AccountId: 011433970860
ContactId: 27ef980a-e067-452e-8006-978be8c2003d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410250 ms
Total Talk Time (AGENT): 195708 ms
Total Talk Time (CUSTOMER): 196614 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/27ef980a-e067-452e-8006-978be8c2003d_20250130T17:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I don't know if I am speaking to the correct department.
[CUSTOMER][NEUTRAL] Um, I have some questions in reference to our benefits.
[CUSTOMER][NEUTRAL] Can I give you um the outpatient benefit uh certification number?
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with your benefits. Um, first, I'll need your name and a good callback number.
[CUSTOMER][NEUTRAL] OK, my name is [PII], and a good call back number would be [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And yes, now I need your policy number.
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 611-631.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, the number 8.
[AGENT][NEUTRAL] Thank you. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] My date of birth is [PII], and our mailing address is [PII], and this is in [PII].
[AGENT][POSITIVE] OK, thank you. I, I found you in our system. Um, how can I help you?
[CUSTOMER][NEUTRAL] I am calling in reference to um some benefits uh related to, to my husband. So my husband went to go see an orthopedic uh doctor.
[CUSTOMER][NEUTRAL] And he's been complaining of some shoulder pain, you know, for, for like a little bit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] The doctor gave him an injection of cortisol.
[CUSTOMER][NEUTRAL] This was back in December of last year.
[CUSTOMER][NEUTRAL] When he went for the follow up to see how the injection, you know, whether he was feeling better, um, they told him that he had a balance of $128 and I believe 40 cents. I'm not, I'm not sure on the change, but I know it was $128 and change. When we told them that we had, you know, this, um, secondary insurance or, or the gap.
[CUSTOMER][NEUTRAL] Um, they do not, you know, uh, they will not bill you. So my question is, are we able to file a claim because he had to pay for the 128 and change right then and there.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, yes, ma'am. You can file the claim yourself.
[AGENT][NEUTRAL] The information that we'll need is the EOB from your primary insurance company. Who's your primary insurance?
[CUSTOMER][POSITIVE] OK, I'm, I'm so sorry because I'm gonna have to like write all this down. I have no idea.
[CUSTOMER][NEUTRAL] So if you don't mind, I would like to write this down.
[AGENT][POSITIVE] Sure. Take your time.
[CUSTOMER][NEUTRAL] Our primary insurance is UnitedHealthcare.
[AGENT][NEUTRAL] OK. And let me know when you're ready and I can give you additional information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I am, I'm I'm grabbing a pen and paper right now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you need, I'm sorry, you said E as in Edward, L as in Larry, B as in boy?
[AGENT][NEUTRAL] No, it's E as in explanation.
[AGENT][NEUTRAL] O as in of.
[AGENT][NEUTRAL] And B as in benefits, explanation of benefits.
[CUSTOMER][NEUTRAL] OK, I didn't catch the 2nd 1. I'm sorry.
[AGENT][NEUTRAL] Of explanation of benefits.
[CUSTOMER][NEUTRAL] Oh EOB, OK, sorry.
[AGENT][POSITIVE] Yes, ma'am. No problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll get that from the primary insurance company.
[CUSTOMER][NEUTRAL] I'm sorry, and we will get that from whom? I'm sorry?
[AGENT][NEUTRAL] Your primary insurance company.
[CUSTOMER][NEUTRAL] Primary insurance OK.
[AGENT][NEUTRAL] Yeah. Who's, and who's your primary insurance company again?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] UnitedHealthcare.
[AGENT][NEUTRAL] Yes, ma'am. You'll contact them and get the EOB or explanation of benefits for the date of service. Um, do you know what date of service that hospital or um office visit was for?
[CUSTOMER][NEUTRAL] It was a doctor.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it was sometime in December.
[AGENT][NEUTRAL] OK. We'll make sure you'll, you have the date of service before you contact them and let them know that you will need the EOB for that date of service.
[CUSTOMER][NEUTRAL] OK, and I'm sorry, excuse my ignorance, what exactly is on the EOB?
[AGENT][NEUTRAL] The EOB will show how much um how much the charges for the hospital visit or the doctor's office visit was, and it'll show which charges went to the co-pay, the co-insurance or deductible, which, um, American Public Life, our insurance company, that's the portion that we pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, we still have benefits pertaining to last year is that, is that correct?
[AGENT][NEUTRAL] Yes, ma'am, for outpatient services, we cover up to 1500 per calendar year, so you still have those benefits available.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright, so then I guess I need to go ahead and contact my my our primary insurance and take it from there.
[AGENT][NEUTRAL] Yeah, you'll need the LLB and you will also need um the diagnosis code. The diagnosis code is not pre-printed on the explanation of benefits, so you would need to con
[CUSTOMER][POSITIVE] OK, so I'm sorry.
[CUSTOMER][NEUTRAL] Diagnosis code, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. And that information, you can call the doctor's office and get that information. Let them know that you would need the diagnosis code um for that date of service and the diagnosis code is the reason why your husband was seeing the doctor.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's it's the code for the illness or injury. And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And once you get that information, you'll write it on the EOB that you get from the primary [PII]pany.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll submit that information to us. You can mail it to us, you can fax it to us, or you guys can file the claim online. Which way do you prefer?
[CUSTOMER][NEUTRAL] OK, and I'm assuming that we would have to um also provide proof of payment?
[AGENT][NEUTRAL] Well, we wouldn't need the proof of payment. You could send it if you have it, that would definitely help, but make sure that um you send the EO the explanation of benefits and the diagnosis codes. Those are the most um important. And yes, if you have that bill that you said that you guys received, send that along as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I guess once I gathered this information, um, you know, I will then call for the final steps, but yeah, it sounds like I have some uh documentation that I need to gather.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Well, that's fine. Yeah, we're here um from [PII] central time.
[CUSTOMER][POSITIVE] OK, so Central, so that's [PII] our time. OK, alright, thank you so much. You have been very helpful.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, no, thank you, thank you, you've been very helpful. Have a great day. All [PII], bye bye. Thank you.
[AGENT][POSITIVE] OK, no problem. You do the same. Thank you for calling ATL. Mm bye.