AccountId: 011433970860
ContactId: 2b250036-4f94-4d97-9f37-8381d3a7739e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514919 ms
Total Talk Time (AGENT): 202882 ms
Total Talk Time (CUSTOMER): 225230 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/2b250036-4f94-4d97-9f37-8381d3a7739e_20250425T20:49_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Hi, um, I got your phone number from my employer. It's, uh, regarding, uh, a bill that I got from my, um, medical from a, you know, from a lab lab test that I did. It was ordered by my primary health care provider and um unfortunately in the time that we, um, they ordered it and the time I got the lab test, we switched insurance companies and this new insurance company is not paying for the bill, so I don't know um.
[CUSTOMER][NEUTRAL] I was told that we have the gap coverage for certain things that don't get covered by the insurance company.
[AGENT][NEUTRAL] OK. Do you have your policy number so I can look that up?
[CUSTOMER][NEUTRAL] Is that for like uh from uh from my insurance company or from you guys?
[AGENT][NEUTRAL] Uh, from us.
[CUSTOMER][NEUTRAL] Uh, I don't. Let me, actually, let me call back because I have to get that from my employer. I'll call back.
[AGENT][NEUTRAL] Oh, I can look it up by your name or social.
[CUSTOMER][NEUTRAL] Um, yeah, just one second, hold on.
[CUSTOMER][NEUTRAL] I know I was gonna.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, can you hear me?
[CUSTOMER][NEUTRAL] Oh OK, so, um, I have my social security number it's [PII].
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And what was your name?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, let me pull up your account. Give me one moment.
[AGENT][NEUTRAL] OK, and so are you're wanting to check on like a certain date of service to see if the doctor submitted it or had we already processed?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, well, no, it hasn't been, uh, processed. I'm just trying to figure out how I can get, um, coverage for this bill because my insurance company AMed, which is the new one we have, they don't wanna cover it because they said that we had a, um, they only cover things that are done by their in-network lab and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My doctor ordered this before we started with them, which was like in December or so or November, so, um, between the time that my doctor ordered it and I got the test, that's when we switched insurance companies and I didn't know that this new company wasn't gonna cover the lab that she ordered for me.
[AGENT][NEUTRAL] OK, so, so has your, has your primary insurance processed the claim? Like, um.
[CUSTOMER][NEUTRAL] I don't know if that makes sense.
[CUSTOMER][NEGATIVE] Uh, yeah, my, my, I have AMed, and they, they denied it.
[AGENT][NEUTRAL] OK, they denied it. OK, so.
[CUSTOMER][NEUTRAL] Yeah, they denied the claim because it was out of there.
[AGENT][NEUTRAL] OK, um, so if it's, if it's denied, so was it actually denied or did it just all go towards the deductible?
[CUSTOMER][NEGATIVE] No, it was denied.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It would they said because it was out of network so if there's a code here they put in there it says denied um let me see where.
[CUSTOMER][NEUTRAL] Um, yeah, it says, um, deny authorization is not on file for this number and then I called them today and they said that I, they don't, um, they don't, they didn't they they they don't cover labs from any other laboratory except Quest.
[AGENT][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Which I didn't know until.
[AGENT][NEUTRAL] The way this policy works, um, and this is not a guarantee of payment, it's a basic outline. So the way this policy works as your secondary insurance is that the primary insurance has to have considered the claim. So if, if your primary insurance just
[AGENT][NEUTRAL] You know, flat out denies the claim, then there's nothing to be processed under this policy. They would have to process the claim and show that it went towards your deductible, you know, or your co-insurance or co-pay.
[CUSTOMER][NEUTRAL] I mean they, I don't know how they did it. They, I have a, they sent me a like a uh an explanation of benefits and then um it has the, the stuff that they covered and then the stuff that I have to pay.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So I don't know if that is what you mean.
[AGENT][NEUTRAL] OK, so, so they did cover something?
[CUSTOMER][NEUTRAL] They covered other stuff but not this, the 6 they're charging $681 to me.
[AGENT][NEUTRAL] OK. So what, what provider did you see? What was it a hospital or a doctor's office or?
[CUSTOMER][NEUTRAL] Uh, it was my primary doctor.
[AGENT][NEUTRAL] OK, so what I would do, and this would be probably the easiest thing, give your primary doctor a call, um, and tell them that you have this secondary policy and can they file it with us so we can potentially look at can we pay on it.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, so I, OK, but OK, so I shouldn't call the lab because they're the ones who put in the claim, not the lab.
[AGENT][NEUTRAL] OK, so, so the lab, you can call them, but again, I, I just wanna explain, if, if the lab was not covered by AvMed and they straight denied the lab, they, we won't cover it either. So, but I mean, you can certainly submit it, um, the other charges could possibly be considered.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] So yes, I mean, you can call the lab and ask them if they want, if they can submit the claim to us. But like I said, if the way this policy works, this, this will only pay or consider it if your AMed paid or processed the claim, like if it went towards your deductible.
[CUSTOMER][NEUTRAL] So should I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and how do I, OK, so what information should I give to them so so that they can contact you guys?
[AGENT][NEUTRAL] Does that make sense?
[AGENT][NEUTRAL] Um, the, the policy number, let me give you your policy number.
[CUSTOMER][NEUTRAL] Oh, OK, thank you, and it's it's Medlink, right? Medlink or?
[AGENT][NEUTRAL] Uh-huh, yeah, Medlik is the policy that you have and let me give you your number and then give them the number you called us at and we can verify what coverage coverage you have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so your policy number is 0228.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] 4033.
[CUSTOMER][NEUTRAL] 4033. OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02284033.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, is, is that all they need to make the claim, or?
[AGENT][NEUTRAL] Yes, just the policy number and then um we'll verify your coverage, etc. but like I said, I just wanted to stress, if, if Amed did not pay for your lab at all and, and denied it completely, there would be nothing to pay on it. But again, if, if you had other services rendered in the doctor's office, that could potentially be processed.
[CUSTOMER][NEUTRAL] Yeah, I mean, I did, but it's just, I don't know, they, they covered. I mean, I don't know who, I think my previous insurance company covered the appointment with my doctor because back then I was with them, but then when I actually went to get the lab test done, uh, we were probably with the new company then.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So yeah, I, it's kind of confusing but um so I, I'm not sure if I should ask the lab or the, the doctor's office to do this, you know.
[AGENT][POSITIVE] Yeah, sorry about that.
[AGENT][NEUTRAL] Well, if the if the charges are from the lab, you can certainly have them submit um but like I said, if, if Amed just denied it completely, I.
[CUSTOMER][NEUTRAL] Because the
[AGENT][NEUTRAL] We, we will deny it also.
[CUSTOMER][NEUTRAL] Mm, OK, let me see if they will do that then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you have a good weekend. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you you too.