AccountId: 011433970860
ContactId: 4034dd42-d716-4171-a6af-eb8f73b88acd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 707340 ms
Total Talk Time (AGENT): 314842 ms
Total Talk Time (CUSTOMER): 216424 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/4034dd42-d716-4171-a6af-eb8f73b88acd_20250516T15:20_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey so, this is [PII] Resources. I have a broker on the phone. He's the agent of record for this employer wanting to check status of a claim, and he gave me the name and policy number.
[AGENT][NEUTRAL] OK, um, go ahead with the policy number.
[CUSTOMER][NEUTRAL] It's 26066997.
[CUSTOMER][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Should be a scout policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Are you gonna transfer him?
[CUSTOMER][NEUTRAL] Yes, if, if you don't mind, his callback number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what's the name of the burger?
[CUSTOMER][NEUTRAL] Let me pull him on.
[CUSTOMER][NEUTRAL] Um, yeah, you would ask me that. Hang on just a second. I wrote it and I can't read Cortland. It's Cortland Twyman. He's said a broke the agent of record for this Ally Pharmaceuticals, which is who the person's with.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, did you verify any information about [PII] with him or no?
[CUSTOMER][NEUTRAL] I did. He just gave me his policy number and his name and calling to check status, so no, I did not. I apologize. I need to be better at that and I will. OK, let me pull him on. OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No it's fine. I just, no, no, no, it's, it's fine. I'll just make sure so I know what to do. Thank you.
[CUSTOMER][NEUTRAL] My screens are different. We haven't the way I have to get to this stuff is different from what I used to have to do on claim side, so I, I'm trying to get used to that. So alright, hold on just a second and I'll call him on the line.
[AGENT][POSITIVE] Thank you, Miss [PII].
[CUSTOMER][POSITIVE] Hi, [PII]. Yes. Hi, I've got Soul on the phone and she has a a customer's information and she's gonna help you with that claim status, OK? Perfect, thank you. Have a great day bye bye. You too bye bye.
[AGENT][NEUTRAL] Good morning, Mr. [PII]. This is [PII] in the care team department and Ms. [PII] was telling me that you're trying to locate a claim for a member.
[CUSTOMER][NEUTRAL] W
[CUSTOMER][POSITIVE] Correct. Mhm. Yeah.
[AGENT][NEUTRAL] Uninsured?
[AGENT][NEUTRAL] OK. All right. Uh, she did give me a policy number and I have the policy for [PII] pulled up. I just need to verify the date of birth for security.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Mhm. Yes, that's perfect. Thank you. And what is the date of service?
[CUSTOMER][NEUTRAL] I mean, I can see the claim here. You want a confirmation number or something or?
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] OSC 98305.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, bear with me.
[AGENT][NEUTRAL] Let me pull the image on that one.
[AGENT][NEUTRAL] It's gonna be a minute. I'm waiting on the system to respond, OK?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The old policy.
[AGENT][NEUTRAL] So it looks like it has not been processed just yet, um.
[AGENT][NEUTRAL] OSC 98.
[CUSTOMER][NEUTRAL] It says processed the status.
[CUSTOMER][NEUTRAL] And they get the wrong number?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OSC 95,080
[CUSTOMER][NEUTRAL] Maybe I gave the wrong maybe I gave you the one I just, I just uploaded one. Did I give you the one I just uploaded?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, yeah, this is the one you just uploaded today. It's OK. Yeah, I'm like, mm, yeah, it's this one.
[CUSTOMER][POSITIVE] OK, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, my bad. Yeah, 995,095,080.
[AGENT][NEUTRAL] OK, all right. It's OK. Let me pull that one and see what it said.
[CUSTOMER][NEUTRAL] Sorry, that moment.
[AGENT][NEUTRAL] Yeah, it looks like on this one we were asking for additional information um let me see what we need and.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And I'm so sorry, our system is moving a little bit slow today. They're, they're working on it.
[CUSTOMER][NEUTRAL] Like how, how, like when you guys need additional information like how do I know that? Like it doesn't say when you log in like you need additional.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Information or anything like how like if I'm trying to help out my group who spends a lot of money on this gap plan and I'm just trying to assist them and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, I, I, I don't know that more information is needed. How do I find that out?
[AGENT][NEUTRAL] OK. So once it's processed, it will give you like a claim number, the claim number should be blue. Um you will double click that blue claim number and it will give you two pages. One is gonna be on the first page just saying what we did, and the second one is giving you a remarks description. On the remarks description it's gonna tell you if we need additional information and what information is needed.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So I'm clicking on the.
[CUSTOMER][NEUTRAL] I'm clicking on it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it all opens up a file viewer opens up and it's just one page it's just a memorial bill.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. Are you clicking under the file or are you clicking under the claim number?
[CUSTOMER][NEUTRAL] The claim number
[CUSTOMER][NEUTRAL] The claim number I, I, I, I can't cl[PII] the claim number.
[AGENT][NEUTRAL] It should be blue and you should be able to double click and get a PDF.
[CUSTOMER][NEUTRAL] No, my claim number is not blue. The only thing that's blue is is the is the file.
[AGENT][NEUTRAL] The file, hm, that's strange, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I'm using a Mac. I don't know if that has anything to do with it, but.
[AGENT][NEUTRAL] Mm, it should not, uh, but that's weird that it's not blue because that's how you get the EOB to pull up is if you click on that blue link or blue numbers. Um, but I can check on that for you. Um, but in this one that I just opened, which is the one that you submitted on [PII], um, it's just needing the explanation of benefits from the primary insurance of carrier.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And we need the diagnosis code for the uh service. So for any claims that are submitted to us, and this is any claim for everybody, uh, we need 3 documents. The first document is the claim form, the one you can find through our website at [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, we need the explanation of benefit, the copy of the explanation of benefits from the primary insurance showing the amount applied towards the deductible co-payment and co-insurance. So we know exactly what to pay. And then we need the copy of the itemized bill. The itemized bill needs to have the diagnosis codes and the procedure codes, and the diagnosis codes will, will let us know um what the reason they have to do the procedure.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Really
[AGENT][NEUTRAL] So and that's why it's so important to have that diagnosis code on the itemized bill.
[CUSTOMER][NEUTRAL] Now what I sent in is, is that considered the itemized bill?
[AGENT][NEUTRAL] Uh, let me check. It looks like he was missing the diagnosis code, but let me look at the paperwork really quick.
[AGENT][NEUTRAL] OK, we found 3 pages.
[AGENT][NEUTRAL] OK so one page.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is like the regular detachable one, the one you used to send in the payment in. um, this is not an itemized bill, no, this is just a regular bill.
[AGENT][NEUTRAL] Um, the itemized bill is a little bit more detailed. Um, usually what you need to do is just get in contact with Memorial Health System and let them know that um you need an itemized bill to submit your claim with the diagnosis codes.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Um, uh provider.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] Uh, itemized.
[CUSTOMER][NEUTRAL] What diagnosis going.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Difficult, um.
[CUSTOMER][NEUTRAL] OK, but I have sending you the I can send over the EOB now, right, at least, and you could just, right.
[AGENT][NEUTRAL] Yeah, mhm, yeah, you can send it separately. You can send that all together. It's best to send it all together because we have a full claim and we can just go ahead and and process and pay, but if you have um only one or two documents now and you want to just go ahead and send those and then just send the rest you can. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, OK, alright, alright, alright, thank you.
[CUSTOMER][NEUTRAL] Alright, I'll do
[CUSTOMER][NEUTRAL] I'll do that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Where.
[AGENT][NEUTRAL] Do you have any other questions, any other information that you need?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, I don't think um.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] And, and there's always the option that the provider of service can send in the claim for them and they they will be able to send all the information we need, which is the itemized bill and the copy of the EOB. So that's another option.
[CUSTOMER][NEUTRAL] Who's, who, who is that?
[AGENT][POSITIVE] If they have the providers sending the claim directly to us that that would be another option that they can use and it's a lot easier and faster.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, OK. Oh, OK, got you.
[CUSTOMER][NEUTRAL] Oh OK OK got you OK all right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright appreciate it.
[AGENT][NEUTRAL] You're welcome. Is there anything else? Any other questions?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, no, that should be it.
[AGENT][POSITIVE] OK. All right. Well, thank you for calling APR and have a good day. You're welcome. Goodbye, Mr. [PII].
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] Alright.