AccountId: 011433970860
ContactId: 33787c50-46c0-4741-87f0-ef0ca3bb55da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 3560649 ms
Total Talk Time (AGENT): 1444800 ms
Total Talk Time (CUSTOMER): 1371324 ms
Interruptions: 10
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/33787c50-46c0-4741-87f0-ef0ca3bb55da_20250212T19:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, who am I speaking with?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Hi, [PII]. My name is [PII], and I was calling to see if you could assist.
[CUSTOMER][NEUTRAL] OK, one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was calling to see if you could assist with um some inquiry or claims on my policy.
[AGENT][NEUTRAL] OK, and what's the policy number?
[CUSTOMER][NEUTRAL] Um, I have a group number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the group number is 23755 and then I have an outpatient benefit certificate number. The card doesn't really say.
[AGENT][NEUTRAL] Let me have that number.
[AGENT][NEUTRAL] Yeah, that's your policy number. Mhm.
[CUSTOMER][NEUTRAL] OK, 0
[CUSTOMER][NEUTRAL] OK, 02443500.
[CUSTOMER][NEUTRAL] M as in Mary. L as in Larry 8.
[AGENT][NEUTRAL] And that should say outpatient policy cert number that's your policy number and what's a good.
[CUSTOMER][NEUTRAL] Outpatient benefits for checking the number.
[AGENT][NEUTRAL] And what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Give me the last four digits.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] And what's your date of birth and mailing address?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your email address on file.
[CUSTOMER][NEUTRAL] Oh yes, that's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Showing it look like a work email maybe.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, and you're checking claim status, do you have the dates of service and the charges ready?
[CUSTOMER][NEUTRAL] Um, so it's
[CUSTOMER][NEUTRAL] Various states because my children's pediatrician's office never put in claims.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And so our account was delinquent and then they put all the claims in at once and so I was wondering what the status was, and I actually.
[CUSTOMER][NEUTRAL] I'm trying to think if I took any notes that would help you.
[CUSTOMER][POSITIVE] Make this process easier.
[AGENT][NEUTRAL] What are the children's name?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] OK, and so were claims submitted on both of them?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And were they just recently submitted in [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'll look at [PII]'s first. I'm showing so far 3 that have been processed this year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I mean, we went back to [PII].
[AGENT][NEUTRAL] Right, but the process date would be this year [PII].
[CUSTOMER][POSITIVE] Yeah, that is correct.
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] I'd like to understand what the process is if I was the one that made the payments.
[AGENT][NEUTRAL] Mhm, OK, let's go over the claims first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So for [PII], um, this is Nicholas Children's Hospital. Uh, this state of service is [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Not for OK, so right now I was calling for Pediatrics associates.
[AGENT][NEUTRAL] OK, and so do you know what their date of services?
[CUSTOMER][NEUTRAL] I have one date of, well, I have one date, which is where my credit card was charged on [PII]. I have [PII]. I have another date [PII].
[AGENT][NEUTRAL] So is that the date you made the payment or is that the date of service or both?
[CUSTOMER][NEUTRAL] That's the date of payment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know if I can tell if that's the date of service.
[CUSTOMER][NEUTRAL] [PII], it looks like it's the same date, date of service and date of payment.
[AGENT][NEUTRAL] OK, so I'm not showing in [PII] date of service for Victoria.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, you're [PII]?
[CUSTOMER][NEUTRAL] Yup.
[AGENT][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] Not because their office never submitted any of this.
[CUSTOMER][NEUTRAL] And so I was out of pocket knowing that I had a supplemental insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm gonna look at the, I'm gonna look at the policy number you had prior to this one because it was effective from [PII], so this claim would have fall.
[CUSTOMER][NEGATIVE] And nothing was ever done.
[AGENT][NEUTRAL] So within this policy um eligibility dates.
[CUSTOMER][NEUTRAL] Um, it's the same exact policy number.
[AGENT][NEUTRAL] It's a different one.
[CUSTOMER][NEUTRAL] No, it's the same one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or at least it should be.
[AGENT][NEGATIVE] The policy number that you gave me was not effective until year [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Then can you give me the policy number that was effective [PII].
[AGENT][NEUTRAL] No
[CUSTOMER][NEUTRAL] 20.
[AGENT][NEUTRAL] It was effective in [PII] and the policy number is 1822314.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I don't show any claims for year [PII] submitted for Victoria.
[AGENT][NEUTRAL] I look under [PII].
[CUSTOMER][NEUTRAL] There should be.
[CUSTOMER][NEUTRAL] And we went through the 67.
[AGENT][NEUTRAL] Yeah, I don't show any.
[AGENT][NEUTRAL] Yeah, I don't show any claims for year [PII] submitted or that we've received for year [PII] for [PII].
[CUSTOMER][NEUTRAL] 2 weeks
[CUSTOMER][NEUTRAL] Oh my [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you see any notes in my file? I mean, we were on the phone with pediatrics associates with American Public Life. I mean, we must have been on the phone for over 2 hours.
[AGENT][NEUTRAL] And what was discovered when you were on the phone for 2 hours?
[CUSTOMER][NEUTRAL] What was discovered was that
[CUSTOMER][NEUTRAL] Pediatrics associates did not realize that we had a supplemental insurance, although every time I go, I provide them.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Both my primary and secondary insurance, they brushed it off as if it was a gap insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so,
[CUSTOMER][NEUTRAL] In that communication two weeks ago.
[CUSTOMER][NEUTRAL] With American Public Life representative on the phone.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And pediatrics associates billing, we basically went back all the way to [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because I think it started [PII], [PII].
[AGENT][NEUTRAL] OK, and so you went all the way back to [PII].
[AGENT][NEUTRAL] And so if that, I mean, so was the doctor to have submitted the claims to us or?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So pediatrics associates billing department was submitting.
[AGENT][NEUTRAL] OK, so charges for year [PII], I do not see any for any of the dependent children.
[CUSTOMER][NEUTRAL] And we went through the whole I mean pediatrics associated printed everything out, printed a report, a statement from [PII], you know, through the date that I was there, which was, uh, a couple weeks ago, and we went through every single transaction that they were going to submit and that they were submitting.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so what I'm saying is we've not received the claims so I'm not I don't show them in the dependence file as received.
[AGENT][NEGATIVE] They did send some, but it's not for [PII].
[AGENT][NEUTRAL] There for [PII].
[CUSTOMER][NEUTRAL] Do you think
[CUSTOMER][NEUTRAL] OK, but that would just be for last year and that's based on the new policy.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And, and, and, um, I show them from [PII] Children's, I don't show them from the pediatric group.
[CUSTOMER][NEUTRAL] No, [PII] would be something different.
[AGENT][NEUTRAL] I know, yeah.
[CUSTOMER][NEUTRAL] Um, I haven't gotten to [PII] Children's Hospital yet. I'm working with pediatrics associates right now. Um, so I, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] So what do you see for [PII]?
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] So I'm gonna go back to [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, policy number is 01822314.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] ML 7 same group number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We provided all of this to pediatrics associates.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And for the year of [PII], those claims would have been or should have been or can be filed under that policy number and it's not a timely filing limit so they can still send them to us, but I mean at this time, yeah, they've not sent them in.
[CUSTOMER][NEUTRAL] Under
[CUSTOMER][NEUTRAL] Yes, I am, yeah.
[CUSTOMER][NEUTRAL] That's what I'm told.
[AGENT][NEUTRAL] And so
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] All right, so for.
[AGENT][NEUTRAL] [PII] year.
[AGENT][NEUTRAL] Show several claims for this year for [PII] for [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I have the [PII] statement.
[AGENT][NEUTRAL] So are you wanting each of the dates of service?
[CUSTOMER][NEUTRAL] Um, I think for [PII] I have.
[CUSTOMER][NEUTRAL] I only have one.
[AGENT][NEUTRAL] And what date is that do you that you have?
[CUSTOMER][NEUTRAL] I have the date that I paid which was [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] for $125.37.
[AGENT][NEUTRAL] So I see a [PII] day of service. This is an office visit.
[AGENT][NEUTRAL] So was it an office visit?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, this is the only May charge I'm showing for [PII]. Let me pull that up and see.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, this was processed on [PII]. It's a charge from Kids Medical Services.
[AGENT][NEUTRAL] And we paid a $75 benefit to Kids Medical services.
[CUSTOMER][NEUTRAL] No, but kids medical service is
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Kids Medical Service is not pediatrics associates.
[AGENT][NEUTRAL] You know I'm just telling you what we've received and paid for that data service.
[AGENT][NEUTRAL] So other than that date, I don't show any other dates of service for May.
[AGENT][NEUTRAL] And I do not show is it is Nicholas date of service May as well or is it a different date of service?
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] I know
[AGENT][NEUTRAL] Yeah, I don't show any May dates of service for Nicholas.
[CUSTOMER][NEUTRAL] Let's see what I have here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And you don't see any notes in in our files.
[AGENT][NEUTRAL] Regarding
[CUSTOMER][NEGATIVE] I find that so difficult to believe regarding my conversation two weeks ago.
[AGENT][NEUTRAL] Yeah, I see the phone note but that doesn't mean that they sent them, so we're at the mercy of them sending us your claim documentation.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Do you have a name for anybody there at Pediatric Associates?
[AGENT][NEUTRAL] I do not because we've not received a claim so I don't have any information for that entity for that office.
[CUSTOMER][NEUTRAL] That maybe
[CUSTOMER][NEUTRAL] Yeah, for [PII], I don't see that I paid anything out of pocket.
[AGENT][NEUTRAL] Yeah, I see your call. I think it was around the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so what are the steps that need to be taken so that.
[AGENT][NEUTRAL] You can send them in yourself.
[CUSTOMER][NEUTRAL] I can speak to him.
[AGENT][NEUTRAL] Are you going to submit them yourself?
[CUSTOMER][NEUTRAL] Well, I, at this point, honestly, I don't know because I, what happens is, is that
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I provide them like both of my cards and then later on I end up getting a bill and then
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I call them and I tell them about this supplementary card. Apparently nothing has been happening with the supplementary card so my account ends up going into delinquency.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] Sometimes I pay, and I've had to pay in the past because they won't see my child.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] But I've been at this for over 11.5, almost 2 years now, dealing with this supplemental insurance and the different practices because my daughter got so sick.
[CUSTOMER][NEGATIVE] So at this point, I don't know how to handle this. I don't know what the best way to handle this is because obviously I left it to pediatrics associates to submit everything and we went line item line item by line item from [PII] and you're saying that you're not seeing anything being submitted.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't show any any claims submitted for [PII] and [PII].
[CUSTOMER][NEUTRAL] Or right, so I, and I don't understand that because I've got several items that we circled for both [PII] and [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, and so it may have been discussed. Was that a was that a conference call with [PII] with him on the phone?
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] It was with pediatrics associates and and an American public life representative.
[AGENT][NEUTRAL] When
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and so the call did take place, um, they circled the dates of service in question, but as of this date, the dates that you're referencing, we've not received them.
[CUSTOMER][NEUTRAL] OK, so how do you suggest and recommend that I proceed?
[AGENT][NEUTRAL] Um, you said that you have been paying out of pocket or no? Or at times you've paid out of pocket?
[CUSTOMER][NEUTRAL] I have been
[CUSTOMER][NEGATIVE] I have been paying at times out of pocket, which is the ones that I circled and that we were both on the same page with.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] And those were the ones that were supposed to be submitted by pediatrics associates.
[AGENT][NEUTRAL] Right, so you can submit the claims yourself, but there are 3 documents that we require.
[AGENT][NEUTRAL] Um, so it's gonna be a little leg work on on your part if you choose to do that. Um, I can email you the APL, um, Metin claim form you'll have that.
[AGENT][NEUTRAL] Um, but then we'll need a copy of the itemized bill, so it sounds like they're looking at a ledger with numerous dates of service. We cannot accept that it has to be an itemized bill for each date of service in question.
[AGENT][NEUTRAL] Um, I can give you that form name and you can request that form from the provider's office that would be an itemized bill that way they won't give you almost like a ledger of a kajillion of dates of service that we cannot use.
[AGENT][NEUTRAL] The third document would be um because we are secondary to your major medical company.
[AGENT][NEUTRAL] Uh, we do require a copy of the explanation of benefits. Who is your primary insurance?
[CUSTOMER][NEUTRAL] United Healthcare.
[AGENT][NEUTRAL] Yeah, we require a copy of United Healthcare's explanation of benefits that coincides with each date of service that you're gonna be sending us.
[AGENT][NEUTRAL] So those are the 3 documents that we do require for each date of service.
[CUSTOMER][NEGATIVE] I don't understand that part. Um, am I supposed to call United Healthcare and ask them for a copy of explanation of benefits for a specific date?
[AGENT][NEUTRAL] You know, generally when your insurance company processes your claim, um, you either have an account set up online or they mail it to you, um, as to how the claim was processed. Have you ever received an explanation of benefits from United?
[CUSTOMER][NEUTRAL] Um, I mean, I'm sure at some point I did, but
[AGENT][NEUTRAL] Yeah, if, if you don't have them, you could either go to their website.
[AGENT][NEUTRAL] And download the explanation of benefits or you can contact their office and request that they provide it to you.
[CUSTOMER][NEUTRAL] But you're saying it's just like a, it's just their explanation of benefits.
[AGENT][NEUTRAL] You know, United United Healthcare's explanation of benefits.
[AGENT][NEUTRAL] It's just a document that tells you um how much your doctor charged if you received any adjustments or discounts that's noted um it'll tell you what your copay amount is or if there is a deductible amount, it'll have that on there. um, and if it there's a coinsurance amount, it'll have that on that ELB or that explanation of benefit, which is what we need because that determines what we pay you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If a[PII], any benefit is available.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so that's the 3rd document, and you're saying all this can be uploaded to APL's website?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, what is the website?
[AGENT][NEUTRAL] So it's secured [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm, so you wanna repeat the whole address?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Secured. [PII].
[AGENT][NEUTRAL] Correct, and I show that there's I show that there's already an account created.
[CUSTOMER][NEUTRAL] Now, do we need to have
[CUSTOMER][NEUTRAL] Um, let me check my notes. Um, yes, I believe there's a username and password.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Why doesn't it work?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Uh, you do not have to put the [PII] in front.
[CUSTOMER][NEUTRAL] Reload.
[CUSTOMER][NEGATIVE] No, not working now.
[CUSTOMER][NEUTRAL] OK let me see.
[CUSTOMER][NEUTRAL] Let me test another site.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I have internet, which is fine.
[CUSTOMER][NEUTRAL] So let's try again. secured. Apublic.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The home page, OK.
[CUSTOMER][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] And so since an account is already created, you can just click the log in tab.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] See if this works.
[CUSTOMER][NEUTRAL] Submit
[CUSTOMER][NEGATIVE] Your password is expired.
[AGENT][NEUTRAL] And so then what you can do um on the login page at the bottom it says if you you can if you forgot it you can reset the password so just click on that link.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, verification code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] New password set.
[AGENT][POSITIVE] OK, and I do show now that it is in an active status, so that's good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So now,
[CUSTOMER][NEUTRAL] Um, why didn't log me in?
[CUSTOMER][NEGATIVE] Because now I have to log in and get.
[AGENT][NEUTRAL] Yeah, so it's, it's, yeah, it's gonna take you back to log in again since you updated the password.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So these are processed.
[CUSTOMER][NEUTRAL] So this is what the hospital processed.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like, let me ask you this question.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How do I know which practice will submit and which practice will not submit?
[AGENT][NEUTRAL] So I heard you say earlier that you are presenting both cards, your primary insurance card and your APL card. Um, I would go, yeah, I would go an extra step, you know, we think that they may know this is prim. I would go an extra step and say, OK, um, will you be submitting my claims to United Healthcare and then after that, will you be submitting them to American Public Life?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] You know, just kind of ask them that way they're.
[CUSTOMER][NEUTRAL] And what if they say yes?
[AGENT][NEUTRAL] Right, and then so um it's just a matter of trusting their system and their processes. If they say yes, we will submit it.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You know, I would give them about a week or two because they have to, you know, um, create the itemized bill and all of that. They have to wait until your primary insurance processes the claim and then mail them back or it could be electronically send them your explanation of benefits at that time they will send it to American Public Life for review.
[AGENT][NEUTRAL] So, if, if I, if.
[CUSTOMER][NEUTRAL] Right, so I have to imagine.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have to imagine that the first step that they do is send it to my primary, and then after that, that's it. They wash their hands of anything after that, because why would anybody follow, why would they follow up?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Why would they continue to do their job? Like,
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, and so that's the standard process.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And did you ask them if they were submitting them to APL?
[CUSTOMER][NEUTRAL] No, they specifically told me no this last time because they thought it was a gap insurance.
[AGENT][NEUTRAL] Which you know technically it is kind of like a gap it's a supplement to united's policy.
[CUSTOMER][NEUTRAL] Correct, but in their eyes, a supplemental insurance is different than a gap insurance.
[AGENT][NEUTRAL] OK, I got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so the, OK, so once I'm in here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There there is a green tab where it says upload files.
[AGENT][POSITIVE] Correct, that's what you're going to select.
[AGENT][NEUTRAL] And then once you once or upload documents once you click on that green button.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It will um ask you to select your policy in which you want to submit the claim under and this is the crucial part because if you have claims for year [PII].
[AGENT][NEUTRAL] You know, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then all of those claims would need to be, you would need to select policy 1822314.
[CUSTOMER][NEUTRAL] But where, how do I know which
[AGENT][NEUTRAL] So on your end, it should show the two policies that you have. One is no longer active. OK. And does it, it should show you the effective dates.
[CUSTOMER][NEUTRAL] It's that
[CUSTOMER][NEUTRAL] Well, it just shows, I mean, it shows the policy number, it shows the effective date of [PII], but then the status it says lapsed.
[AGENT][NEUTRAL] Correct, because it is, but if you have claims that falls within that range [PII], you can still click that policy and it'll accept your claims with dates or service for that date range.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Even though it shows lapsed, we can still process claims under that policy number.
[CUSTOMER][NEUTRAL] OK, so I clicked on the policy number 1822314.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And all it is giving me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] is a
[CUSTOMER][NEUTRAL] A 49 page document.
[CUSTOMER][POSITIVE] Dear customer, thank you for giving American Public Life Insurance. They should help your service your insurance needs.
[AGENT][NEUTRAL] Is that your policy?
[CUSTOMER][NEUTRAL] OK, it's a letter. The first page of a letter.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, just take when I click on the policy number it it downloads a 49 page document.
[AGENT][NEUTRAL] OK, that may be the policy with your benefits and everything for that time frame. So.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So it shouldn't have the upload button is to upload your documents.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEGATIVE] But it doesn't. It only has one upload button and it's below the two policies. It starts with my coverage and then it jumps to my claims and there's only one button.
[AGENT][NEUTRAL] Do you see a dashboard that says filing a claim online?
[AGENT][NEUTRAL] I know where you are. You're, uh, you're in the the my coverage dashboard where you can download your policy and your ID card. go further down.
[AGENT][NEUTRAL] And look for the dashboard that says filing a claim online.
[CUSTOMER][NEUTRAL] OK, hold on, because.
[AGENT][NEUTRAL] It's gonna have a similar box with your policy numbers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I only have two options. Um, my
[CUSTOMER][NEUTRAL] So my policies, I mean my coverage and my claims. That's it. There's nothing else.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so where you say my claims, what does it say?
[CUSTOMER][NEUTRAL] Um, my claims upload documents. Do you have documents to upload for a claim and then it's the green box.
[AGENT][NEUTRAL] OK, click that box. Is that what you clicked before?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I did, but it like it doesn't specify, so it says file a claim number one enter claim details.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Number 2, upload documents. Number 3 complete. So claimant, it asks, you know, for us to choose who the claimant is, and then it says click here if claimant or coverage type not listed, which that's I, I don't need that because they're all listed there. So let's say I go to [PII]. OK, so I clicked on one of the claimants and he gives me the option to choose the policies.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And so depending on the date of service, mhm, then you would select select the policy that that's applicable to the date of service that you're trying to submit.
[CUSTOMER][NEUTRAL] So this is when.
[CUSTOMER][NEUTRAL] OK. So let's say I
[CUSTOMER][NEUTRAL] Received so you're saying I need to receive an itemized.
[CUSTOMER][NEUTRAL] Bill
[AGENT][NEUTRAL] Bill. Mhm. And you would get that from your doctor's office.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] For each service.
[AGENT][POSITIVE] For each day that they were seeing, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's number 1. What was number 2? Because I know #3 is explanation of benefits from United Healthcare, and I have to imagine once I get the explanation of benefits, I mean, it doesn't change. I'm gonna just upload it however many times I'm gonna put the claims in. It's gonna be the same thing, correct?
[AGENT][NEUTRAL] Uh, the
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, that's my number 3. What's my number 2?
[AGENT][NEUTRAL] The APL claim form which I can email that to you that way you don't have to download it from our website.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] OK, so you're gonna email me an APO claim form. Can I fill it out digitally or it has to be handwritten?
[AGENT][NEUTRAL] You'll have to print it.
[AGENT][NEUTRAL] And completed
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so if you let yeah well no let's say if you're submitting hypothetically 30 claims, so when I say 30 claims that means it's gonna be 3 documents for one data service claim form, APL claim form, the itemized bill, and the ELB.
[CUSTOMER][NEUTRAL] For every single one.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So let's say you upload 20 you can just fill out one claim form if you're sending them at the same time.
[CUSTOMER][NEUTRAL] But if
[CUSTOMER][NEUTRAL] OK, but wouldn't I have 2 if I'm doing 20 on the APL claim form, wouldn't I have 20 itemized bills?
[AGENT][NEUTRAL] Yeah, that's what I'm saying.
[AGENT][NEUTRAL] So you're gonna have 3 documents in each.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] 3 documents each.
[AGENT][NEUTRAL] So then if
[CUSTOMER][NEUTRAL] Every time I submit.
[AGENT][NEUTRAL] Yes, but what I'm.
[CUSTOMER][NEUTRAL] Or can I submit it all together?
[AGENT][NEUTRAL] Yeah, which is what I'm saying if you have several dates of service that you want to submit, of course we know there's gonna be 3 documents for each date.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If and when you submit them at the same time you only need to complete one APL claim form.
[CUSTOMER][NEUTRAL] I only need to complete one APL claim form and one explanation of benefits.
[CUSTOMER][NEUTRAL] If I do it all at the same time?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] So let's see, so we, we already know that in order to process a date of service 3 documents are required, right?
[CUSTOMER][NEUTRAL] Yeah, so it's either I do 30 times 3.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, because it's 30 itemized bills with 30 claim forms and 30.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Explanation of benefits.
[AGENT][NEUTRAL] And one APL claim form if you're sending all of that at once.
[CUSTOMER][NEUTRAL] Mm. But
[AGENT][NEUTRAL] You do not have to fill out an APL claim form for each of those.
[AGENT][NEUTRAL] If you're sending them at the same time, no, just complete one.
[CUSTOMER][NEUTRAL] I do not.
[AGENT][NEUTRAL] With your other 60 documents, just complete one APL claim form.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] But I still have to send the explanation of benefits 30 times if it's the same exact document.
[AGENT][NEUTRAL] It's not, it's gonna be for each date of service, so if they were seen on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You'll have an itemized bill for that date.
[AGENT][NEUTRAL] Then there's going to be an ELB that matches that date, right?
[CUSTOMER][NEUTRAL] Oh I.
[AGENT][NEUTRAL] And if they went to the doctor on [PII], you'll have the itemized bill for [PII].
[AGENT][NEUTRAL] And the EOB
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That matches [PII].
[CUSTOMER][NEUTRAL] Understood.
[AGENT][NEUTRAL] And then if you send, you know, those documents, all you'll need to complete if you send them together all you would need to complete is just one claim form, one APL claim form.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I understand. So the explanation of benefits are all going to be different.
[AGENT][NEUTRAL] Yes, because the date that they went to the doctor is a different date.
[CUSTOMER][NEUTRAL] Right. I thought it was just like a generic explanation of benefits. OK.
[AGENT][NEUTRAL] Oh, no, no, no, no, they process it based on the data service.
[CUSTOMER][NEUTRAL] Right, I, this is like a full-time job for somebody like.
[AGENT][NEUTRAL] That's what I was saying it's a lot of leg work, but if you know you've made an attempt uh to reach out to the provider, uh, with APL and they said that they were gonna send them now we did receive some but not from the provider that you that you that you had on the line the last time you called.
[CUSTOMER][NEUTRAL] Yeah, I just
[CUSTOMER][NEUTRAL] With pediatrics associates.
[AGENT][NEUTRAL] Yeah, pediatric associates.
[CUSTOMER][NEUTRAL] I mean, I'm sorry, with some kids.
[CUSTOMER][NEUTRAL] With the kids, medical services. That's a different.
[AGENT][NEUTRAL] Mhm, provider.
[CUSTOMER][NEUTRAL] That it's a different provider and I have.
[CUSTOMER][NEUTRAL] See, they were, they at one point told me I have to submit.
[CUSTOMER][NEUTRAL] And so I have
[AGENT][NEUTRAL] Yeah, I will see.
[AGENT][NEUTRAL] I will say that some providers, they may be upfront and say, well, we, we will submit it to your major medical carrier, but we will not send it to your secondary. At least they're letting you know upfront.
[AGENT][NEUTRAL] Which means then you would have to to seek reimbursement you would have to send uh APL the documentation yourself.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] But at least you know they're not, you know, willing to do it. Most I would say 99% of the providers do.
[CUSTOMER][NEUTRAL] Providers do.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] But even I mean even if they give me the receipt.
[CUSTOMER][NEUTRAL] For, for that.
[AGENT][POSITIVE] Yeah, we can
[CUSTOMER][NEUTRAL] Like, even if they give me the auto.
[AGENT][NEUTRAL] Yeah, we can't
[AGENT][NEUTRAL] Right, so if they give you like a ledger, we can't we can't use the ledger nor a receipt we need the itemized bill and let me give you the name of the form to request.
[CUSTOMER][NEUTRAL] I still have to go down 5.
[CUSTOMER][NEUTRAL] OK, what is that?
[AGENT][NEUTRAL] It's an acronym
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] C as in Charlie, M as in Mary, S as Sam.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then the number 1500, so that's the CMS 1500 form and this is an itemized bill when services are rendered in a physician's office.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And they have this form.
[AGENT][NEUTRAL] That's the form that they submit to your major medical and that's the form that they submit to APL as well, so that's their itemized bill.
[AGENT][NEUTRAL] And that should have all the information we need to include, you know, the diagnosis code and procedures and a lot of other information on there that we need.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So be sure and request that form.
[CUSTOMER][NEUTRAL] But it's
[CUSTOMER][NEGATIVE] I mean, do they not know this? Like why give me
[AGENT][NEUTRAL] I do.
[AGENT][NEUTRAL] I'm sure they do. I mean they're in billing if you spoke, you know, [PII] if it was billing that we spoke with when you called before, um, or they should be aware let me just say that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of the process
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, well, I mean, I guess at this point I have a lot of
[CUSTOMER][NEUTRAL] Homework to do.
[AGENT][POSITIVE] And you know, fortunately um American public life, there's no, no timely filing limit in which to submit a claim. Some insurance companies will give you a year or the provider a year to submit a claim for 90 days. So that's one plus in your favor.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, yes, I do agree with that. Uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How do I know? OK, how do I know if let's say Quest submitted a claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For me, for certain dates because I have delinquent accounts for blood work that was done. I obviously, I gave them both cards like I always do.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How do I know what I need to do for this particular provider?
[AGENT][NEUTRAL] You're meaning, meaning quest or?
[CUSTOMER][NEUTRAL] West.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Yes, like, can we now move on away from pediatrics associates, away from my kids? because I know what I need to do.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, and so anytime you you submit a claim to us, those three documents are required. So even if it's Quest Diagnostic.
[AGENT][NEUTRAL] We'll need a copy of their itemized bill.
[AGENT][NEUTRAL] Of course, the APL claim form and then unit it's explanation of benefits same same documents.
[CUSTOMER][NEUTRAL] Right, but how can we check to see if they submitted before.
[AGENT][NEUTRAL] OK, and did you say this is for you or is it for the dependent children?
[CUSTOMER][NEUTRAL] So now this one's for me.
[AGENT][NEUTRAL] OK, so let's look under your name [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh-huh, let's see.
[AGENT][NEUTRAL] And did you have any services between [PII] with Quest?
[AGENT][NEUTRAL] Or should I be looking at your current policy?
[CUSTOMER][NEUTRAL] Um, we would be looking at the current policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For me, we would be looking at the current policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK now I don't see any claims for you.
[CUSTOMER][NEUTRAL] Right, so that tells me that Questt basically did nothing with American public life. Is that correct?
[AGENT][NEUTRAL] Submitted on
[AGENT][POSITIVE] Correct, because we've not received any claims.
[CUSTOMER][NEUTRAL] Right, so what I'm, so, OK, which is why I end up getting these.
[CUSTOMER][NEUTRAL] Invoices and then I wait for them to do their end.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Apparently they never do their end and then my account goes into delinquency without them even gone through the process of submitting under American public life.
[AGENT][NEUTRAL] Got it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Correct, yeah, that's unfortunate.
[CUSTOMER][NEUTRAL] OK, so a provider like Quest.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If I call them and I speak to someone in their billing department which.
[CUSTOMER][NEUTRAL] If I'm lucky to speak to somebody in their billing department.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I requesting?
[CUSTOMER][NEUTRAL] And I, and what's the best way for them to submit before I start making payments on all these invoices?
[AGENT][NEUTRAL] And so you can request that they send American Public Life a copy of their itemized bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And generally the document that Quest sends does not have the diagnosis code on there which we need.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so what do I tell them?
[AGENT][NEUTRAL] And, and so with that being said, someone would have had to request the lab be done. So would that be like your primary care doctor or your specialist?
[CUSTOMER][NEUTRAL] It is like a specialist.
[AGENT][NEUTRAL] OK, and so you should have maybe office notes or office records for the date that you were seeing.
[AGENT][NEUTRAL] And within those notes should indicate or disclose what you were seeing for whether it's the description of your diagnosis or if they have the code in the records.
[AGENT][NEUTRAL] Something that
[CUSTOMER][NEUTRAL] They do have code in the description.
[AGENT][NEUTRAL] Well, are they procedure codes or diagnosis codes? Most times it's probably just the the procedure codes, basically saying what it is that they did and not the why they did it.
[CUSTOMER][NEUTRAL] Um, I
[CUSTOMER][NEUTRAL] No, it's more, I mean, it's all blood work, so it's just codes for the.
[AGENT][NEUTRAL] Yeah, so it's different labs, yeah, those are procedure codes or CPT codes. That's not the diagnosis code. The reason that they did the lab is not on there, but it should be in your office notes for that day which you would obtain from your your the specialist office.
[CUSTOMER][NEUTRAL] A diagnosis code.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Or you can ask them for the ICD 10 code. They're familiar, same thing.
[CUSTOMER][NEUTRAL] What is it called?
[AGENT][NEUTRAL] ICD.
[AGENT][NEUTRAL] 10
[CUSTOMER][NEUTRAL] ICD 10.
[AGENT][NEUTRAL] 10, number 10 code. That's the diagnosis code. That's just.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] An acronym for the diagnosis code.
[CUSTOMER][NEUTRAL] ICD 10 code.
[AGENT][NEUTRAL] Mhm. And parenthesis, you may wanna put diagnosis code just so you'll know.
[AGENT][NEUTRAL] Later on
[CUSTOMER][NEUTRAL] What does the I stand for?
[AGENT][NEUTRAL] You know, I don't know. Give me just a second.
[CUSTOMER][NEUTRAL] OK, so ICD 10 code and you're saying that.
[CUSTOMER][NEUTRAL] I don't so.
[CUSTOMER][NEUTRAL] Summary of consultation and recommendations.
[CUSTOMER][NEUTRAL] What is this?
[CUSTOMER][NEGATIVE] I don't understand here.
[AGENT][NEUTRAL] What are you looking at?
[CUSTOMER][NEUTRAL] Um, summary of consultation and recommendations.
[CUSTOMER][NEGATIVE] But that does not provide me an ID, an ICD 10.
[AGENT][NEUTRAL] Mhm. And that stands for International Classification of Diseases. The 10, it's just that it's the 10th revision. They usually update it.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so you're saying if I call Quest to submit to American Public.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It's gonna be a waste of time because they're they're not gonna submit the correct.
[CUSTOMER][NEUTRAL] Information
[AGENT][NEUTRAL] No, what I'm saying is that the document that they provide, it's, it's a detailed document. It has your procedure codes, the date of service, the charges, the procedure codes, but it doesn't have the, your diagnosis code on there, so the document is detailed and so I was saying in addition to that document.
[AGENT][NEUTRAL] We need to somehow obtain your ICD 10 or the diagnosis code um and usually, you know, when you go for lab, a doctor has requested that you do lab and you can go back to that doctor and get the office notes for that day and it should have your code in there, your diagnosis code in the, in the office notes.
[CUSTOMER][NEUTRAL] All right. And then, but I would be the one submitting it.
[AGENT][NEUTRAL] For the
[AGENT][NEUTRAL] Right, so that means not only will you reach out to Quest to get a copy of their bill.
[AGENT][NEUTRAL] You would then contact the yeah the the specialist office and request a copy of the notes for that day.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And let them know that you're trying to obtain the diagnosis code for date of service and whatever that date is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I understand. So I'm at, so question other than Quest providing me the procedures, codes form.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I am basically I will be the one uploading. But here's my, here's my question though. If this is out of pocket doctor who doesn't have primary in like doesn't receive primary insurance, it's just all out of pocket.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] There is no explanation of benefit.
[AGENT][NEUTRAL] Um, Quest is more than likely sending that to your primary insurance carrier.
[AGENT][NEUTRAL] For payment.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] I said Quest Diagnostics will send that bill, their bill to your United.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yes, Quest will, yes.
[AGENT][NEUTRAL] So then all you would need to do is go online, UnitedHealthcare's website.
[AGENT][NEUTRAL] And download the ELB that matches the date of service that you're looking for.
[CUSTOMER][NEUTRAL] Because there'll be an EOB related to the day I took the blood work.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] To unite it, yes, exactly. They'll, you know, uh, plus will submit a bill to them and then they would they'll process it and so then they'll, you'll have there should be an explanation of benefits on file.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] For that, uh, data service from request.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] That makes sense?
[CUSTOMER][NEUTRAL] Um, yeah, so that gives me the 2nd form, the 3rd form, and then,
[CUSTOMER][NEUTRAL] What's, well, the, the fir the first one is the procedure, but I would still need to fill out the APL claim form.
[AGENT][NEUTRAL] And let me send you this email with the claim.
[AGENT][NEUTRAL] The APL claim form and
[CUSTOMER][NEUTRAL] So I have 13.
[CUSTOMER][NEUTRAL] 13 and then I need 2 which is the APL form.
[AGENT][NEUTRAL] And you can complete one APL claim form, make copies of it, don't sign it because it'll need the current signature date on it.
[AGENT][NEUTRAL] And then when you, you know, that way you don't have to complete it's the same information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And maybe make copies of it, but then don't sign or date it until you're ready to send it.
[CUSTOMER][NEUTRAL] Understood.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me make sure that I have now are you wanting me to send it to the email address on file or do you wanna change your email address to your personal?
[CUSTOMER][NEUTRAL] You have the VB at [PII] correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, that's my husband's so yes if you could, or if you could add another email.
[AGENT][NEUTRAL] Well you know what, you know what? I can't change it because your husband is the primary holder and so we'll have to send it to that email unless he gives us permission to change it.
[CUSTOMER][NEUTRAL] Can I get him on a call right now? Not to change.
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] I mean, even though he'll probably want you to change it anyway to add me, um, OK, hold on one second.
[AGENT][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] Well, we can only, we can only have one email address, so you all need to de[PII] which one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, let me add him to this call and we can explain the situation. Hold on one second and.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] No, it went straight. I mean it went to his voicemail. Hold on, let me send him a message.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] Like never.
[CUSTOMER][NEUTRAL] Please let me know when you can pick up the call.
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] I was like what.
[AGENT][NEUTRAL] Would it be a problem sending it to his email?
[CUSTOMER][NEUTRAL] It wouldn't, it wouldn't. Um, but at the end of the day,
[CUSTOMER][POSITIVE] It probably makes the most sense to put mine since I handle all the insurance in the family.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] What is your email address?
[CUSTOMER][NEUTRAL] I'm surprised they don't allowed to put 2.
[CUSTOMER][NEUTRAL] [PII], the last name.
[CUSTOMER][NEUTRAL] The letter [PII], but yes, it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK, it's just a claim form, so I'm gonna go ahead and send it.
[CUSTOMER][POSITIVE] I appreciate that.
[CUSTOMER][NEGATIVE] Um, what kind of correspondence, being that his email is on the account, what kind of correspondence would he be receiving? Because I'll be honest with you, I haven't seen anything, which means he hasn't forwarded me anything.
[AGENT][NEUTRAL] As
[AGENT][NEUTRAL] As far as what?
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] I mean, is there anything that he would have received where he should be sharing like,
[AGENT][NEUTRAL] You know, you know, if we were to receive a.
[CUSTOMER][NEUTRAL] I don't know. I don't wanna miss anything.
[AGENT][NEUTRAL] Yeah, when we receive claims and process the claims, he receives an explanation of benefits.
[CUSTOMER][NEUTRAL] She received the explanation of benefits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I can see that I can see that on the account.
[AGENT][NEUTRAL] You can.
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] Claim number, is a claim number associated to an explanation of benefits?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] OK, so if I just randomly open, I don't know the last one, which was for we claim number 356-0945.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What will that show me?
[AGENT][NEUTRAL] Who, what name are you looking under?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, and, and um what's the claim number?
[AGENT][NEUTRAL] Did you say
[CUSTOMER][NEUTRAL] Explanation of that.
[AGENT][NEUTRAL] Yeah, 35, OK.
[CUSTOMER][NEUTRAL] I got it.
[AGENT][NEUTRAL] And I think that that one is from [PII]'s.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] This was [PII]'s, yes.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] OK. So basically, I can probably do the same thing for United Healthcare.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And.
[AGENT][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] You know what's another one, another bill that I have.
[CUSTOMER][NEUTRAL] OK, here's quest.
[CUSTOMER][NEUTRAL] Here is
[CUSTOMER][NEUTRAL] What is this one? [PII]. Oh, this was United.
[AGENT][NEUTRAL] So Ms. [PII], I am due in a meeting at [PII].
[AGENT][POSITIVE] But I will be more than happy to call you back at the number that you gave me if you have further claims that you wanna take a look at.
[CUSTOMER][NEUTRAL] I do. I mean, I could be here just to, just to give you a little background.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] My daughter was, my daughter was diagnosed with leukemia a couple of years ago, so all this whole insurance and bills, it's just very overwhelming.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] And I think today is the day that I've had the headspace.
[CUSTOMER][NEUTRAL] To kind of start looking into all of this.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] This is very overwhelming and it's frustrating because I know we pay in for a supplementary insurance and I just don't think it's right for us to continue to pay all these deductibles without even having tried to submit through our supplemental insurance.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] I understand that.
[AGENT][POSITIVE] And I will help you, um, I'll go step by step with you.
[CUSTOMER][NEUTRAL] Like I just can't let it go.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And you know, trying to obtain the information that's needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I mean, I, I'm, at least I have an idea.
[CUSTOMER][NEUTRAL] For some of these providers what I need to do. Um.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, I
[CUSTOMER][NEUTRAL] So you have to go into a meeting and I have to pick up my daughter.
[CUSTOMER][NEUTRAL] In an hour.
[AGENT][NEUTRAL] OK. What's your time zone?
[CUSTOMER][NEUTRAL] How much time? I'm in Eastern.
[AGENT][NEUTRAL] OK, I'm Central Standard, so it's it's [PII] now, almost [PII] here.
[CUSTOMER][NEUTRAL] OK, so one hour difference.
[AGENT][NEUTRAL] OK, so was it [PII] there?
[AGENT][NEUTRAL] Or 2 there? OK, we'll be free. OK, yeah, we're here until [PII] I get off at [PII], I'll call you right after the meeting ends, um, about what time do you think you'll be back home?
[CUSTOMER][NEUTRAL] It will be [PII], yes.
[AGENT][NEUTRAL] Or we can pick up tomorrow it's up to you.
[CUSTOMER][POSITIVE] Yeah, I think we'd have to pick up tomorrow. I promised her I would do something with her after school toda[PII], um.
[AGENT][POSITIVE] Totally understand. So we can pick up tomorrow. I'm here at [PII], so that'll be [PII] your time.
[CUSTOMER][NEUTRAL] And is, I mean, is there a direct line? Is there an extension?
[AGENT][NEUTRAL] You know our calls come through a queue. um I can reach out to you if you'd like or when you call you can specifically ask for me um my today's call will be documented and I'll put a note in there that if you call to transfer you to me.
[AGENT][NEUTRAL] Or I can call you either way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And your name is [PII], correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes. Um, what is better?
[CUSTOMER][NEUTRAL] OK, so I have, I have a I have.
[CUSTOMER][NEUTRAL] You're going into a meeting now correct?
[AGENT][NEUTRAL] I am.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] You can call me if that's more convenient, you know, with your schedule, you know what you have to do tomorrow.
[CUSTOMER][NEUTRAL] I'm available for
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's probably what I'll have to do, cause I do have a couple of other questions.
[AGENT][POSITIVE] OK, absolutely.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Uh, just from looking at the claims, it doesn't seem like a lot of these providers went the second went a step further.
[AGENT][NEUTRAL] Submitted them to APL mhm.
[CUSTOMER][POSITIVE] Correct
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Um, OK. All right, [PII], thank you very much. Thank you for your patience. I know I've had you on the phone for a long time.
[AGENT][NEUTRAL] You're abso.
[AGENT][POSITIVE] No, you're fine that's not a problem at all.
[CUSTOMER][NEUTRAL] All right. Um, we will, I guess, speak soon.
[AGENT][NEUTRAL] OK, I'll connect with you on tomorrow and then we can finish up.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK, thank you, bye bye.
[AGENT][POSITIVE] OK, you're welcome have a good day.
[CUSTOMER][NEUTRAL] You too, bye bye.