AccountId: 011433970860
ContactId: 422cd8f2-58dd-45c7-b351-0b41ae9f4c00
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2405659 ms
Total Talk Time (AGENT): 859835 ms
Total Talk Time (CUSTOMER): 951772 ms
Interruptions: 18
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/422cd8f2-58dd-45c7-b351-0b41ae9f4c00_20250410T13:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help?
[CUSTOMER][NEUTRAL] Yes, good morning, [PII]. I have, um, hello.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, can you hear me?
[AGENT][NEUTRAL] I, I can hear you now.
[CUSTOMER][NEUTRAL] Can you hear me now?
[AGENT][NEUTRAL] I can hear you at the moment. Yes, ma'am.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK, great. I had um put in two claims and unfortunately they've been denied so I just need some clarification because I, I uh spoke with my HR administrator and it seems that um these claims should not have been denied so I was hoping you can help me.
[AGENT][NEUTRAL] OK, so you're just needing to get some.
[AGENT][NEUTRAL] Additional information on two claims for yourself that that correct?
[CUSTOMER][NEGATIVE] Oh, you're breaking up.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so yes, ma'am, I can help you with that and who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you. And Miss [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, I'm so sorry. I missed part of your phone number. Say that again for me.
[CUSTOMER][NEUTRAL] I know you keep going in and out. Maybe you wanna call me back [PII].
[AGENT][NEGATIVE] Yes, and we have a bad connection.
[CUSTOMER][NEUTRAL] Yes, we do [PII].
[AGENT][NEUTRAL] OK, thank you, and your policy number?
[CUSTOMER][NEUTRAL] Policy number, let's see, I don't have my card in front of me. Let me go get that. Hang on one second.
[CUSTOMER][NEUTRAL] I just had these claims in front of me.
[AGENT][NEUTRAL] And Miss [PII], on your, if you have the explanation of this, your policy number is on there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] APL let's see here.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] 019.
[CUSTOMER][NEUTRAL] 756 87 M as in Larry.
[CUSTOMER][NEUTRAL] I mean, M as in Mary, I'm sorry, L as in Larry, number 8.
[CUSTOMER][NEUTRAL] Didn't have enough coffee yet this morning.
[AGENT][NEUTRAL] OK, thank you, Miss [PII]. So give me a.
[AGENT][NEUTRAL] I understand. I can relate to that. So give me just a moment please to get your information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so Miss [PII], I will need to verify several things with you first for security purposes and also any information that is provided would be a verification of excuse me, any information that I provide for you will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And your home mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] The phone number that we have on file for you is the same as the one with your best contact number, is that correct?
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that, please?
[AGENT][NEUTRAL] The phone number you gave me is also contact number that we should have on file for you. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you. And lastly your email address and this does appear to be your work email.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so we have something different as far as the beginning of your email.
[CUSTOMER][NEUTRAL] You might
[CUSTOMER][NEUTRAL] [PII] yeah maybe [PII].
[AGENT][NEUTRAL] Uh yes, ma'am. Is that still valid?
[CUSTOMER][NEGATIVE] Yeah, they changed it so either one works. I wish they would update that but that's.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, all right, thank you very much, Ms. [PII], for verifying your information. So what is the first data service that you're calling about?
[CUSTOMER][NEUTRAL] [PII], 0 no, that was when I sent it in. Hang on a second.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Date of service.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, one moment, please.
[AGENT][NEUTRAL] OK, and the amount on that claim?
[CUSTOMER][NEUTRAL] Um, the total amount was $200.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And the claim ends in, uh, the claim number is 3585954.
[CUSTOMER][NEUTRAL] No, oh wait, wait, wait, wait, wait, see, um.
[CUSTOMER][NEUTRAL] Say that again.
[AGENT][NEUTRAL] So the the claim number for that data service is 358-595-4.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so yes, ma'am, I have that pulled up and I do see that this was denied. It states durable medical equipment is not covered under this policy.
[CUSTOMER][NEUTRAL] OK, for one, number one, we don't have the right claim number, so I'm a little confused.
[AGENT][NEUTRAL] OK, so the
[CUSTOMER][NEUTRAL] That is not. I have 250785.
[AGENT][NEUTRAL] My number
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK, what is the claim number you have?
[AGENT][NEUTRAL] Yes ma'am, Miss [PII], what is the claim number that you have?
[CUSTOMER][NEUTRAL] 250.
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Yes, ma'am. I can hear you at the moment. Uh-huh.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] 25078527529
[AGENT][NEUTRAL] OK, now that is not an APL claim number, is that your primary?
[CUSTOMER][NEUTRAL] Oh, that's
[CUSTOMER][POSITIVE] Yeah, I'm sorry, I'm sorry, hang on a second, I apologize.
[AGENT][NEUTRAL] Free insurance
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I don't know if I have a claim number that I sent you. Hang on, let me go online. Would it be probably online? Let's see.
[AGENT][NEUTRAL] Yes, ma'am. Well, it's the one that I just gave to you, if you'd like to write that down.
[AGENT][NEUTRAL] And you would be able to see that online as well in your portal with APL.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] All right, go, go ahead. I, I broke my arm, so I'm having a hard time with this. So go ahead. What's the.
[AGENT][NEUTRAL] Oh, I'm, oh, I'm sorry to hear that. So the claim number is going to be 358.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 5954.
[CUSTOMER][NEUTRAL] Alright, I don't see that on any of this. I don't know. All I have is the confirmation number.
[CUSTOMER][NEUTRAL] Um what I submitted to APL, so let me go back and some my.
[CUSTOMER][NEUTRAL] Claims here.
[CUSTOMER][NEUTRAL] So this one was.
[CUSTOMER][NEUTRAL] OK, now I see it. OK. All right. So why is it denied?
[AGENT][NEUTRAL] Because durable medical equipment is not covered under this policy.
[CUSTOMER][NEUTRAL] Medical equipment is not covered. OK.
[AGENT][POSITIVE] Durable medical equipment.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. All right. I have another one that was denied. I just, I, I'm, I'm getting confused because like I said, my, I spoke with my administrator letting him know that all these, I have another claim that I'm looking at. Let me go get that number for you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And what is the data service for that claim?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I have 2 of them on here. Hang on a second.
[AGENT][NEGATIVE] Fucking.
[CUSTOMER][NEUTRAL] I had one at 11:15 23.
[CUSTOMER][NEUTRAL] And 11 1 23 there was.
[AGENT][NEUTRAL] OK, so for, for the first day.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] For [PII] 2023, what's the total bill amount on that claim?
[CUSTOMER][NEUTRAL] Um, it was a co-pay of $100.
[AGENT][NEUTRAL] OK, so we don't have a claim on file at APL for data service 11-15-2023.
[CUSTOMER][NEUTRAL] OK, let me just go ahead and.
[CUSTOMER][NEUTRAL] Look that up here.
[CUSTOMER][NEUTRAL] Let me get back here one moment.
[CUSTOMER][NEUTRAL] One moment. I'm a little slow. I'm doing everything with my left hand here.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so this one was.
[CUSTOMER][NEUTRAL] 952-74.
[CUSTOMER][NEUTRAL] And I have that, let's see now.
[CUSTOMER][NEUTRAL] They put it, I don't know why, but they put it together.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] 35801777
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] That claim has multiple dates of service, but [PII] is not one of those dates of service.
[AGENT][NEUTRAL] That's all
[CUSTOMER][NEUTRAL] Alright, I'm downloading it now.
[AGENT][NEUTRAL] 358.
[CUSTOMER][NEUTRAL] I don't know why they put, I put them. I put two of them.
[AGENT][NEUTRAL] 0
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] The claim number that you just gave me, my small one that has two different dates of service 10/[PII] and [PII].
[CUSTOMER][NEUTRAL] No, it was in [PII], it's 23.
[AGENT][NEUTRAL] I'm, I'm sorry, 23, but I'm sorry, the dates of service are [PII], [PII], and [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then
[AGENT][POSITIVE] How can I help you with that one?
[CUSTOMER][NEUTRAL] That one was paid. I paid $500.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] So that's not the one I'm calling about. I'm calling about the one that I submitted for.
[CUSTOMER][NEGATIVE] A total of $200. I don't know why they put both of they put two claims together on one. I don't know why they did it. I submitted two different claims and they put it on one. I don't know why they did that.
[CUSTOMER][NEUTRAL] So let me see and I don't see that on here.
[CUSTOMER][NEGATIVE] I don't know why they did that. I submitted them both the same day and they.
[AGENT][NEUTRAL] You uploaded to, OK, so if you're
[CUSTOMER][NEGATIVE] You keep cutting out. I'm so sorry. I don't, I can't hear you.
[AGENT][NEUTRAL] That's OK and I'm sorry about the line. Yes, so you're at you had asked about a data service of 11:15, which we don't have a claim for the claim number ending in 77.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Those were two separate uploads on the same day on [PII].
[AGENT][NEUTRAL] First of this year.
[AGENT][NEUTRAL] And so they were [PII] the the only.
[CUSTOMER][NEGATIVE] Oh, I, I, you keep cutting out. I can't get the whole information that that you're explaining to me. I'm sorry.
[CUSTOMER][NEUTRAL] Do you mind calling me back?
[AGENT][NEUTRAL] Yes, I don't think it's going to be any better. It's something internal in the system. I'm so sorry.
[CUSTOMER][NEUTRAL] All right, let me take you off the speaker. I just, I have a hard time. So I submitted a claim with a total of $200. It was $100 co-pay to Doctor [PII] and then $100 to MD Now Medical Center. Do you see that?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] The small owner
[CUSTOMER][NEGATIVE] I'm here. I'm here. You keep cutting out.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEGATIVE] OK, your voice, yes, ma'am. You cut out that time. Yes, ma'am, I'm here, but you cut out that time. Your voice completely went away. I wasn't able to hear anything. I thought the call had dropped.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, I submitted a claim for $200 100 dollars to Eason as Mali, and another one to MD Now Medical Center at $100 for a total of $200. That was a.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, for
[AGENT][NEUTRAL] OK, and so what is the date of service for each of those amounts?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. [PII] was the date was [PII]. The total amount was $785.44 and I paid out of pocket $100.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we do not have that claim on file at all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know why. I have a confirmation number that I got.
[AGENT][NEUTRAL] What's your? You can, you can give me that and I, mhm.
[CUSTOMER][NEUTRAL] You want that? Would that help you?
[CUSTOMER][NEUTRAL] O
[CUSTOMER][NEUTRAL] OK, O as in Oscar, S as in Sam, S as in Sam, C as in cat.
[CUSTOMER][NEUTRAL] 952-74
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] OK, so on that
[CUSTOMER][NEUTRAL] Um, included in the other claim of $500. I don't know why they put them together like that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's for data service 1025-2023.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Not 11:15.
[CUSTOMER][NEUTRAL] OK, right, I, I don't know why that, that was a Sunday. I apologize.
[CUSTOMER][NEUTRAL] I don't do well with insurance stuff, so I'm just, I don't know why they combined. I sent two claims the same day and they combined them. OK.
[AGENT][NEUTRAL] Oh, you're fine.
[CUSTOMER][NEUTRAL] The one they paid at $500 but the other one.
[AGENT][NEUTRAL] You did, but if you'll notice.
[AGENT][NEUTRAL] Right, they just put them because you uploaded them the same, the same day for the same dates of service. That's why they were issued that same claim number. But that claim number has 3 different dates of service on it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, for all of your uploads are under that one number and they're for dates of service [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1024 and [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And we did pay the $500.
[AGENT][NEUTRAL] And then the other um remark codes states the maximum benefit payable for this service date has been met.
[AGENT][NEUTRAL] Again, on page 2, which would make it easier for you instead of trying to write all this down, especially since you have an issue with your arm is so it's on page 2, all of the.
[AGENT][NEUTRAL] File remarks with the code that it.
[AGENT][NEUTRAL] Is the
[CUSTOMER][NEUTRAL] Uh, I, I have no idea.
[AGENT][NEUTRAL] So you have a per calendar day max.
[AGENT][NEUTRAL] OK. You have a per calendar day benefit maximum for outpatient covered services of $500.
[AGENT][NEUTRAL] So when we paid the 500 on that one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For 10/23 that maxed out your calendar day benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the 1024 data service.
[CUSTOMER][NEUTRAL] I got it.
[AGENT][NEUTRAL] Office, it states office visits are not covered under the policy.
[AGENT][NEUTRAL] And then for your 10:25.
[AGENT][NEUTRAL] For 3 different line items for that.
[AGENT][NEUTRAL] And one of the remarks states that we have received it, uh, an overview of it, that we have received it, but in order to provide further consideration we need.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Reporting documentation to evidence.
[AGENT][NEUTRAL] The sickness and it states the supporting documentation.
[CUSTOMER][NEUTRAL] I didn't hear any half of that.
[AGENT][NEUTRAL] OK. On page 2 of that X18.
[CUSTOMER][NEGATIVE] I don't, I didn't get any of that.
[AGENT][NEUTRAL] On page 2 of that claim.
[AGENT][NEUTRAL] It gives you the the
[CUSTOMER][NEUTRAL] Page 2, OK.
[AGENT][NEUTRAL] Uh-huh. It will give you the denial remark.
[AGENT][NEUTRAL] Uh, denial remarks.
[AGENT][NEUTRAL] That match
[CUSTOMER][NEUTRAL] I don't see any of that information that you're talking about, honestly.
[CUSTOMER][NEUTRAL] Coming from
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So when I click on what the confirmation number, where do I find all this information?
[AGENT][NEUTRAL] Are you looking?
[AGENT][NEUTRAL] No, under the claim number. Do you see the claim number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][NEUTRAL] Yes ma'am, click on that.
[CUSTOMER][NEUTRAL] OK, hang on a second, I clicked on something else, so let me go on the claim number.
[AGENT][NEUTRAL] And the claim, uh, the explanation of benefits.
[CUSTOMER][NEUTRAL] I see that and I have the $500.
[AGENT][NEUTRAL] It will be 2 pages in length.
[CUSTOMER][NEUTRAL] One moment, let me just get there please.
[CUSTOMER][NEUTRAL] I only have page 10 wait, here's page 2.
[AGENT][NEUTRAL] Hey, you're fine.
[CUSTOMER][NEUTRAL] There's page 2.
[CUSTOMER][NEGATIVE] Office visits, they're not covered by this policy.
[CUSTOMER][NEGATIVE] Um, now, that seems to be untrue.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because I have a PowerPoint presentation that my HR.
[AGENT][NEUTRAL] OK. No, ma'am, it is.
[CUSTOMER][NEUTRAL] And it says that.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Inpatient going to the hospital is $3500 per calendar year.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct for an inpatient admission, mhm.
[CUSTOMER][NEUTRAL] Emergency rooms are up to $500. Urgent care, $500.
[AGENT][NEUTRAL] But that's a total.
[CUSTOMER][NEUTRAL] Outpatient surgery $500.
[AGENT][NEUTRAL] That's a total benefit per calendar day for covered outpatient. You do have a rider for office treatment, but the office visit itself is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Well, this is for another claim um when I hurt myself, you know, as you can see, it was a couple of years ago just because I didn't even know how to, I never had a secondary insurance, so I was, I wasn't sure on how to submit the paperwork. So unfortunately, with this accident, um,
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] When I went to uh go have surgery, they took $500 out of pocket for me as well as $1100 pocket, one for the doctor and one for the surgery itself. So, will that be paid?
[AGENT][NEUTRAL] For an outpatient surgery, again, your total benefit max.
[AGENT][NEUTRAL] Maximum per calendar day is $500 for covered outpatient services.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, as you can
[CUSTOMER][NEUTRAL] So they won't pay both the $500 and $1100.
[AGENT][NEUTRAL] See for the year [PII].
[AGENT][NEUTRAL] No, no, ma'am. Your maximum benefit, yes ma'am, is 500 per calendar day.
[CUSTOMER][NEGATIVE] Oh, you're cutting off.
[AGENT][NEUTRAL] If you will notice on the team, but if you'll read through your remarks on those on those codes on that page too for your 1025 data service we just need some additional information it tells you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's see, let me go back there. I, I closed out on it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Office visits are not covered, insured, which one?
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] The the one starting with receipt of your claim is acknowledged. However, in order to provide further consideration of this loss on this spot, we will need supporting.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Of sickness supporting document food.
[CUSTOMER][NEUTRAL] OK, now which one is that for? I don't understand.
[AGENT][NEUTRAL] 10:25. Yes, ma'am, if you
[CUSTOMER][NEUTRAL] The number 4, is that what you need?
[AGENT][NEUTRAL] If you'll, yes ma'am, if you'll look on page one that D1 that code is listed out next to your 1025 data service. So once you get that additional information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The itemized bill with the diagnosis codes, any
[AGENT][NEUTRAL] of that information that's listed there. You can upload that into your portal for us to review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I don't see that on page one. I don't know what that's pertaining to or what it's actually asking me for additional information.
[AGENT][NEUTRAL] Let me look at your explanation of benefits as well. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't see it 404.
[CUSTOMER][NEUTRAL] Oh there it is like.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] 0404. I don't see it anymore.
[AGENT][NEUTRAL] It's out next to the data service 1025, 2023.
[CUSTOMER][NEUTRAL] Um, yeah, there was a couple different dates.
[CUSTOMER][NEUTRAL] But the remark on page 2.
[AGENT][NEUTRAL] Right, you have 3 dates.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But the remarks on page 2, you're that number 4 with the D1 EO. OK, I don't see what that pertains to on page 1.
[AGENT][NEUTRAL] It's still loading.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, so if you'll go back and look at page one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And where it has the data service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're going to be looking at the
[AGENT][POSITIVE] It's still loading. I'm sorry.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] I'm just trying to educate myself going forward because now I'm gonna have more claims with this broken arm that I got, so I just wanna make sure this is when I asked, I was replacing a battery on my car fob and
[CUSTOMER][NEGATIVE] The, the tool that I was using slipped and went right in the middle of like between my thumb and finger.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][POSITIVE] Was smart.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I went back because I never even tried to file a claim cause I had no idea. Like I said, I'm very new to secondary of APL, um, Medicare that's added to her. So I decided to give it a whirl.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so I'm just trying to educate myself because I wanna make sure I do the proper paperwork with my, with my current injury.
[CUSTOMER][NEGATIVE] And it seems everything that I've, I'm, I'm sending it's getting denied and I thought, and I spoke with a few people in the office yesterday and they said their co-pays get covered, so I don't know why mine aren't.
[AGENT][NEUTRAL] Yes, ma'am, but office visits.
[CUSTOMER][NEUTRAL] Maybe because I met my $500.
[AGENT][NEUTRAL] Yes, because office visits are not covered. So if you'll notice, OK, so on page one, do you see the column that says remark?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And it gives you those numbers, right?
[CUSTOMER][NEUTRAL] OK, right, right.
[AGENT][NEUTRAL] OK, so you're gonna refer to that remark number on page 2.
[CUSTOMER][NEUTRAL] So that's the one.
[CUSTOMER][NEUTRAL] Oh OK, OK, OK.
[AGENT][NEUTRAL] When you're looking at what we need.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Or what has been paid?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I have no idea what that is though.
[CUSTOMER][NEUTRAL] 125.
[AGENT][NEUTRAL] But
[CUSTOMER][NEGATIVE] This is very confusing. I don't know even how you deal with this every day.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I don't know. I have no idea.
[AGENT][NEUTRAL] So again, when you look on page one to the far left, it's gonna have your data service.
[AGENT][NEUTRAL] Then you've got your provider's name under the provider service column.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then you'll have your remark code number.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So when you come to page.
[CUSTOMER][NEUTRAL] But I don't see.
[AGENT][NEUTRAL] What I'm sorry, what don't you say?
[CUSTOMER][NEUTRAL] Go ahead, go ahead.
[CUSTOMER][NEUTRAL] Uh, I'm just trying to find it on my paperwork that I sent you on what you're actually looking for additional information.
[CUSTOMER][NEUTRAL] 20103 says procedure. I wonder if that will help me.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, I, I have no idea. I really don't. I don't know what what they're actually asking for additional information.
[CUSTOMER][NEGATIVE] I those those numbers don't coincide with anything that I sent you.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I don't know.
[CUSTOMER][NEUTRAL] Amount billed I guess my share.
[AGENT][NEUTRAL] So you're looking
[CUSTOMER][NEUTRAL] I don't know what additional information that I've given you all the the details, I mean the statement details and the EOB the explanation of benefits and that's what I was told that I needed to send to APL and.
[AGENT][NEUTRAL] For your 1.
[CUSTOMER][NEUTRAL] I don't know what
[AGENT][NEUTRAL] Right, for the 1025 data service that we didn't receive all of the information needed for that data service.
[AGENT][NEUTRAL] For Doctor [PII].
[CUSTOMER][NEUTRAL] Mhm. Yeah, I have a few of them.
[AGENT][NEUTRAL] I'm not sure if I'm saying that right, but that's the one where, right.
[CUSTOMER][NEUTRAL] I have the clothes on there.
[AGENT][NEUTRAL] Right, but we don't, we need the diagnosis code.
[CUSTOMER][NEUTRAL] They have all the codes.
[AGENT][NEUTRAL] Yes, ma'am, we need the diagnosis code, which that is not on that doc on those documents.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, I, I can't even, all right, all right, whatever. OK. I, I.
[AGENT][NEUTRAL] So you can
[CUSTOMER][NEUTRAL] Pardon me?
[AGENT][NEUTRAL] Contact your provider.
[AGENT][NEUTRAL] Your physician for that data service and you can let them know that for 1025-2023, your insurance company is needing the diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me see what I can do.
[AGENT][NEUTRAL] For that data service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. And then again, we just
[AGENT][NEUTRAL] For the 11:15 data service that you include that one we do not have a claim at all, OK, so that one would still need to be submitted.
[AGENT][NEUTRAL] To us
[CUSTOMER][NEUTRAL] I'm sorry, which one?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I don't [PII].
[AGENT][NEUTRAL] Mhm. Yes, ma'am, you gave me that date several times, but we don't have a claim on file for that date.
[CUSTOMER][POSITIVE] OK, I think I was giving you the wrong date on that, so, all right, well, thank you so much for your help. I hopefully next time I call though we get better connection because it was very difficult, so, um, but you need the.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Well, I'll be happy to answer any.
[CUSTOMER][NEUTRAL] I need the prognosis code you said?
[AGENT][POSITIVE] Diagnosis code, exactly how it's worded on remark. That'll be the best. That's the easiest way, Ms. [PII].
[AGENT][NEUTRAL] We're needing a diagnosis code for that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, diagnosis, not a problem. OK, diagnosis. D I A G N O S I S?
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Mhm. Yes, ma'am. Itemized bills with diagnosis. Uh-huh.
[CUSTOMER][NEUTRAL] OK, for 10:25.
[AGENT][NEUTRAL] That's the number 4 remark.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] On, on page two of your explanations.
[CUSTOMER][NEUTRAL] OK, alright, let me see what I can do.
[AGENT][NEUTRAL] And then when you get that information?
[CUSTOMER][NEUTRAL] All right, well, at least I think I could go in.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You can upload that into your portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, all right, excellent thank you so much. I appreciate your help.
[AGENT][POSITIVE] Well, you, oh, you're very welcome. So again, is there anything else I can help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Well, I guess I should ask you this. I just got, you know, like I said, I just had a new injury. So, um, I have
[CUSTOMER][NEUTRAL] It was completed.
[CUSTOMER][NEUTRAL] My explanation of benefits and the claim details.
[CUSTOMER][NEUTRAL] Of what they my first insurance paid but again I paid out of pocket $500.
[CUSTOMER][NEUTRAL] So I can, I, I can also submit.
[CUSTOMER][NEUTRAL] My receipt that I paid out of pocket with my credit card when I went to the emergency room.
[CUSTOMER][NEUTRAL] Would that be sufficient enough with the claims of benefits?
[AGENT][NEUTRAL] Well, for APL.
[AGENT][NEUTRAL] For APL there is the Medlik claim form.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] That has the, so you're gonna have to have your, the claim form, your primary insurance company's explanation of benefits, and then an itemized bill including your diagnosis and procedure codes from your provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, are your providers, will they not file both of your insurances?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I didn't have my secondary insurance card with me at the time. It was an emergency and I just.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] I didn't grab it.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, I get, I get wheezing colds and everything, so I don't know.
[AGENT][NEUTRAL] Uh, sure, I
[AGENT][POSITIVE] OK, so I, I always recommend.
[AGENT][POSITIVE] Yes, ma'am. I, I just, I always recommend to present your APL card along with your primary insurance card when you go for medical services because most providers will file both of your insurances. So that just would save you from having to write and without you having to do.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then I wouldn't have to do this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So much of that legwork and getting all different places to follow it.
[CUSTOMER][NEUTRAL] Yeah, I don't know.
[CUSTOMER][NEGATIVE] I know, I know, going forward, I, I know I I've made a big mistake, but by not having it with me because this is a lot of work on my end and I don't know.
[CUSTOMER][NEUTRAL] I don't know if they've been sent it to you. Um, is there a way of telling, because I did call them after the fact.
[CUSTOMER][NEUTRAL] And gave them my APL information.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But I'm not sure if they're, you know.
[CUSTOMER][NEUTRAL] They've
[CUSTOMER][NEUTRAL] They've done that.
[AGENT][NEUTRAL] Uh, what's the data service and I can tell you if we've received anything as of now.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um, let's see what's the data service.
[CUSTOMER][NEUTRAL] 3 1225.
[AGENT][NEUTRAL] 312 of 25. OK, let's see.
[AGENT][NEGATIVE] No, ma'am. As of now, we have not received anything.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I think I'll wait for another week or so and then if not I'll try to do this, this one because this one's $500 out of my pocket as well as like I said the $1100 but if I, if $500 is cap, I don't know if you're gonna pay the $1100. I don't know.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you may want to just follow up, you may just wanna follow up with your provider since you have given them your information to see, um, you know,
[CUSTOMER][NEGATIVE] I don't know, it's very confusing.
[AGENT][NEUTRAL] If they are going to file that for you.
[CUSTOMER][NEUTRAL] OK, you mean my, the, the doctor that I went to for my surgery?
[AGENT][NEUTRAL] Mhm, right, for the data service you said 312 that we haven't.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, well that I said we haven't received a claim on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] OK. All right. Well, thank you again for all your help. I appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, yes, ma'am. Well, you're certainly very welcome. So is there anything else, Miss [PII] I can help you with?
[CUSTOMER][POSITIVE] Nope, that'll do it. Thank you so much.
[AGENT][POSITIVE] Yes, ma'am. You're very welcome and thank you for calling APL. I hope you have a nice.
[CUSTOMER][NEUTRAL] OK. You too now. Bye-bye.
[AGENT][NEUTRAL] Say and if you have any other questions, please give us a call.