AccountId: 011433970860
ContactId: 28d44328-72cf-48e2-8ede-399809947119
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 984820 ms
Total Talk Time (AGENT): 591894 ms
Total Talk Time (CUSTOMER): 286447 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/28d44328-72cf-48e2-8ede-399809947119_20250620T14:20_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Hi, my name is [PII], and I have APL and I've tried to submit a claim and obviously I don't know what I'm doing. Um, it was back on the [PII] is when I sent it and I still have not heard anything.
[AGENT][NEUTRAL] OK, Ms. [PII]. So you're wanting to check claim status. Is that correct?
[CUSTOMER][NEGATIVE] that and to make sure that I'm filing it correctly because I'm thinking that's what I'm doing wrong.
[AGENT][POSITIVE] OK. Yes, ma'am. I can help you with that. And Miss [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then your policy number?
[CUSTOMER][NEUTRAL] Let's see, see if it tells me where would that be? Oh, is it C 0638223?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No, ma'am, um, do, you should have an ID card. Well, it depends, Miss [PII], on what type of policy you have, but there should be a number on your ID card.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Well, and that's the other thing, I don't know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I thought I saw a place on there where I could look up my card and I'm so sorry.
[AGENT][NEUTRAL] That's OK. I, I can, Ms. [PII], look it up with your full social if you're the primary policy holder.
[CUSTOMER][NEUTRAL] Sure, yes, it's [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and Miss [PII], I will need to verify several things with you first for security and also any information that is provided will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then also your home mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you provided for me, so that is your best contact number that we should have, is that correct?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you and lastly your email address?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you. And Miss [PII], what is the date of service and the billed amount on the claim you filed?
[CUSTOMER][NEUTRAL] Let's see, hm hm, there were two claims actually, so.
[CUSTOMER][NEUTRAL] See if I can find that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEGATIVE] It'd be easier to go to my calendar here than trying to find it on the computer because that my log in for APL is not what I want, OK.
[AGENT][NEUTRAL] And just an
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Oh, I'm so sorry. Go ahead, Ma. Uh-huh, of this year.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That, yes, ma'am.
[AGENT][NEUTRAL] OK. And do you have the billed amount for the claim?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let's see that was downloaded so what did I do with that?
[AGENT][NEUTRAL] OK, so actually you only so yours is a little easier, Miss [PII], because we don't have just um two claims on file for you and it appears that they're both for that same data service.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] On and you should be able to see these claim numbers in your portal so you are signed into the online service center, is that correct?
[CUSTOMER][NEUTRAL] I am, yes.
[AGENT][NEUTRAL] OK. So under claim number 360.
[AGENT][NEUTRAL] 4954 we'll discuss that one first because that was the first upload um that you sent and that shows for a billed amount of $1140.
[AGENT][NEUTRAL] You uploaded that one on [PII].
[CUSTOMER][NEUTRAL] Uh no, I believe it was just.
[CUSTOMER][NEUTRAL] OK, but I believe it was just the part that I paid which was like the $189 of that is what I was.
[AGENT][NEUTRAL] OK, so we look at the entire bills amount to start with, so that's the information that I can see, and it shows on this particular claim and, and you do have access to the explanation of benefits with the remark on it that I'm going to read to you, but this shows it was for SSM Health Breast Care.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Is that correct? OK. So yes, ma'am, this claim was initially denied and this claim, there are two reasons. Uh, the first reason states that receipt of your claim is acknowledged. However, in order to provide further consideration of this loss under this policy, we will need supporting documentation to evidence the accident or sickness.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Supporting documentation may include, but is not limited to itemized bills with the diagnosis code.
[AGENT][NEUTRAL] Super bills, office notes, hospital admission and discharge summaries, and or diagnostic testing results.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is one of the remarks. Um, the other remark on here states to please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I believe that's going to be the same remark as the information that you uploaded on the [PII]. Give me just a second to look at that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] So yes, ma'am. That is also the same remark um for claim number 3614788.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Now I thought that I had sent in the explanation of benefits on the downloads but I guess it was not enough.
[AGENT][NEUTRAL] So you can, so we need the.
[AGENT][NEUTRAL] We do need the primary insurance, uh-huh, we do need the primary insurance company's explanation of benefits, and then we also do need your diagnosis codes.
[CUSTOMER][NEUTRAL] Diagnosis code.
[AGENT][NEUTRAL] That can be in the form of any of those things that are, that I just read to you. And again, you should be able to see that on page 2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The [PII] of your explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for, I mean, just for future reference, um, now, did your doctor, would they not file your claim for you or you just chose to file it yourself?
[CUSTOMER][NEUTRAL] Well, supposedly, and I guess I'll have to talk to HR about this at work, but I thought that with APL they are supposed to pay for anything that the insurance doesn't pay that we pay out of pocket except for um.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, code.
[CUSTOMER][NEUTRAL] And so I had to pay $189 for the CAT scan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Out of pocket.
[AGENT][NEUTRAL] OK, so you we.
[CUSTOMER][NEUTRAL] So that's my other question is, am I filing it under the wrong plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, it's not that, but we do now and the reason I had to ask you about your provider not filing, it's.
[AGENT][NEUTRAL] If your provider will file the claims for your supplemental policy, Ms. [PII], it's easier, um, all for you, OK, to, to prevent you from having to do so much leg work to provide us all the documentation. So I always recommend that whenever you go for medical services to always present your APL card along with your primary insurance card to your provider.
[AGENT][NEUTRAL] But in the event that they do not file with APO then obviously you can um the claim form, the medin, which is the type of plan you have, the Medlink claim form actually has the instructions on the page one at the very top so I always recommend to use that as a checklist if you're filing your own claim because that tells you exactly what you would need to provide.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In addition to your claim form, and it does show that it would be an itemized bill, including the diagnosis code and along with the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, alright, so, um, mm.
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] I can give you the website just for future reference for where to obtain that claim form if you should have to file your claim again yourself.
[CUSTOMER][NEUTRAL] Is it all on the APL website?
[AGENT][NEUTRAL] Yes, you can actually go to our main web page, our public webpage at [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Dot
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And when that page pulls up, Miss [PII] at the top, you're gonna see a link that says claims and forms.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you would just click on that.
[AGENT][NEUTRAL] And scroll down the page about middle ways down on that page you should see a box that says filter by product and it has a green drop down arrow in it.
[AGENT][NEUTRAL] And if you click on that arrow, it gives you a list of different products and you're looking for the word medlink.
[AGENT][NEUTRAL] Mhm. You would click on, right. So you would click on Medlink.
[CUSTOMER][NEUTRAL] [PII], OK, yeah, I knew we had the Medlink too, so.
[AGENT][NEUTRAL] And then you should see on your screen out to the right a blue button that says download form.
[AGENT][NEUTRAL] And if you click there, it will open up the claim form and again all the instructions are at the top of that claim form on page one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, well, I will start with getting a hold of my doctor to make sure because like I said I, I thought I had the explanation of benefits but I don't know if I had the CPT codes on it, so.
[AGENT][NEUTRAL] Yes, ma'am. And we need the diagnosis codes, not the procedure code. It's the diagnosis. Uh-huh. Yes. Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Diagnosis case.
[CUSTOMER][NEUTRAL] OK, diagnosis codes. OK.
[CUSTOMER][NEUTRAL] Um, I have tried to give my APL card to my physician in the past, and they would not accept it. Now, my doctor has moved, and I have not given it to her since she's moved, so I need to.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do that.
[AGENT][NEUTRAL] So yes, I would always, because generally most, again not all but most providers will file your primary and then your APL because they do have to file your primary insurance first, since we have to have a copy of your primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] When we review a claim.
[AGENT][POSITIVE] Um, and it does. It just makes it a little easier, a little less leg work for you and trying to get all the required documentation, but in the event that they don't file it or, you know, obviously you can.
[AGENT][NEUTRAL] And the easiest way to make sure we have everything is to just use that instruction section on the claim form as a checklist.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, I will do that, um.
[AGENT][NEUTRAL] So, so when you do get your information that we're needing, you can just log into your portal you cannot add to the claim numbers that you see so you're going to just upload your information like you're submitting a new claim, but our system will know that this is a piece piece of missing information for this data service that we've already started a review on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, well, that's a lot for me to think about someone who doesn't know much about this, so I, that I appreciate your time and.
[AGENT][NEGATIVE] Uh no.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] I just wish that the um website would explain why they haven't updated anything send me a message or something I know that's not your fault, but that would be much easier.
[AGENT][NEUTRAL] Well, that's, you can, you can opt in for text notification alerts within the portal so that once the claim has been reviewed, but otherwise, you know, you can log in any time to check the status in your portal and once it has been reviewed, a claim number is assigned.
[CUSTOMER][NEUTRAL] Oh my
[CUSTOMER][NEUTRAL] Well, and I do, and I just
[CUSTOMER][NEUTRAL] And it just keeps telling me the same thing on lets let me go back to it um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, it doesn't matter. I'm not gonna, uh, OK, um, I will get that information and go from there. OK, would it be easier for me to take my APL card to my doctor and have them to refile it?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, probably not because I've already paid it though.
[AGENT][NEUTRAL] Correct. I mean, typically if typically the claim would be processed and any benefits paid to whomever files the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Unless, you know, there's a different assignment of, of benefits.
[AGENT][NEUTRAL] On there.
[AGENT][NEUTRAL] So at this point because you have submitted so much, Ms. [PII], I mean, if you can just get those two pieces of documentation for that data service and upload them yourself, that would probably be probably be better. But you can look at that claim form or your explanation of benefits when you speak to your provider and you can read them exactly that you're needing an itemized bill with the diagnosis code.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, I will do that.
[AGENT][NEUTRAL] And you can
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then you can just, I'm sure you have access online to your explanation of benefits from your primary insurance.
[CUSTOMER][POSITIVE] I'm writing all this down. Alrighty, I will get a hold of them. Thank you so very much.
[AGENT][NEUTRAL] Mhm, OK.
[AGENT][POSITIVE] All right. Well, you're very welcome. Is there anything else that I can help you with today or any other questions that I can help you with?
[CUSTOMER][POSITIVE] No, that is it. Thank you very much.
[AGENT][POSITIVE] OK, well, you're welcome, Ms. [PII], and thank you for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.