AccountId: 011433970860
ContactId: 2f15725e-49cd-481c-a04d-935687f1ea69
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482880 ms
Total Talk Time (AGENT): 264667 ms
Total Talk Time (CUSTOMER): 102828 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/2f15725e-49cd-481c-a04d-935687f1ea69_20250529T12:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm calling because um I'm receiving bills from Quest and I just like to know if um the secondary APL covers it.
[AGENT][NEUTRAL] OK, so you're wanting to see if you have benefits for laboratory, outside laboratory testing?
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Ah [PII]. I have the ID number if you like.
[AGENT][NEUTRAL] I'm sorry, can you spell your name for me, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And now your policy number, please.
[CUSTOMER][NEUTRAL] And for the outpatient it's gonna be 024.
[CUSTOMER][NEUTRAL] 89437 M as in Mary, L as in Larry 8 the number 8.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please to get your information pulled up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] It's a I mean for what I'm a.
[AGENT][NEUTRAL] OK, so first, you know, Ms. [PII], any information that I provide for you will be a verification of benefits and not a guarantee of payment. I will have to verify several things first. So what is your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[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 gave me, so again that is the best number that we should have. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you and lastly your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying your information. Now, Ms. [PII], have you ever created your profile in our portal called the online service center?
[AGENT][NEUTRAL] Where you can have access to your ID cards, policy information, claims information.
[CUSTOMER][NEUTRAL] I don't think
[AGENT][NEUTRAL] And should you have to submit your own claim.
[AGENT][NEUTRAL] Then you can also, I mean you can actually upload your information and submit that through the portal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, if you've not done that I'll email you the user guide that gives you some instructions on how to go about doing that.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] Um, and I'll, the email that I will send to you will come from [PII].
[AGENT][NEUTRAL] And I'll do that as soon as we get off the phone. So what is one of the, you do have benefits for lab.
[AGENT][NEUTRAL] On this policy and again any information that I provide would be a verification of your benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] But we can review independent lab facilities under your outpatient benefit, which is on this supplemental policy you have an outpatient benefit maximum of $500 per calendar day for covered outpatient services with no deductible.
[CUSTOMER][NEUTRAL] OK, so it just needs to be submitted to you guys.
[AGENT][NEUTRAL] For review, yes, ma'am. We, if you want like for me to check a particular data service to see if they.
[AGENT][NEUTRAL] Have submitted a claim if we've received a claim for you, I'll be happy to do that but if you know they haven't, then that's OK too.
[CUSTOMER][NEGATIVE] Yeah, they told me they only submitted to United Healthcare, not you guys.
[AGENT][NEUTRAL] OK. So what I'll do is I will
[AGENT][NEUTRAL] I'll go ahead and send you this email.
[AGENT][POSITIVE] With the user guide and I will also include one of the Medli claim forms because it does give you instructions on the claim forms so you know as to what else is needed.
[AGENT][NEUTRAL] When you file your claim?
[AGENT][NEUTRAL] So I will send that right now.
[AGENT][NEUTRAL] So again, the email will come from [PII] and I did put APL in your subject line so that that's easy to recognize.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and that has been sent.
[AGENT][NEUTRAL] So is there anything else that I could help you with this morning?
[CUSTOMER][NEUTRAL] Um, do I need to print anything out or?
[AGENT][NEUTRAL] You would. You'll have to complete your claim form and we'll have to have a copy of your explanation of benefits from your primary insurance carrier as well as an itemized bill that includes your diagnosis code.
[AGENT][NEUTRAL] And that would be obtained if you're gonna have to be filing it.
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] And the diagnosis.
[CUSTOMER][NEUTRAL] So I need to contact my primary.
[AGENT][POSITIVE] I'm so sorry, ask that again, please.
[CUSTOMER][NEUTRAL] So I will need to contact my primary, the United Healthcare Insurance to see.
[AGENT][NEUTRAL] OK, so you will have to, yes, you will have to send us a copy of their explanation of benefits for the data service you're filing your claim for and then you will also have to have a copy of your itemized bill.
[AGENT][NEUTRAL] From the lab facility and then you'll have to get your diagnosis code if they don't have that from your provider who ordered your lab work.
[AGENT][NEUTRAL] But again, the instructions are on the top of page one of the claim form that I attached to your email.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And then once you have all of that completed, yes ma'am, you can.
[CUSTOMER][POSITIVE] All right, thank you much.
[AGENT][NEUTRAL] Upload it directly into your portal for review or it can be mailed or faxed. The quickest way to get it in for submission is obviously through uploading it.
[AGENT][NEUTRAL] Into the online service center but we just cannot accept claims information via email.
[CUSTOMER][NEUTRAL] OK, so I'll need to create that account you said right?
[AGENT][NEUTRAL] Yes, ma'am, you will. Uh-huh, if you have not. Mhm.
[CUSTOMER][NEUTRAL] Because you
[CUSTOMER][POSITIVE] OK. Thank you much.
[AGENT][POSITIVE] OK, well, you're very welcome. So again, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's all. Thank you.
[AGENT][POSITIVE] OK, well then thank you very much for calling APL and I hope you have a very nice day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] OK bye.