AccountId: 011433970860
ContactId: 30d4cfcc-dc0b-417e-9921-2902864b2514
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 911179 ms
Total Talk Time (AGENT): 353665 ms
Total Talk Time (CUSTOMER): 353599 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/30d4cfcc-dc0b-417e-9921-2902864b2514_20250506T15:48_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hi, good morning. I am calling because I got a letter in response to, um, some information I uploaded into the um portal.
[CUSTOMER][NEUTRAL] Um, and I have some questions. Do you want me to give you the policy number or the claim number?
[AGENT][NEUTRAL] Um, well, 1st may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, sure, uh, my name is [PII], and you can reach me at [PII].
[AGENT][NEUTRAL] Thank you for that. and Ms. [PII], may I have, um, well, I can do both the claims and the policy number.
[CUSTOMER][NEUTRAL] OK, so the policy number is 02069775.
[CUSTOMER][NEUTRAL] And uh the claim number on the letter is 359-63997.
[AGENT][NEUTRAL] Thank you. And I have your policy here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Sure, uh, date of birth is [PII]. Address is [PII], and the email is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And hold on one moment, I'm just waiting for the claim to come up here.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] OK. And what questions did you have in reference to the claim?
[CUSTOMER][NEUTRAL] So I had submitted a claim for a payment I did for an MRI and I also included the explanation of benefits and I got a response telling me that I had to get from the facility that did the MRI, um, like a breakdown with the uh codes, I guess the billing codes or the whatever codes they use.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So I called them and I was able to get that and I wrote on it. I put the my policy number and I put the claim number and like in response to the letter and I uploaded into the system right the online.
[CUSTOMER][NEUTRAL] portal you guys have and I see now that the answer to that upload it's telling me that this thing that the above reference appears to be a duplicate of a previously submitted expense.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I guess I'm just calling to kind of sort it out. I submitted documents in response to a request. I didn't, I didn't want it to look like I'm trying to file the same claim twice.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me do this. Um, so what's being asked is the itemized bill for the diagnosis and um,
[AGENT][NEUTRAL] Let me look at the documents. Hold on one moment.
[AGENT][NEUTRAL] So you're saying
[CUSTOMER][NEUTRAL] I can tell you the date of the first letter if you need.
[AGENT][NEUTRAL] No, I have them both here. So, so I just want to make sure um.
[AGENT][NEUTRAL] I understand what you're saying correctly. So you're saying for the 2nd 1 here that's been denied as a duplicate, this is where you submitted the itemized billing?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, so like on the first one I did the EOB and my receipt.
[CUSTOMER][NEUTRAL] And then on my second upload, I did the uh itemized that the diagnosis place gave me.
[AGENT][NEUTRAL] All right. And do you mind if I place you on just a brief hold while I look over everything?
[CUSTOMER][POSITIVE] No, of course. Sure, no problem.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] No, this isn't even a bill. This is a ledger.
[AGENT][NEUTRAL] OK. Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, thank you so much for holding. So I'm gonna try to call this number that's on the ledger here. So this isn't, this is not an itemized bill. This is just a, this is a ledger. Um, what we're asking for is an actual itemized bill from the facility um for like audits and things, so it has
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So it has
[CUSTOMER][NEUTRAL] Yes, go ahead.
[AGENT][NEUTRAL] So, where it shows procedure, um, this just tells us what was done and what was paid. We need to know why the diagnosis, but this is not a bill. So I'm gonna give them a call and explain what we're needing. Um, do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Uh, yeah, no, that's fine. I asked them for that, but they'd um, how can I say it, not sounding like mean or anything. Um, the person I spoke to.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Didn't sound too uh I guess familiar, but I said, yeah, I said itemized, and that's what they emailed me.
[AGENT][NEUTRAL] All right, hold on one moment, OK?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] You have reached Homestead Diagnostic Center. If you know your party's extension, you may dial it at any time. For appointments, dial 1. Medical records, dial 2. Billing, dial 3.4.
[CUSTOMER][NEUTRAL] Come to diagnostics.
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm calling from American Public Life. Um, we have a mutual patient. We're trying to, um,
[AGENT][NEUTRAL] Continue processing a claim for. But we're needing a copy of the um itemized billing like a UBO4 or a CM 1500. Um, but what's being presented is just a patient ledger. It's not real itemized billing. Um, so I'm just trying to see if we can get some assistance so that we can continue processing her claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Sure, can I have the patient's last name?
[AGENT][NEUTRAL] Mhm. It's [PII]
[CUSTOMER][NEUTRAL] First name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And for which is it for the MRI?
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] She's on the line as well.
[CUSTOMER][NEUTRAL] Oh, OK, OK, yeah, that was, yeah, that was the only thing I got done there, the MRI.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Hm, we didn't even send it to your secondary.
[CUSTOMER][NEUTRAL] That's fine. I can go ahead and fax over the claim form to your to the that's all you're missing is the claim form.
[AGENT][NEUTRAL] Not the claim form, the itemized billing.
[CUSTOMER][NEUTRAL] The itemized billing patient ledger.
[AGENT][NEUTRAL] Like it needs to have the diagnosis, mm mm. It needs to have the diagnosis codes, the procedure codes, all the charges. The patient ledger just shows
[CUSTOMER][NEUTRAL] So the CMS 15 form.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And this is for you said American Public Life, that's a secondary insurance, correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, do you have a fax number I can send it to?
[AGENT][NEUTRAL] Mhm. Our fax number is [PII].
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK and just uh.
[CUSTOMER][NEUTRAL] The claim for, do you have the patience um.
[CUSTOMER][NEUTRAL] ID number so I can put it in the claim form.
[AGENT][NEUTRAL] Um, for us or for y'all?
[CUSTOMER][NEUTRAL] For you guys.
[AGENT][NEUTRAL] Um, it's 206.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9775.
[CUSTOMER][NEUTRAL] 206-977-5
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK and you said American Public Life.
[CUSTOMER][NEUTRAL] OK, I'll go ahead and.
[AGENT][NEUTRAL] And it shows, um, that's gonna show the surgery charges and everything, right?
[CUSTOMER][NEUTRAL] Of what we charge for the exam, yes, it'll have everything it'll be a CMS 15 form.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Well, thank you very much.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You're welcome have a good day bye bye.
[AGENT][NEUTRAL] Alright, bye bye.
[AGENT][NEUTRAL] OK, hello, uh Ms. [PII].
[CUSTOMER][NEUTRAL] How long?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, so they're faxing um the form over to us so that we can continue processing.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so I guess I'll just wait another couple of days and I can check back online or?
[AGENT][NEUTRAL] Um, yes, you
[CUSTOMER][NEUTRAL] Will I be able to see what they send to you guys or is that something that happens between you and them?
[AGENT][NEUTRAL] Um, so once they send it and we receive it, it'll be, um, you'll see it as like a new, I guess like a new entry on the online service center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then once that has finished processing, you'll then see the decision as well.
[AGENT][NEUTRAL] But you'll see it on the online service center first because that's linked with our systems.
[CUSTOMER][NEUTRAL] OK, so I guess I'll just give it the days that it needs to get processed.
[AGENT][NEUTRAL] Yes, um, we usually just to be on the safe side, say the 7 to 10 business days from when we receive it. Um, so if you want to call to see if we've um received it, what's today, Wednesday?
[AGENT][NEUTRAL] Tuesday.
[CUSTOMER][NEUTRAL] Tuesday, I think. Tuesday, you doubt, you made me doubt. I didn't know.
[AGENT][NEUTRAL] Maybe about
[AGENT][NEUTRAL] Um, maybe like Wednesday or Thursday.
[CUSTOMER][NEUTRAL] No, I just ask in case I need to do anything else. Yeah, I just ask in case what, because I'm, I thought I was doing what I was supposed to do. So when I get those responses, I call you guys because I'm just like I'm confused. I thought I did what I had to do so, OK, so I'll just check it out in the next few days.
[AGENT][POSITIVE] And you know what, um, moving forward, if you wanted to, because she said they hadn't even filed the claim with us. Anytime you give your primary insurance, if you want to go ahead and give our card too, that way they'll bill your primary and then they'll automatically bill us next and you don't have to worry about filing unless you want to.
[CUSTOMER][NEUTRAL] So let me ask you a question, like right now I'm doing physical therapy. And when I had filed the first claim was for my urgent care, I spoke to a rep and they told me that my, I guess my plan that I have with you guys also covers for, I guess, physical therapy.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I thought I had to wait until I was done with the therapy to then go ahead and file everything to you guys. Uh, you're telling me now that I can have the
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] The, the, I can have the, the medical office, like the PT place send it to you guys directly?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, you don't have to wait for anything. So when they ask you for your insurance information, that's what they're, they're asking for it for. So when you give them the United Healthcare, any anything, doctors, hospitals, physical, anything, if you give your United Healthcare, um, just go ahead and give your APL card as well because we we pair with United Healthcare. So they're gonna bill UnitedHealthcare first and then United Healthcare is gonna answer and then they're gonna bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, us next. So what we're asking for that billing, that would have automatically come over to us if they found it.
[CUSTOMER][NEUTRAL] OK, and then I'll get, it'll get processed and I guess whatever benefits I qualify for you guys just send them out automatically?
[AGENT][NEUTRAL] Exactly. Mhm. So like if you have to pay a copay or um co-pay deductible, yeah, so we.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have been, I have been, I'm like on my 3rd week. I've been, yeah, I pay every time I go.
[AGENT][NEUTRAL] So I would definitely, um, so your primary and your secondary has its own benefits, but if you have your, um, hold on, let me check here, hold on one second.
[AGENT][NEUTRAL] So your policy pays up to $1500 per calendar year. So like for your co-pays or deductibles, if you have already paid them, um, you still can have the provider file it or you can file it if you like, but you can be reimbursed for that, or if the um provider is still owed something, they could possibly be paid as well up to that $1500 per calendar year.
[CUSTOMER][NEUTRAL] OK. Um, all right, I guess I'll mention it to them. I still gotta, I gotta go see them again and then I'll try to figure, um, figure this out, so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, alright, I guess I'll just keep working on it.
[AGENT][NEUTRAL] All right, well, was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Um, no, I think that's it for now. Thank you so much. You've been very helpful.
[AGENT][POSITIVE] You're very welcome. Well, thank you so much for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Same to you. Take care.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.