AccountId: 011433970860
ContactId: 2534b057-b39b-451d-b247-92204bb2c070
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1062109 ms
Total Talk Time (AGENT): 545568 ms
Total Talk Time (CUSTOMER): 310245 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/2534b057-b39b-451d-b247-92204bb2c070_20250228T19:42_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to verify that you guys received a claim.
[AGENT][POSITIVE] It would be my pleasure to assist you. May I ask your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] And a callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And the policy number, please?
[CUSTOMER][NEUTRAL] 0227
[CUSTOMER][NEUTRAL] 9404.
[AGENT][NEUTRAL] Alright, thank you. And what is your date of birth and current mailing address, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And then finally we do have an email on file for you. Do you mind verifying that email, Mr. [PII]? It looks like a Yahoo email.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you. And what's the claim for yourself, [PII] or [PII]?
[CUSTOMER][NEUTRAL] Uh, it's for [PII].
[AGENT][NEUTRAL] OK, let me take a quick look.
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Do you know, um, was the claim for a facility claim, like a hospital or was it?
[CUSTOMER][NEUTRAL] Uh for Quest Quest Diagnostics.
[AGENT][NEUTRAL] Request.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Yes, so we did receive a claim. Let me see when we received that. Looks like on [PII].
[AGENT][NEUTRAL] On [PII] we processed and paid Quest Diagnostics $9.66.
[CUSTOMER][NEUTRAL] OK, so that was one of them. So I've been actually going back and forth between Quest and APL for well over 6 months now, um, Quest keeps sending APL the bill.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] APL keeps saying oh we don't receive the bill.
[CUSTOMER][NEUTRAL] Um, so we've gone to faxing. We've tried faxing. Some of them have gone through, like you guys at APL have received them through fax, but it seems like you don't receive all of them.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I live
[AGENT][NEUTRAL] Yeah, um.
[AGENT][NEUTRAL] So there's more charges.
[AGENT][NEUTRAL] For that data service from Quest.
[CUSTOMER][NEUTRAL] Yes, I, I have 3 separate bills that.
[CUSTOMER][NEGATIVE] You guys just can't seem to receive.
[AGENT][NEUTRAL] Yeah, now,
[AGENT][NEUTRAL] Do you happen to have the phone number for Quest?
[AGENT][NEUTRAL] All right. When you talked to them, did they say that they'll have it faxed or?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So they keep have they're having it faxed so the last one that should have been faxed was on like Monday or Tuesday.
[CUSTOMER][NEUTRAL] And they told me it takes it could take up to 72 hours um that you guys should have it by Friday today.
[AGENT][NEUTRAL] For them to fax it.
[CUSTOMER][NEUTRAL] Um, if you guys do not have it, then they basically said they want to speak to somebody at APL to try to get this figured out.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Oh, can we do it, can we do a 3 way call?
[CUSTOMER][NEUTRAL] Um, yeah, we can attempt it, I guess.
[AGENT][NEUTRAL] Now, the, the other thing I was gonna say, um, Mr. [PII], do you have your explanation of benefits for that data service?
[AGENT][NEUTRAL] Request
[CUSTOMER][NEUTRAL] Um, so yeah, I believe this is what you know the code and what it is and the charge.
[AGENT][NEUTRAL] And is that from your primary insurance?
[AGENT][NEUTRAL] Cause I was gonna say.
[CUSTOMER][NEUTRAL] This is from this is from Quest itself, the bill that I received prior to APL.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Because I was gonna say you can actually if you've got that information you can.
[AGENT][NEUTRAL] Submit a claim and we can pay you direct um I'm just gonna tell you the truth it seems like for some reason we don't get claims from Quest a lot and I don't know if it's there not sending them to us.
[AGENT][NEUTRAL] Um, if we could get somebody on the phone, I would love to be able to tell them that, you know, if they will fax it while we're on the phone, I can check to see if we get it and just verify the fax number or they can mail it.
[AGENT][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, um, I'm sure we could do that, but I mean, would, would this bill work as my.
[CUSTOMER][NEUTRAL] Like the bill that I received from them, will that for me sending in the claim.
[AGENT][NEUTRAL] Yeah. So we'll have to have your primary insurance explanation of benefits along with the bills. Um, is it for the same diagnosis?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You can submit that bill.
[AGENT][NEUTRAL] And then if you I can give you a claim number and if you do you have our online uh portal account?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, because, OK, so what I was gonna say is on that if you can put.
[AGENT][NEUTRAL] I if you can write it on the bill and just say diagnosis code is on claim and I can give you a claim number.
[CUSTOMER][NEUTRAL] The backhand
[AGENT][NEUTRAL] Why are they sending you bills with separate charges, do you know?
[CUSTOMER][NEUTRAL] Because they were separate days.
[AGENT][NEUTRAL] Oh, separate days. So, the bill that you have is that for the [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The bill that I currently have is for the [PII].
[AGENT][NEUTRAL] OK, because we do have this one for the [PII].
[CUSTOMER][NEUTRAL] Which there were 2 of them for that day.
[AGENT][NEUTRAL] OK, because we have the one.
[CUSTOMER][NEGATIVE] And one of them, one of them got paid, one of them didn't, or one of them got received, one of them didn't.
[AGENT][NEGATIVE] See that's just odd to me. Hang on just a second. This, this charge is for $66.83.
[AGENT][NEUTRAL] That was paid
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Why would they send one and not the other? I'm sorry, I'm thinking out loud. I shouldn't think out loud.
[CUSTOMER][NEUTRAL] No, you're fine. Well, they keep saying that they, they send them all and.
[CUSTOMER][NEUTRAL] I, I don't know where, how it's getting lost between like.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I'm checking this document that we have with this claim just to make sure that it was just this charge.
[AGENT][NEGATIVE] But I just don't understand why they're just sending one charge at a time if it's for the same day either.
[AGENT][NEGATIVE] I mean, I don't work for them. I, I don't, I don't understand. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, you're fine.
[AGENT][NEUTRAL] I would like to if we can if you've got a phone number.
[AGENT][NEUTRAL] If, if you've got time.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Let's do a three-way call.
[CUSTOMER][NEUTRAL] Yeah I mean I I can I can call them but it's gonna be one of those I have to call and wait for somebody to be available to talk to.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Not just a call and somebody answer and.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm just looking at this claim, there's no other charges.
[AGENT][NEUTRAL] Um, yeah, but if you want to file a claim, but we will need the diagnosis code on that bill, is there an ICD 10 code or can you see a code that starts with a Z3401 on that bill?
[AGENT][POSITIVE] And I hear something adorable in the background.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, that's, that's the reason for these bills.
[AGENT][POSITIVE] That's a good reason.
[CUSTOMER][NEUTRAL] Oh yeah, yeah, OK.
[CUSTOMER][NEUTRAL] Um, the only thing that I see is.
[CUSTOMER][NEUTRAL] Uh, CPT code.
[AGENT][NEUTRAL] Yeah, that's the 87086. Well, that's not probably not gonna be that one.
[AGENT][NEUTRAL] That was the one that was paid.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, otherwise I don't see.
[CUSTOMER][NEUTRAL] I told like that.
[AGENT][NEUTRAL] OK, so on the bill, if you have got your prime.
[CUSTOMER][NEUTRAL] I've got a bill, a bill code 60060M00505.
[AGENT][NEUTRAL] I think that's their code request.
[AGENT][NEUTRAL] OK, if you've got that bill and then if you've got the primary EOB on that bill, if you would um you can put.
[AGENT][NEUTRAL] And see that if they will.
[AGENT][NEUTRAL] Use that information put on there that please refer to claim.
[AGENT][NEUTRAL] 355.
[AGENT][NEUTRAL] 1775.
[AGENT][NEUTRAL] For diagnosis code.
[AGENT][NEUTRAL] Because it is the same data service, I believe that they can use that now they may determine that they're gonna have to have something from Quest with the diagnosis code on it.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, but so what about?
[CUSTOMER][NEUTRAL] I, I still have two other bills.
[AGENT][NEUTRAL] Let's check those.
[CUSTOMER][NEUTRAL] That I need to send in.
[CUSTOMER][NEUTRAL] I mean, is the, the diagnosis code is, is that like can I find that on my main insurance?
[AGENT][NEUTRAL] Who's your primary with? Let's see.
[CUSTOMER][NEUTRAL] When they got billed then.
[CUSTOMER][NEUTRAL] My pri my primary is Anthem.
[AGENT][NEUTRAL] See, Anthem does not.
[AGENT][NEGATIVE] I don't believe that Anthem's gonna put your diagnosis code on there.
[AGENT][NEUTRAL] You can check with them and see.
[AGENT][NEUTRAL] But a diagnosis code is going to start with a letter followed by two numbers, usually a decimal point and two more numbers. For example, Z 34.01.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm saying, get this paid, get this paid.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] She's saying
[CUSTOMER][NEGATIVE] She's tired of me talking about it.
[AGENT][NEUTRAL] Let her come and talk to Quest and get that claim over here.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, would, would u have the diagnosis code?
[AGENT][NEUTRAL] Yes. Quest has the diagnosis codes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so pretty much I just, I should call them and get the diagnosis code for all three of them.
[AGENT][NEUTRAL] Yeah, in fact, if they would, I don't know if they can provide this to you, but let me give you, you can request a form from them. They should be able to to provide that to you.
[AGENT][NEUTRAL] And if you can get them to send you a form called a CMS 1500, that's C as in Charlie, M as in Mike, S as in Sam.
[AGENT][NEUTRAL] 1500.
[AGENT][NEUTRAL] That is actually the forms that they use to submit claims for insurance and it'll have your charges, your codes, your dates of service.
[AGENT][NEUTRAL] And then we'll also need that explanation of benefits from Anthem showing what was applied to your deductible co-pay or coinsurance. I mean that's an option if you wanna just see if you can get that from them and get it to us so we can get it paid.
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] I either need the CMS 1500 form, the explanation of benefits, and then this med link claim form.
[AGENT][NEUTRAL] Well, the missing claim form online you can submit that it's not required.
[AGENT][NEUTRAL] But if you submit the medli claim form, then it's gonna show that you are submitting the claim and benefits uh should come to you.
[AGENT][NEUTRAL] And then you can pay them and be done with it.
[CUSTOMER][NEUTRAL] OK, so if I, if I just submit the med link claim form.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What do I need with that?
[AGENT][NEUTRAL] That's gonna be either the bill from Labor or the CMS 1500.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then we'll need that explanation of benefits from Anthem for each data service for request.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK, I'm, I'll probably just probably end up doing that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It might be the easiest thing to do.
[AGENT][NEUTRAL] Yeah, as, uh, you know, if you, if you wanna call Quest again and just tell them that we only have this one claim on file for that data service and then, um, ask them if they can send you that CMS 1500.
[AGENT][NEUTRAL] And then you can upload it on your policy online.
[AGENT][POSITIVE] It can be submitted online and then that way you know we're gonna get it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we can process that for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] My explanation of benefits.
[CUSTOMER][NEUTRAL] Um, from Anthem, is that for this visit itself?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, so you can go to if you have their um online access for Anthem or you can call them.
[AGENT][NEUTRAL] And uh tell them that you need or
[AGENT][NEUTRAL] On the uh websites, I'm not familiar with their website, but you can go to the claims processed.
[AGENT][NEUTRAL] And look for that data service and that specific claim from Quest.
[AGENT][NEUTRAL] It's also called an EOB, short for explanation of benefits.
[CUSTOMER][NEUTRAL] Uh uh.
[AGENT][NEUTRAL] And that would be for each data service from Quest.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] A lot of times they mail those to you as well.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] And I'm sorry you've been, I know that's gotta be frustrating, especially when they say you know we're sending it, we're sending it and we don't have it. I don't know.
[AGENT][NEUTRAL] Where the breakdown is.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I mean we get a claim document?
[AGENT][NEUTRAL] I mean even if we can't find an insured which.
[AGENT][NEUTRAL] You know, sometimes they'll send with incorrect information we send it back to them and ask them for more information.
[AGENT][NEUTRAL] So we have not received the documents.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][POSITIVE] But we'll be happy to process them for you once we get them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][POSITIVE] Yeah, I'm gonna try to get all this together and I'll probably call them and we'll see where we go from there.
[AGENT][NEUTRAL] Yeah, and if you have any problems, you know, any further problems or if you get them on the phone.
[AGENT][NEUTRAL] And you know, get them to hold on and call us and get a representative that can verify that we only have this one claim for data service 1324.
[CUSTOMER][POSITIVE] Yeah, if, if anything, what I do because it seems to be, it's easier to get a hold of somebody from APL than this from Quest quicker at least.
[AGENT][NEUTRAL] Either way,
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, so they should be able to wait for a three-way.
[CUSTOMER][POSITIVE] OK, all right, sounds good I appreciate it.
[AGENT][POSITIVE] Just some options. I'm so sorry we don't have it, but hopefully we can get that soon for you.
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Hopefully
[AGENT][POSITIVE] Mhm. Well, it's been a pleasure to assist you and I hope you have a wonderful day and enjoy that new little precious angel.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] I will thank you.
[AGENT][POSITIVE] Mhm. You're very welcome. You take care.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.