AccountId: 011433970860
ContactId: 1cdd63d7-26ec-41ff-970e-7239b9eae1a5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1139319 ms
Total Talk Time (AGENT): 467314 ms
Total Talk Time (CUSTOMER): 633368 ms
Interruptions: 16
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/1cdd63d7-26ec-41ff-970e-7239b9eae1a5_20250310T20:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], um, I've got a couple of questions. I was, um, I had been asked to try to provide some additional information on some claims, and I did finally get that information from the provider, but when I went up on when I went up on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Your site
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It indicates that my coverage is lapsed, which
[CUSTOMER][NEUTRAL] It doesn't make sense because I have a, I'm covered, uh, on a COBR plan, uh, which is an extension of the benefits that I have, and I know the UnitedHealthcare piece, which is primary, is still active, so it would make no sense that the APL piece is not active.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, OK.
[CUSTOMER][NEUTRAL] Um, so I don't know, so, so first can we check on that and then we can go through with some of the documentation that I was asked to provide.
[AGENT][NEUTRAL] Absolutely, yes, we'll take a look at those claims and then of course make sure your account's in good standing um what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] Uh, so I'm listed as [PII], last name [PII] I have the group number if you need that.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Uh, do you happen to have the policy certificate number?
[CUSTOMER][NEUTRAL] The what?
[AGENT][NEUTRAL] Your policy number or the certification number?
[CUSTOMER][NEUTRAL] So it's is that the I'm holding the card, is that the payer ID number or is that the group number?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, um, do you see something that says member ID or in a hospital or outpatient certification number?
[CUSTOMER][NEUTRAL] In hospital certification number, yeah, I get that.
[AGENT][POSITIVE] That's perfect, yes, I'll go ahead and take that.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] 021.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 636-7 M as in Mary, L Larry 7.
[CUSTOMER][NEUTRAL] It should come up as part of 365 data centers.
[AGENT][NEUTRAL] OK, I'm sorry I think I missed a digit there, right? Um, I heard 021 or if you wouldn't mind repeating it, that'd be great.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah, sure. 021.
[CUSTOMER][NEUTRAL] 63
[CUSTOMER][NEUTRAL] 673.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, 7. I think I missed the 3 when I gave it to you, yeah.
[AGENT][NEUTRAL] Thank you. I missed that 3 at the end. OK, I appreciate you verifying that. I'm just gonna verify a couple of pieces of information real quick. Um, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you and can I get your mailing address?
[CUSTOMER][NEUTRAL] Uh, yes, although that I, um, that was updated last year, so I believe, yeah, yeah, yeah, yeah, I because I think you mailed stuff to me here, so it should come up now as [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that is not what I've got, right? Um, I've got one for uh [PII].
[CUSTOMER][NEUTRAL] Well then you [PII]
[CUSTOMER][NEUTRAL] Yeah, right.
[CUSTOMER][NEUTRAL] Right, so that was the last but gosh.
[AGENT][NEUTRAL] OK, so does that need to be updated?
[CUSTOMER][NEUTRAL] Yeah, I thought I honestly, because I updated it with United Healthcare at the same time. I mean, I've been up, I've been here since um [PII].
[AGENT][NEUTRAL] Oh man, yeah, let's go ahead and get that changed um, if you wouldn't mind, can you verify this address that we've got that's the [PII].
[CUSTOMER][NEGATIVE] Uh, let me think for a sec, um, uh, oh crap, um.
[CUSTOMER][NEUTRAL] Hold on a second so it's probably on my old license so.
[CUSTOMER][POSITIVE] That's very funny. It's already out of my head. Give me one sec uh.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Yeah, [PII] no, that's, that's the old one.
[CUSTOMER][NEUTRAL] [PII]. It's [PII]. Yep.
[AGENT][NEUTRAL] That's it. OK, thank you so much for verifying that. OK, and then what was that new address that was I heard [PII], um, if you wouldn't mind repeating that for me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, no worries. [PII]. So [PII] and it's uh [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] OK, got it. I will get that updated um and then the last thing I need is the email address we've got on file for you.
[CUSTOMER][NEUTRAL] So it should be uh that one should be my name it's [PII].
[AGENT][POSITIVE] Yes sir. OK, that is it. I appreciate you verifying all of that information. Give me just a moment.
[CUSTOMER][POSITIVE] Yeah, no worries.
[AGENT][NEUTRAL] Let's take a look here.
[AGENT][NEUTRAL] OK, so I'm not sure that the policy that you gave me, this is for your secondary medical and this is what we're referring to, correct?
[CUSTOMER][NEUTRAL] Yeah, that's that's the only thing that, uh, yeah, that we have.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, you did have a couple of other policies with us and I'm not sure if maybe that's what you saw um was uh terminated. You used to have an accident policy and a critical illness policy. Both of those terminated last year, but your uh secondary medical is still active.
[CUSTOMER][POSITIVE] Oh, you know what? You're absolutely right. So it, it's interesting. Oh, covered dependence. 00, I read it completely wrong. Yeah, yeah, yeah, yeah, yeah, yeah, yeah, because, yeah, yeah, yeah, yeah, yeah.
[AGENT][NEUTRAL] Oh yes, so you are the only one who is covered under this is that accurate?
[CUSTOMER][POSITIVE] Yeah, yep, that's exact, yeah, that is accurate that is accurate. OK, sorry to, sorry to put you through all that crap, right.
[AGENT][POSITIVE] OK, OK, awesome. Alright, well, that's one big bullet dodge. No, no, that's fine. I was worried we'd have to do some digging, find out what was wrong.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] Yeah, it didn't make any sense to me.
[AGENT][NEUTRAL] So this claim that we're looking for is this for your secondary medical or is this for one of the other ones?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, so, um, this is the one that is dated, uh, [PII].
[CUSTOMER][NEUTRAL] And the claim number is 3479055.
[AGENT][NEUTRAL] OK, just the 6:10, was that the date of service?
[CUSTOMER][NEUTRAL] Yeah, date of service [PII].
[AGENT][NEUTRAL] OK, and this was for you correct?
[CUSTOMER][NEUTRAL] This is for me.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] Yeah, and I gave you that claim number 3479055.
[AGENT][NEUTRAL] Yes sir, OK.
[AGENT][NEUTRAL] Just a moment, let me get that.
[AGENT][NEUTRAL] OK, yeah, it looks like there are quite a few items on this claim, so let's see.
[CUSTOMER][NEUTRAL] So the issue that I was uh it's uh this is the first time that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A claim like this for lab work was rejected by you guys, so it had always been.
[CUSTOMER][NEUTRAL] Um, paid.
[CUSTOMER][NEUTRAL] Uh, when I was in [PII], and the person that I spoke with at one point said, well, we don't have the diagnosis code.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, yes, I am showing that that's what's the missing information correct.
[CUSTOMER][NEGATIVE] And so that's the reason why we couldn't pay it.
[CUSTOMER][NEUTRAL] But, but the, but.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So that was the first time I was being asked for. So the diagnosis code is, is B as in boy 20 and I have the lab work to show it. So this is all related.
[AGENT][POSITIVE] Cool, OK.
[CUSTOMER][NEUTRAL] Right, so this is, so I'm, I, I have to be tested every 3 months and um and so that's why this occurs. There's a, there's a patient reason DX code before it that's Z as in zebra 21, but the B20 is.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, is what it is. And, uh, and so that's why I have to have that blood work done and it's, it's, so I have the
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What I asked them to do is send me.
[CUSTOMER][NEUTRAL] The original receipt that shows this and shows the code on it so that you have that and so I'll send that I'm gonna I'm gonna upload that now.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Um, so that we can put out that fire because they've been chasing me for $1000 and I, I know I wasn't, and, and, and in fairness, it's been a long time, so I mean, they, you know, they deserve to chase me. Um, and, and then each, I guess.
[AGENT][POSITIVE] But yeah, definitely.
[CUSTOMER][NEUTRAL] What you're gonna need me to do each time then is to.
[CUSTOMER][NEUTRAL] Submit
[CUSTOMER][NEUTRAL] Not only the explanation of benefits, but you're gonna need to have me.
[CUSTOMER][NEUTRAL] Submit the actual receipt from the provider which would have this patient code on it.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, so what I would generally say for this kind of policy as every provider is different, so I wouldn't just take that and assume that's going to be for everything regarding this kind of policy, um, because some people, some providers might just give you a receipt with nothing on it but the dollar amount, um, so I would say it would be closer to the itemized statement that does show those codes, um, and if they don't give it to you right away, you know, of course you can just ask for it and then upload it all at once for us.
[CUSTOMER][NEUTRAL] OK, now.
[CUSTOMER][NEUTRAL] OK, and that's fine now, so then.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like I have a
[CUSTOMER][NEUTRAL] I have something here from.
[CUSTOMER][NEGATIVE] I have a laboratory bill from Quest for a different date that I was about to submit, but I realized it does not have.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Any
[CUSTOMER][NEUTRAL] Um, it has a something called a, it has something called a CTT code.
[AGENT][NEUTRAL] Diagnosis codes.
[AGENT][NEUTRAL] Mhm those are typically procedure codes which for certain things we do need those as well um but they are different than uh diagnosis codes. So in that case I would reach out to Quest and just request that information just ask for an itemized statement that shows those diagnosis codes.
[CUSTOMER][NEUTRAL] And I guess.
[CUSTOMER][NEUTRAL] Well, it probably was, uh, I probably should just go back to my provider who created the, the lab work. So you know what my insurance, the way my insurance works is that uh my primary insurance with United Healthcare works is that um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My coverage is better to go through one of their approved labs, and I had forgotten that and so this one out and it's an outrageous bill for the same lab work that Quest would do for less money, but um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And so what, so that was part of what caused this problem and so from that point forward I've asked.
[CUSTOMER][NEGATIVE] The, uh, the doctor who is resident at a clinic who sent me downstairs for the first set of labs, to give me a script that I take to Quest on a going forward basis. But so I'm gonna need to request that for this one for 101, because I just went for new lab work and they made me pay a $156 bill out of pocket before they would test me again. Um, so that was frustrating. So,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEGATIVE] Um, and the other problem I'm gonna send this documentation over now going back to 6:10. The problem with this now is this payment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Needs to either go to me or it needs to go to a collection agency because it can't go directly to the hospital anymore.
[AGENT][NEUTRAL] Sure, OK.
[CUSTOMER][NEUTRAL] Um, so, so I can also submit the collection notice.
[CUSTOMER][NEUTRAL] So that you have that documentation as to where it goes or do I need.
[AGENT][NEUTRAL] We do not need that. That is perfectly fine. So the way that it works for any and all claims filed with us, if the provider is the one to file the claim, give us all the information, we would send the payment to them. If you file the claim and give us that information, we would send you that payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is that the way you've always done it?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] And you can set up if you haven't already I don't know if you are familiar with this at all you can set up a direct deposit um if you're comfortable with that and then of course once it's been uh processed you would get that within a couple of business days depending on your bank, otherwise we would send a paper check in the mail.
[CUSTOMER][NEUTRAL] Can you check and see if that direct deposit is set up?
[AGENT][NEUTRAL] Oh sure, yeah, let me see if you've got that set up.
[CUSTOMER][NEUTRAL] I'm pretty sure I set it up.
[AGENT][POSITIVE] Yes, I do see that, yes sir.
[CUSTOMER][NEUTRAL] I didn't remember that, so that's interesting. I just want to make sure.
[AGENT][NEUTRAL] Of course I do see that I can verify that information if you need it, but I do see the routing and account number.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah, so it's if it's Bank of America it's fine, um.
[CUSTOMER][NEUTRAL] Um, OK, no, because that, that hasn't, that hasn't changed. All right, well, that's good, um.
[AGENT][POSITIVE] OK, yes, I I definitely feel like it's much safer and much quicker.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, OK, alright, so here's what I'm gonna do I'm gonna send in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm going to upload a bunch of this documentation and then
[CUSTOMER][NEUTRAL] Um, because it needs to, yeah, I have documentation also for.
[CUSTOMER][NEUTRAL] Uh, some radiology stuff that wasn't fully covered, um, so I'll, I'll go back and look at anything from, I just don't want to run out of run out of, you know, have it expire for, for [PII], so I wanna get that done and this, this is the oldest one I think I have here is for is for 610. So I assume I've got, do I have a year? Is that the way it works?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, well, I will say, um, yeah, I was gonna say just so that you're aware there's no timely filing limit so any time that you're from your effective date of this policy which was [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] If there was anything from that point to now uh that you might have forgotten to file or anything like that, there is no like timely filing limit, no time where you have to get it done, um, any time with it, even if the policy had lapsed, as long as your policy it was effective during that time you can still file those claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, alright, so I will, uh, I'll do this and then I'll just make sure on a going forward basis that uh that I have this whatever the hell they call this form I have in my hand here that is like a just a.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, list all the.
[CUSTOMER][NEUTRAL] Whatever lab tests and then it uh.
[AGENT][NEUTRAL] Yeah, I would say um for labs that's general but uh for just about anything uh the itemized statement that shows diagnosis and procedure codes and then of course the EOB from your primary insurance that's what we need for this kind of policy to file claims.
[CUSTOMER][NEUTRAL] OK. All right, I will, uh, alright, I'll get that done. All right, I will, uh.
[AGENT][POSITIVE] Well, sounds good. Did you have any other questions for me, [PII]?
[CUSTOMER][NEUTRAL] So I just upload it.
[CUSTOMER][NEUTRAL] All
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then, and then how do you.
[CUSTOMER][NEUTRAL] Uh, like this, like the, the claim for 6:10 was already processed, but it's pending this additional information so then do I just, do I have to alert you or do you guys see that I've uploaded documents and you automatically look at?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, so.
[AGENT][NEUTRAL] Right, so this claim actually did deny um but as it was missing information that's not of course a hard no it's not covered it just denied as in we do need that information so if you were to upload that additional information as long as it's what we were missing it would be processed as a separate claim.
[CUSTOMER][NEUTRAL] So you mean I would have to file a new claim.
[AGENT][NEUTRAL] Uh, yes, or I mean, do you have all of the original information?
[AGENT][NEUTRAL] Like the EOB from your primary insurance and all that?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, well, I'm pretty sure I do, yeah.
[AGENT][NEUTRAL] OK, that's fine then yeah you can just go ahead and start um if you wanted to do it through our website you can just fill out that claim form and then upload that information um it'll be a separate claim then we would send you that benefit amount.
[CUSTOMER][NEUTRAL] So this is, so this is uh under the heading file a new file a wellness claim, is that what I do?
[AGENT][NEUTRAL] Not wellness, um, so this policy is called um Medlik, M E D L I N K. You would find that claim form that's called um Medlink. You would fill that out and then you can upload that information um in the spot on the main page there.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, I remember this. Now I remember this. So although when I go over to when I go over to claim forms, it, it.
[CUSTOMER][NEUTRAL] Asked me to log in.
[CUSTOMER][NEUTRAL] So maybe I should go under my policy number.
[AGENT][NEUTRAL] Um, let me make sure, um, that so I know it's a bit confusing, especially if it's been a while, um, we do have a couple of different websites so we have our public website and then we have our actual online portal that web address that you would need to go on is secured. [PII]. The other one is just [PII] and that one's not.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The one where you would file claims.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, so I'm on I'm on that, um, and, and it secured and um and so what it says is you know up on top it says contact us or it says claim forms or it says help um and when I click on claim forms.
[AGENT][NEUTRAL] The secured
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] First of all, says this is if I'm not signed in here.
[CUSTOMER][NEUTRAL] Uh, it says sign in and uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sign and register so I don't, I'm not sure why.
[CUSTOMER][NEUTRAL] uh, this is not the way I did this before, but it was just a form just a place where I clicked.
[AGENT][NEUTRAL] Uh, if you'd like, um, because I know the website does kind of change a bit, um, I can send you, I can just email you a copy of this claim form if you'd like so you don't have to worry about hunting for it.
[CUSTOMER][NEUTRAL] And they could fill out the form.
[CUSTOMER][NEUTRAL] So is it an actual form that I physically print and fill out or is it a or is it just an online.
[AGENT][NEUTRAL] You can.
[AGENT][NEUTRAL] If you do it so you can print it out if you prefer. no, not at all um so and then of course I just wanna make sure you um you are on a desktop or a laptop computer correct?
[CUSTOMER][NEUTRAL] But I, I don't need to.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Yeah yeah yeah yeah yeah I've done, I mean this is where I filed that claim before.
[AGENT][NEUTRAL] OK, I, I ask because our website really doesn't have sure our website doesn't have much support for mobile devices, so I do have to ask that but um depending on the browser that you're using, which I know Google Chrome is typically really good about that, you should be able to fill out that information through the browser you could just type in the boxes and then you can save the form and then upload it to our site.
[CUSTOMER][NEUTRAL] OK, um, uh, alright, I'll, I'll, uh.
[AGENT][NEUTRAL] Do you want me to just go ahead and email you a copy?
[CUSTOMER][POSITIVE] Uh, yeah, that'd be great and then in the meantime I'll, I'll, uh, I'll see if I can figure it out. All right, I appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, no worries, of course, um, and you just want me to send it to this email we have on file for you?
[CUSTOMER][POSITIVE] Yeah, that'd be great.
[AGENT][POSITIVE] OK, I will get that sent to you. Was there anything else I could help you with [PII]? I know that was quite a bit of information.
[CUSTOMER][POSITIVE] That'd be great.
[CUSTOMER][POSITIVE] No, but, uh, I think all good so let's uh see if we can make this work this time.
[AGENT][POSITIVE] All right, glad to hear it. Yes sir, let us know if you have any other questions.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thanks so much.
[AGENT][POSITIVE] Alright thank you bye bye.
[CUSTOMER][NEUTRAL] All right. Bye-bye.