AccountId: 011433970860
ContactId: 34c59a43-81d8-4678-9888-f9120b2570bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 607090 ms
Total Talk Time (AGENT): 261663 ms
Total Talk Time (CUSTOMER): 284431 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/34c59a43-81d8-4678-9888-f9120b2570bd_20250117T19:46_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good afternoon. Um, my name is [PII], and I'm calling because I received a bill that was not covered by Blue Cross Blue Shield. It was for my daughter and, um, the company sent me a claim form to submit to APL.
[CUSTOMER][NEUTRAL] I wasn't quite sure how to get that completed.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, and Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] Sure, um, on the card, what does it say? It has payer ID and then it has, I guess outpatient benefit certificate. Do you want that?
[AGENT][NEUTRAL] Mhm. Yes. Uh-huh.
[CUSTOMER][NEUTRAL] It's 02473377 M as in Mary, L as in lemon, and the number 8.
[AGENT][NEUTRAL] Thank you. All right. And I just need to verify, uh, for security, your date of birth, mailing address and email address on file.
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII]. Uh, mailing address is [PII]. And my email address is [PII].
[AGENT][POSITIVE] Perfect. All right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said that um Blue Cross Blue Shield did not cover?
[CUSTOMER][NEUTRAL] Well, I think they covered a portion of it based on it says adjustment on the um on the initial bill, so I assume that they made the adjustment or based on insurance and then um when I called them because I still noticed that, you know, I still had a balance and they said, well, their primary insurance doesn't cover the full cost, so you have to go through your secondary or supplemental insurance.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so, all right. Um, so you're, uh, so you're trying to submit a claim yourself, correct?
[CUSTOMER][NEUTRAL] Yes, because they sent me a uh form a claim form with all of my information and Sierra's information on it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It says health insurance claim form.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and when you said they send you, uh, who sent you the form?
[CUSTOMER][NEUTRAL] The company that was uh that sent the original charges, the name of the company is Care Centric.
[AGENT][NEUTRAL] OK, is that your like your employer?
[CUSTOMER][NEUTRAL] Nope, it's not my employer. It's actually um the people that uh did the errors post-surgery, I guess, knee equipment or knee something.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It's in reference to her surgery that she had on [PII] of last year.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, you said [PII] of last year. Um, let me, let me check and see if we got anything, um, that we have received for that day.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, one moment, and this is for um.
[AGENT][NEUTRAL] [PII] or Sierra?
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's for Sierra, [PII]
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I don't see any claims for [PII]. Um, Ms. [PII], do you still have like owe a balance to the provider?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I guess that's what I'm doing.
[AGENT][NEUTRAL] OK, um, the reason I'm asking is because it's easier for them to send in the claim, um, so we can pay them directly, but if, if you need a reimbursement, we can go ahead and send you a reimbursement, but you have to submit all the paperwork, um, in order to submit a claim.
[CUSTOMER][NEUTRAL] So here's the thing, when I, when I did that, when I asked them, I said, can you submit the claim to APL for me? They said they don't submit to secondary um companies.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Gotcha. Got you.
[CUSTOMER][NEUTRAL] So I said, OK, so what do I do? And then the lady said, OK, I'll mail it to you and you have to get it to them.
[AGENT][NEUTRAL] Got you. OK, OK, so.
[CUSTOMER][POSITIVE] So she sent me a bill and this red uh claim form. So I'm happy to fax it or whatever it is that I need to do, I can scan it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Well, it's gonna take a little bit more documents than just that. So let me just go ahead and give you instructions on how to submit a claim to your secondary. Um, so you let me know when you're ready and I can go ahead and give you those instructions.
[CUSTOMER][NEUTRAL] OK, one second for me.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] OK. So in order to submit a claim, we need 3 documents. Um, the first document is gonna be the claim form.
[AGENT][NEUTRAL] The claim form you can find it on our website at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I'm on that AM public website now, um, but where do I, I see where it says claims form at the top and what do I.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, uh-huh, click on that.
[CUSTOMER][NEUTRAL] OK, clicked on it, it opens another page and then what do I click on after that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, scroll down to the bottom of that page and look for metin claim form.
[CUSTOMER][NEUTRAL] Mail paper form.
[AGENT][NEUTRAL] It's gonna be a medling claim form.
[CUSTOMER][NEGATIVE] Ned link claim form.
[AGENT][NEUTRAL] Mm let me see exactly where is it at. It's gonna be on the 2nd page and you see there's a um.
[CUSTOMER][NEUTRAL] OK, so I see the second page. OK, so I see med meddling claim form, so I have to download the form.
[AGENT][NEGATIVE] In the bottom, there's an error, second page. Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Does it allow you to fill it out online?
[AGENT][NEUTRAL] If you have the capability of like you have Adobe, you can go ahead and fill it out electronically if you would like, yes. Mhm.
[CUSTOMER][NEUTRAL] I've not
[CUSTOMER][NEUTRAL] Yeah, so my question for you is, where it says insured, that's gonna be my information and where it says about patient that'll be Sierra.
[AGENT][POSITIVE] Correct, yes. Perfect. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I need that form first and then what else?
[AGENT][NEUTRAL] OK, um, included with that form, which is in the first part of that form, you see the instructions. We need the itemized bill which is what they sent to you and then we need the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then explanation of benefits from
[AGENT][NEUTRAL] The primary insurance.
[AGENT][NEUTRAL] And that will be indicating the amount that it was applied towards the deductible co-payment or co-insurance.
[CUSTOMER][NEUTRAL] OK, so I think I have that as well because when I um I what I did is I went online to look at um I guess what.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, Blue Cross Blue Shield had um paid for already. Hold on a second, so I'm just, I'm sorry, I'm just looking through my downloaded forms because I see here it says view EOB and it says individual claim report and it has amount you owe provider and it has this specific amount that was charged for this so it's like 5 or 6 pages do you need you need these pages along with it the 8 pages.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Because on here it has in net benefits at a glance deductible out of pocket member it has all of that on there.
[AGENT][POSITIVE] Um, correct.
[AGENT][NEUTRAL] Oh, no, it's gonna be the specific one. so you're gonna open the one that is for that date of service for that provider or that facility. OK, and it's gonna have the amounts applied towards the deductible co-payment and co-insurance. Um, we just need a copy of that page. Um, you don't have to send all of them. There's some that just have general information. Um, we just need the copy of the one that has the amounts applied towards the deductible co-payment and co-insurance, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you. I have that now, so.
[AGENT][POSITIVE] You're welcome. OK, perfect.
[CUSTOMER][NEUTRAL] So the claim form I'm gonna fill out the itemized bill is what I got from Care Centric with that claim form, and then the EOB is from Blue Blue Cross Blue Shield.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm. Correct. Yes. So once you have all three, you can just go ahead and either send it by mail, you can send it by fax, or if you register online through our website, you can upload it to your account. And the fastest way would be if you upload it because it comes here automatically and it's put in line to be processed, so that's the fastest.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] All right, so that's what I will do. Thank you so much. I'll go ahead and fill these out now.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Nope, that's it. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good afternoon.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Yes. Thank you. Bye bye.