AccountId: 011433970860
ContactId: 1c8f547a-9681-4aac-9439-4487e9591284
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398279 ms
Total Talk Time (AGENT): 172027 ms
Total Talk Time (CUSTOMER): 166712 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/1c8f547a-9681-4aac-9439-4487e9591284_20241231T15:13_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APM. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, [PII], my name is [PII], and I'm calling on behalf of my husband. My husband's sitting right here if you'd like to verify it.
[AGENT][NEUTRAL] Yes, I will need to verify that information. Um, may I have a policy number, please?
[CUSTOMER][NEUTRAL] With him
[CUSTOMER][NEUTRAL] Um, the policy number is 01897865.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, may I, I need to speak with the policy holder, please.
[CUSTOMER][NEUTRAL] Hi, [PII], excuse me, this is [PII].
[AGENT][NEUTRAL] Good morning, Mr. [PII]. If you could verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And also verify your mailing address.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK. And your phone number, please?
[CUSTOMER][NEUTRAL] Uh, my cell phone is [PII].
[AGENT][POSITIVE] Thank you so much. And the last thing to verify is your email address.
[CUSTOMER][NEUTRAL] Uh, my email address is [PII].
[AGENT][NEUTRAL] We have a different email address on file, maybe a personal email address.
[CUSTOMER][NEUTRAL] Uh, uh, let's see, [PII].
[AGENT][NEUTRAL] Yes, that is what we have on file. Thank you for that verification. Um, now the number you gave me, your cell phone number, is that a good callback number if we were disconnected?
[CUSTOMER][NEUTRAL] Uh, uh, call, call back at [PII].
[AGENT][NEUTRAL] OK, thank you. And also, Mr. [PII], there is a young lady on the phone, if you could verify um and give authorization for her to speak on the policy during this call.
[CUSTOMER][NEUTRAL] Yes, that is my wife and she's authorized and you can make her permanently authorized if there's a way to do that.
[AGENT][NEUTRAL] What is your wife's name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and you're given her authorization. OK. And I can see if I can send over email you over a, a HIPA authorization form to um allow her to speak on the policy um and if you're not able to give verbal authorization during the call.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I can speak with Ms. [PII]. Thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] OK, um, I have a bill that, uh, Quest has been trying to file with you for, um, over a year now and it's not paid.
[AGENT][NEUTRAL] Um, you can submit the claim on your husband's behalf, um, but I can check the date of service just to make sure that we do not have it on file.
[CUSTOMER][NEUTRAL] OK, data services [PII].
[AGENT][NEUTRAL] OK, thank you. And that's from Quest. One moment.
[CUSTOMER][NEUTRAL] They said they last submitted it in September. They submitted it more than once, but September was the last time it got submitted.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] OK. And we do not have that claim on file. What you will need to do um to file the claim on your husband's behalf, we would need the itemized bill that has the diagnosis code on it, diagnosis or diagnosis codes on it, along with the explanation of benefits.
[AGENT][NEUTRAL] From the major medical insurance provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm sorry. I thought I lost you for a second. Um, I'm sorry, let me just repeat that. Dusty. I my bill with the diagnosis procedure and diagnosis codes on it, along with your explanation of benefits from the primary insurance provider.
[CUSTOMER][NEUTRAL] OK, um, can you, uh, do you have an email where I can email that to you?
[AGENT][NEUTRAL] No, um, we do have a website if your husband has a an account created with us on the online service center, the claim can be uploaded, um, but if not, I can provide you with our fax number and mailing address for claim submissions, but we do not accept via email.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, that's fine, that's fine. Uh, the fax number is [PII]?
[AGENT][POSITIVE] Yes, that is correct, thank you.
[CUSTOMER][NEUTRAL] OK, um, I think I do have an account set up for him, um, on the APL site, so let me, uh, let me go ahead and give that a try and see if I can upload, and you need the explanation of benefits and the bill from Quest with that that give you the codes for the for the diagnosis.
[AGENT][NEUTRAL] Yes, that
[CUSTOMER][NEUTRAL] So like it's blood work and it shows the payments made by our insurance company and the adjustment and all that that should be sufficient correct? and then it has a CPT code.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] OK. I was about to say the CPT code is different from the diagnosis code. So once, we will need the diagnosis code, the reason why your husband had to have um lab work done, that's the diagnosis or the sickness. We will need that code.
[AGENT][NEUTRAL] Or codes.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] I don't know how I would get that, um, because like his doctor ordered the, the blood work.
[AGENT][NEUTRAL] Then you can get that information from, or he can get the information from his doctor.
[AGENT][NEUTRAL] But yes, we will need the diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, let me see what I can do.
[AGENT][POSITIVE] OK, yes, ma'am, of course.
[AGENT][NEUTRAL] Anything else I can help you guys with?
[CUSTOMER][NEUTRAL] Uh, no, that's fine, um, and you say you never received the one submitted in, uh, in September of this last year.
[AGENT][NEUTRAL] We do not have data service of [PII] on file.
[CUSTOMER][NEUTRAL] OK, all right, um, thank you very much. Um, is there a chance, can you just look and see maybe it was coded with the incorrect, uh, date or something and, uh, by an amount?
[AGENT][NEUTRAL] Um, it was OK, but it was in [PII], is that correct?
[CUSTOMER][NEUTRAL] It was done in [PII].
[AGENT][NEUTRAL] OK, I did not show any claims for lab for [PII].
[CUSTOMER][POSITIVE] OK. Thank you very much. I'll, uh, I'll give the doctor a call. Thank you.
[AGENT][POSITIVE] OK. You're welcome, Ms. [PII], and thank you so much. You guys have a great day and thanks for calling APL.
[AGENT][POSITIVE] Thank you. Happy [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye.