AccountId: 011433970860
ContactId: 3af85993-da7e-441d-ba15-99be43016b67
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375279 ms
Total Talk Time (AGENT): 196329 ms
Total Talk Time (CUSTOMER): 166658 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/3af85993-da7e-441d-ba15-99be43016b67_20250519T13:45_UTC.wav
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[AGENT][NEUTRAL] Good Morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi there, uh, I recently received some, uh, some service from a cardiologist, and, um, they ran, you know, through my primary insurance and then, you know, there's a portion that they didn't cover, but they said that that they don't work with you guys that I have to submit the claim myself. That's why that was weird but whatever, so I wanted to see how I can go about that.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Yeah, it is. OK, go and give me your name. Uh-huh, go and give me your name and your policy number.
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Uh, the policy under my, the policy is under my wife's name, so, so do you need her name too?
[AGENT][NEUTRAL] Uh, no, sir, just the policy number.
[CUSTOMER][NEUTRAL] Uh, and the policy, which one would that, would that be the payer ID or the group number?
[AGENT][NEUTRAL] Certificate number.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] You see that?
[CUSTOMER][NEUTRAL] Man, it doesn't say certificate number. It would that be the uh the outpatient benefit oh the outpatient, OK, so 012.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 99
[CUSTOMER][NEUTRAL] 855
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 8.
[AGENT][NEUTRAL] Alright, thank you for all of that information. Now, let's see, go ahead and uh are you uh covered under this plan?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's your date of birth and your address for me?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][POSITIVE] Alrighty, I'm on. Thank you for all of that information. Now, [PII], go ahead and give me a good return telephone call number just in case we get disconnected, please, sir.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all of that information. OK, so you, you said you went to the doctor and they don't want to submit any of your claims to APL is that correct?
[CUSTOMER][NEUTRAL] Yes, they told me I have to do it myself.
[AGENT][NEUTRAL] Oh my, OK, well, you can submit them yourself because and we can reimburse you any benefit back, um, and of course, um, yes sir, so but what we're gonna need is a copy of your doctor bill from the doctor that's telling you that they won't submit it. We need a copy of that bill along with your primary, along with your primary insurance company's EOB where they have processed it. We need both of those informations.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What do you need my, my primary insurance card and then the bill?
[AGENT][NEUTRAL] Not the card. Yeah, we, we need a copy of your bill and your primary insurance company's explanation of benefits. That piece of paper you get that tells you what they paid, what they had and how they process it. It's called an EOB.
[CUSTOMER][NEUTRAL] EOB
[AGENT][NEUTRAL] Yes, sir, explanation of benefits.
[CUSTOMER][NEUTRAL] And where do I get that from my, my primary insurance?
[AGENT][POSITIVE] Yes, sir. Correct, yes sir.
[CUSTOMER][NEUTRAL] Alright, I'll have to get that from them, I guess.
[AGENT][NEUTRAL] Yes sir, you can call and tell them that you want a copy of your explanation of benefits mailed to you, then you call the provider's office and tell them you need a copy of your bill so you can submit it if they're not willing to do that.
[CUSTOMER][NEUTRAL] I, I got the bill they they mailed it to me.
[AGENT][POSITIVE] OK, well, that's great. As long as it has your procedure codes, diagnosis codes on it from your doctor, that's gonna be what we need.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let's see, they don't have the number code on it. It says the name of them.
[AGENT][NEUTRAL] Tell me, tell me what you're reading. Let's see if that will work.
[CUSTOMER][NEUTRAL] Uh, well, one of the office outpatient.
[CUSTOMER][NEUTRAL] Visits and the other one is the echo echo P T H R C R dash 2.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, dash T.
[CUSTOMER][NEUTRAL] Then 2D, I don't know, W.
[CUSTOMER][NEUTRAL] One mode compliance spec I don't know, just just a long thing, but they didn't put a number code so I gotta get a number code from them.
[AGENT][NEUTRAL] Some letters, OK.
[AGENT][NEUTRAL] Yes, we need what we call an ICD 10 diagnosis code, OK? We have to have that and it has to be from your doctor's office. It cannot be something that you can write down.
[CUSTOMER][NEUTRAL] Alright, I'll have to call them too. God, what a process. OK, what else? and then what I thought.
[AGENT][NEUTRAL] I know, it's crazy that they won't send that in.
[CUSTOMER][NEGATIVE] Yeah, I don't know, there's just really, you know, I don't know, I'm probably not gonna go to the doctor anymore. The office is terrible, you know.
[AGENT][NEUTRAL] Yeah, and not cause I'm, yeah.
[CUSTOMER][NEUTRAL] So
[AGENT][POSITIVE] But yes, sir, but you can submit your own claims in or any benefit that might be due to you, we can reimburse you back. That would be no problem.
[CUSTOMER][NEUTRAL] OK, so I'll, so once I get these two things, the EOB and uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the procedure, the, you know, the procedure description with the the codes.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, what do I do with it? I call you guys back, I email them, what do I do?
[AGENT][NEUTRAL] And, and you
[AGENT][NEUTRAL] Uh, no, you, you can either submit them, you can upload them on our OSC website with a claim form, or you can put them in the mail either way.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and that information should be on your ID card, our address.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Is that a secure.Amub AMP OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm. That is it, and you can upload it.
[CUSTOMER][NEUTRAL] OK alright let me work on those things.
[AGENT][NEUTRAL] Yes, sir, and the claim form that you need to submit with that if you do the upload is Medlik, M E D L I N K Medlink.
[CUSTOMER][NEUTRAL] Yeah, yeah, that's what my plan says. OK, alright, OK, thank you. OK, bye bye.
[AGENT][NEUTRAL] OK. Yes, sir.
[AGENT][POSITIVE] Well, you're welcome. All right. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it for now thank you appreciate it.
[AGENT][POSITIVE] OK, no worry, I'm. Yes, sir. Have a great day and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] OK.