AccountId: 011433970860
ContactId: 4d0c98c1-bb28-4266-9f30-43a1bcf119c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 506809 ms
Total Talk Time (AGENT): 249312 ms
Total Talk Time (CUSTOMER): 254971 ms
Interruptions: 5
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/4d0c98c1-bb28-4266-9f30-43a1bcf119c3_20250108T16:25_UTC.wav
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[AGENT][POSITIVE] Good morning and thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning, so you said?
[AGENT][NEUTRAL] Yes, mhm, right.
[CUSTOMER][NEUTRAL] Uh, this is [PII] calling um regarding just to follow up on a claim, um, what do I need to give you?
[AGENT][NEUTRAL] OK, um, you're calling from a provider's office, [PII]?
[CUSTOMER][NEUTRAL] Can I give you like
[CUSTOMER][NEUTRAL] No, no, no, I'm the I'm the patient.
[AGENT][NEUTRAL] Owner? OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK sure um let me have a callback number just in case we get disconnected and then you can give me the policy number if you have it.
[CUSTOMER][NEUTRAL] OK, um, 954.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 878-3.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] 022
[CUSTOMER][NEUTRAL] 86563.
[AGENT][NEUTRAL] Thank you. And OK, so I need to verify your date of birth, mailing address and email address.
[CUSTOMER][NEUTRAL] OK, 131771565 [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. And let's see.
[AGENT][NEUTRAL] And what is the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, it was [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] For [PII] Woman Care?
[CUSTOMER][NEUTRAL] Uh, yes, [PII] Women Care.
[AGENT][NEUTRAL] OK. Um, it looks like we send a benefit amount of $1,469.63 to the provider. Um, this was sent on the [PII].
[CUSTOMER][NEUTRAL] Um, OK, it, it was sent to the Florida Women Care LLC, not Humana, correct?
[AGENT][POSITIVE] Correct, it was sent to the provider.
[CUSTOMER][NEUTRAL] OK, so directly to them, um.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you guys send out a check or is it an electronic um just in case to verify that um are you able to let me know what address it was sent to because I did reach out to them to make sure to see if they've received it already and they said they haven't.
[AGENT][NEUTRAL] It's a check.
[AGENT][NEUTRAL] OK, I can check and see um.
[AGENT][NEUTRAL] Let me go ahead.
[CUSTOMER][NEUTRAL] Yeah, if it, you know, if you could see it because I did send them the, I, I was online and you know, opened the EOB and I did send them the copy so that they have one on file, but she said um she just responded to me and say can you call APL and make sure that they paid.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Florida woman and not Humana.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, it did send, uh, it was sent out to Florida Women Care LLC.
[AGENT][NEUTRAL] Um, the address where it was sent to was [PII]. It's still outstanding because due to the holidays it's probably gonna take a little bit to get there. Mhm.
[CUSTOMER][NEUTRAL] Yeah, what she said it's probably gonna take another week or two. You said the address was [PII]?
[AGENT][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 0 [PII].
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] And zip code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and it was sent to Florida Women Care LLC.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] Here
[CUSTOMER][NEUTRAL] OK, um, I think.
[CUSTOMER][NEUTRAL] Sorry, just give me one more moment.
[AGENT][NEUTRAL] Um, yes, OK.
[CUSTOMER][NEUTRAL] Oh, they have a different address. It's a [PII].
[AGENT][NEUTRAL] That may be the location but not the building.
[CUSTOMER][POSITIVE] Oh well, the location I did it on is in um OK so billing is the [PII]. OK, perfect. If anything, um, I guess I can just give you guys a call back hopefully all is good.
[AGENT][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, yes. Um, I will say give it about a one more week to see if they get it, OK? You're welcome.
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] OK perfect and yeah because it does show what the check number is when it was sent. I do see that um OK oh and uh before I let you go um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If I file a claim,
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Alright, can I file a claim through the website?
[AGENT][POSITIVE] Yes, you can. Mhm.
[CUSTOMER][NEUTRAL] Um, what will they need to file a claim because I didn't realize you guys covered, um, MRIs and I had to, I did have to pay for that MRI, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, sure. Mhm.
[CUSTOMER][NEUTRAL] And uh they did have the APL number but for some reason they they just don't go over the the secondary insurance. I'm not sure why.
[AGENT][NEUTRAL] Uh, sometimes they don't have the system to, uh, report it or collect on it, so it really depends on the place of service that you go to, but I can go ahead and give you instructions for you to send your claim. Um, so, uh, for any claims that you need to send for reimbursement, we're gonna need 3 documents. Um, the first document is the claim form, which you can find out through our website at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] And that's gonna be the, the med link claim form. OK. On the first page is gonna have instructions on, on those instructions. You're gonna see that we need an itemized bill with the diagnosis code.
[CUSTOMER][NEUTRAL] OK, yes, I have that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we also need the car.
[CUSTOMER][NEUTRAL] Um, that should be coming from the doctor, right? That, uh, that referred it? OK, OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, yes, the, yeah, the itemized bill comes from the place of service. So wherever they did the MRI, that's where you get the itemized bill. OK. And um then we need a copy of the explanation of benefits from the primary insurance indicating how much they apply towards the deductible co-payment and co-insurance for that date of service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK perfect um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Itemized bill the the claim receipt from the insurance.
[CUSTOMER][NEUTRAL] And the referral or the one that says the diagnosis and stuff, right?
[AGENT][NEUTRAL] Well, it's not gonna be the referral. It's gonna be the itemized bill. So, um, I'm not sure what, where did you go to have the MRI done, but you need to contact that place, the place that you went in to do the MRI. Have them to send you an itemized bill with diagnosis codes.
[CUSTOMER][NEUTRAL] Um, OK, well, she said she doesn't know what I'm talking about last time I called her, but she did send me something that looks like that has the service day procedure locations charge balance and stuff, physicians and modifiers, and I'm assuming that's it because there's no.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I'll just send everything I have.
[AGENT][NEUTRAL] But you can
[AGENT][NEUTRAL] Yeah, yeah, yeah, let us look into it and maybe it has the information. If it doesn't we'll let you know.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so and you guys will let me know should you know, um, should something be missing?
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][POSITIVE] Correct, yes. Yes, once we're ready to process. Mhm.
[CUSTOMER][NEUTRAL] OK, and do you guys normally email me or?
[AGENT][NEUTRAL] Um, no, we're gonna send an explanation of benefits either indicating we pay or either indicating that we need additional information and what information is missing.
[CUSTOMER][NEUTRAL] Oh, so it'll be mailed out.
[AGENT][NEUTRAL] Yes, or you can see it online. If you have registered, you can just, um, you're gonna be view when we process this. Yes, uh-huh, and you'll be able to pull it up.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK, yes.
[CUSTOMER][NEUTRAL] I'll follow the claim online.
[CUSTOMER][NEUTRAL] Now when I um go and file the claim online, do I have to be logged in or no?
[AGENT][NEUTRAL] Yes, yes, um, to, to file, yes, because, uh, you go to your account and it's gonna say upload documents and that's how you're gonna submit your claim by uploading the documents.
[CUSTOMER][NEUTRAL] Yes I do. OK.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] OK. OK, sounds good. So thank you so much for all your help.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, that's it. Have a lovely rest of your day.
[AGENT][POSITIVE] OK. You as well, Mr. [PII]. Thank you for calling ATL. Bye-bye.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][POSITIVE] You're welcome.