 3 options. You can either mail it, you can either fax it, or if you have registered online, you can just upload it like you did the last time. So just upload it as a new claim, we'll go ahead and put it together with the one you're already sending.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK, what's your fax number just in case, honey?
[AGENT][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So by me sending just like that I don't need to put like a uh uh like a cover letter. Do you guys automatically know by the date of service and blah blah blah and put do you have a claim number for me to put on there that I need to attach to it? What's the number?
[AGENT][NEUTRAL] Mhm. Yeah, you can either put your policy number or you can put the claim number. Um, the claim number is 356-40999.
[CUSTOMER][NEUTRAL] OK. 356-409-9. I put that on there. OK, and that should be sufficient enough.
[AGENT][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] Correct. And you're already paid out of pocket, correct? For the urgent care, you're already paid, yeah, yes. Mhm. Yes. So, yeah, but yeah, usually they just take it and send the claim directly to us and we pay them directly, but yeah, in some of the cases, either if the person is new and they don't know how to manage that system or if they don't have that system where they can put a secondary insurance, they will not take it.
[CUSTOMER][NEUTRAL] OK, I don't know, I don't even know.
[CUSTOMER][NEUTRAL] Yeah, I did. Well you have the receipt. Yeah, I paid it. I paid it.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] But in that case, um, once you're ready to leave, you always ask for a fully itemized bill with the diagnosis codes and they'll go ahead and give it to you at the time of um leaving the office, OK?
[CUSTOMER][NEUTRAL] Diagnosis code.
[CUSTOMER][POSITIVE] OK, alright, let me see if I call them and find out what they can send me. Alright, thank you very much. I appreciate it.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] All right. You're welcome, Miss [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEGATIVE] No, I'm not gonna go to a place where it doesn't accept the firsthand because this is ridiculous.
[AGENT][NEUTRAL] It's a lot of work.
[CUSTOMER][POSITIVE] It's OK. I got you. No, no, no, it's all right, it's all right. You know, it is what it is. I'll get it done. All right, thank you very much, baby. I appreciate it.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Uh, you're welcome. Thank you for calling APO. Have a good day. Bye-bye, Mr.
[CUSTOMER][POSITIVE] OK. Thank you, bye bye.