AccountId: 011433970860
ContactId: 48b4343b-17cc-4041-aa27-7b1203dd2786
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 455179 ms
Total Talk Time (AGENT): 312971 ms
Total Talk Time (CUSTOMER): 126715 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/48b4343b-17cc-4041-aa27-7b1203dd2786_20250401T15:21_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Contacting APO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I was just on the phone with QDX Pathology. They have sent me a uh bill information and um I'm covered through UnitedHealthcare, and I have APL as a supplementary or a complimentary like um sorry, secondary insurance, and I wanted to ask if there was a way that I could claim, uh, or make a claim for a bill that they sent me.
[AGENT][NEUTRAL] Yes, of course, and I'm sorry, I didn't catch your name.
[CUSTOMER][NEUTRAL] My name is [PII]. My, my mother, [PII] is um insured through her employer.
[AGENT][NEUTRAL] Oh, I see. And what is the policy number, please?
[CUSTOMER][NEUTRAL] The policy number. So I have a, so I have a question about that. Like the card that I have to have payer ID and I have the group number. Which one do you need?
[AGENT][NEUTRAL] Does it say inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] OK. Uh, I have outpatient benefit and it says 02216497 M as in male and L as in Larry 8.
[AGENT][NEUTRAL] Thank you. And um I just need to confirm uh your date of birth and the phone number, please.
[CUSTOMER][NEUTRAL] Yes, my date of birth is [PII].
[CUSTOMER][NEUTRAL] And you said phone number?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Um, first of all, your, um, your mom's policy went into effect on [PII]. It is active. Now, you said that the procedure that you had, um, was an outpatient, was it in the physician's office, did you say, or was it an outpatient hospital setting, or?
[CUSTOMER][NEUTRAL] Yes. It was in, uh, it was in my, my gari's neurologist's office and they sent this uh test for
[AGENT][NEUTRAL] Outpatient also.
[CUSTOMER][NEUTRAL] Yeah, for procedures for stuff like that.
[AGENT][NEUTRAL] Of course. OK. So what you'll do is you will get um uh a uh
[AGENT][NEUTRAL] What is considered like a, a walkout sheet from them. Um, all that is is it, it tells us it's uh what they give you, the, the paper that they give you as you, as you're leaving and it has, uh, who you saw, what they did that day, um, what you were seeing for. It's usually called an assessment or uh uh the diagnosis, and it will tell us what the charges are. And then you turned in your uh major medical uh card as well, right?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You, you gave them your, OK. So once this goes through major medical, what you will do is um you can uh you can go online, there's several different ways that you can submit this, this claim to us. So you'll have the documentation from your doctor, you know, your walkout sheet that says, uh, what the charges were, the date that you saw, and, and the assessment or what the diagnosis code was. You'll have that explanation of benefits for today's service.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you can submit that to us online. Our website is [PII]. Now, when you get on here, I, I don't know whether you've already um built a record or not. uh uh your, your mom may be the one who has to do.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, no, I have not.
[AGENT][NEUTRAL] OK, so, um, it doesn't, I'm just seeing that it doesn't look like you've, you've, uh, you guys have turned in, um, too many, uh, um.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Self, um, self-insured, uh, submission, so that's fine. Um, what you'll do is when you go in, uh, when you go into our website, um, it says, uh, sign in. This is on the right hand side and it will, it will say ATL at the top of the, the screen, uh, workforce benefits that work for you. You'll sign in.
[AGENT][NEUTRAL] You'll need to sign in probably using your mother's um uh email because the system recognizes you by the email that you use and so this may end up being your mom's email um and then you will uh you can go in and you can create a uh uh an online presence, uh, like the, the username in the in the um uh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Passcode and then you can just, uh, there's gonna be a sign, there's gonna be a little green thing on the right hand side when you do get into the system and it says start here. And what you'll do is you'll just submit them that way. You can, what you'll be doing is submitting the uh explanation of benefits from your major medical and that walkout sheet from the doctor. And uh that is what you'll end up doing. Uh, you can either mail it to us as well. We also take faxes, um, but doing it online is, we, you know, we get it immediately.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, it usually takes us 8 to 10 business days to process those, but that's the way that you submit it. Either online, uh, you can mail it to us or fax it to us, but those are the documents that you'll need is the, is the is the itemized bill from the doctor, um, and then that explanation of benefits from your major medical telling us what your deductible, co-payment or co-insurance is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so just to, just to verify, I have the only document I have at hand of this procedure is the bill that the, the laboratory sent me. The doctor didn't necessarily give me uh a summary of my, of my results, only the phone call. So do you want me to ask for, for, for a diagnosis or something?
[AGENT][NEUTRAL] Yes, you'll ask for um an itemized bill that shows your uh what they, what um what they consider to be your diagnosis or your assessment. Uh, what, what was the, what did they decide that, you know, you're going in there for. So yes, you could certainly ask for that. Um, and a lot of doctors, a lot of places now, um, will have these things online, uh, where they'll even, as soon as you walk out of the office, they're, they're sending you a link to their online, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, office, uh, thing and so you can sometimes find these things online already, um, but if you can't, uh, then I would certainly call up the office and tell them that you need this because you're gonna be submitting this bill, um.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the explanation benefits will just come to you in the mail. You'll just get that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] Perfect. So I'm gonna have that, uh, I'm gonna get that done and I'm gonna start the whole thing. Do you need me to call anybody else like my uh major insurance because they did, they, they did not, um.
[CUSTOMER][NEUTRAL] They not filling the gap. So this is like a, a gap that I have to do.
[AGENT][NEUTRAL] Well, you, um, no, your, your major medical, uh, once you turn in your claim or once you hand them that card, your, um, your physician's office or the lab or wherever, uh, is probably already sending that uh claim into your major medical already. So the only thing, uh, we don't actually do anything. The only thing we do is process the paperwork that you give us. So, um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Yeah, yeah, so in, in, in the next couple of days, you should be getting that EOB from your major medical and uh that will tell you uh what your deductible co-payment or co-insurance is, but it'll just come in the mail as soon as, as soon as you hand it, uh, as soon as you hand them the cards, they, they just take care of that themselves.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your doctor does. Your doctor files a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is, is there anything else that I can help with? Anything else at all?
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Not for now, but I will be sure to give you guys a call if anything comes up.
[AGENT][NEUTRAL] OK, yes, well, when you're, um, when you're sending that in, um, just if you have any questions, please just let us know. If you have any questions about um uh the website or anything like that, just let us know and, and the paperwork if you want us to look at it first, and we'll be glad to.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. I appreciate that.
[AGENT][POSITIVE] Thanks for contacting if you have a good day.
[CUSTOMER][NEUTRAL] Mhm.