AccountId: 011433970860
ContactId: 246ec8d0-9b72-4453-8423-7bc9b059df55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401040 ms
Total Talk Time (AGENT): 159642 ms
Total Talk Time (CUSTOMER): 103592 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/246ec8d0-9b72-4453-8423-7bc9b059df55_20250530T16:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm calling in regards to a bill um that I'm receiving from a doctor that was from what I believe is supposed to be covered by APL.
[AGENT][NEUTRAL] OK, do you have your policy number with us? I can pull it up.
[CUSTOMER][NEUTRAL] Yeah, um,
[CUSTOMER][NEUTRAL] It would be the outpatient cert certificate number is it that one?
[AGENT][POSITIVE] Yeah, you can give me that, yeah.
[CUSTOMER][NEUTRAL] 019
[CUSTOMER][NEUTRAL] 355
[CUSTOMER][NEUTRAL] 47
[CUSTOMER][NEUTRAL] ML8
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And can I get your name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then lastly for security, I will need to verify please the physical address on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. Um, do you have a date of service for when you were seen?
[CUSTOMER][NEGATIVE] It's super old. Um, I don't know why they're billing me now and sending this to like I guess I don't know if it's collections office or what I gotta go for.
[CUSTOMER][NEUTRAL] Um, I don't even, I don't even let me see if I have, I have here.
[CUSTOMER][NEUTRAL] I'm in my car. I have a bill from the.
[CUSTOMER][NEUTRAL] Attorney's office I guess but I don't have it.
[CUSTOMER][NEUTRAL] Gynecologist right now.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I don't know, I don't know.
[CUSTOMER][NEUTRAL] Are you able to see it on your own?
[AGENT][NEUTRAL] Um, I need a little bit more information like the year, month, any, any idea?
[CUSTOMER][NEUTRAL] You have a doctor's name?
[CUSTOMER][NEUTRAL] Let me see if I have an email but let me just.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Who was, do you know who the doctor or provider was?
[CUSTOMER][NEUTRAL] Yeah, the doctor's office of Jimenez.
[CUSTOMER][NEUTRAL] Uh, the Jimenez and Simon M D LLC.
[CUSTOMER][NEUTRAL] I go down there
[CUSTOMER][NEUTRAL] I see who you manage with the doctor's name.
[CUSTOMER][NEUTRAL] Let me check the email.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Were you able to find it through the name?
[AGENT][NEGATIVE] I'm looking at all these claims that have been processed. Give me just a second. I don't have a way to search my name unfortunately.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK, yeah, they never sent me an email.
[AGENT][NEUTRAL] So the only provider I see on here is back from [PII] it says [PII].
[AGENT][NEUTRAL] Are you sure, [PII]?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Everything else.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Baptist urgent care, there was
[AGENT][NEUTRAL] Baptist Hospital.
[AGENT][NEUTRAL] There's a diagnostic center for women.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, it has to have been
[CUSTOMER][NEUTRAL] Either [PII] or even [PII] that but no no later than that.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So there are no claims on file, yeah, I mean there are no claims on file for you past [PII], so that I see, so the very first claim that was submitted on this.
[CUSTOMER][NEUTRAL] Does that mean that they didn't bill you that?
[AGENT][NEUTRAL] It was for a date of service of [PII]. There's nothing older than that. So if it's prior to [PII], they didn't file anything with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have to call them
[CUSTOMER][NEUTRAL] For them to go ahead and file that.
[AGENT][NEUTRAL] So either they can still bill us as your secondary because you know you're active and still are active at the time of service, or you can file the claim yourself um and do it that way, whatever is easiest for you, but it's not too late to still file it, they can still do it.
[CUSTOMER][NEUTRAL] OK, and for me to do it myself, what, what information would I need the dates of service?
[AGENT][NEUTRAL] You would need the claim form, you would need an itemized bill from the provider with the procedure and diagnosis codes, and then you need an explanation of benefits from your primary insurance showing what was paid and what was not.
[CUSTOMER][NEUTRAL] OK, so maybe easier for them to do it because they probably already have all that.
[AGENT][NEUTRAL] Yeah, I mean usually it's easier if they'll do it on your behalf. I don't, you know, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] But if you need, if you end up having to do it yourself, we can definitely walk you through on how to do that as well.
[CUSTOMER][POSITIVE] OK, I'm gonna go ahead and call them and see if they're able to do that for me, um, but if not, I'll give I'll definitely call back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, and when you talk to them, if I mean, I guess if they give you any kickback, just see if you can find out what the exact data service was because that would help us narrow down the search to see if there really was anything.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect thank you so much I appreciate it.
[AGENT][POSITIVE] You're welcome. Have a good one, [PII].
[CUSTOMER][NEUTRAL] OK. You too
[AGENT][NEUTRAL] Bye.