AccountId: 011433970860
ContactId: 6dd03001-fb1c-469c-91a5-9e3d5bcba3d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 280570 ms
Total Talk Time (AGENT): 105894 ms
Total Talk Time (CUSTOMER): 125728 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/6dd03001-fb1c-469c-91a5-9e3d5bcba3d8_20250211T20:17_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, good afternoon uh my name is [PII]. I'm trying to log on to your portal and I keep getting some kind of error message. Are you guys having issues with your portal?
[AGENT][NEUTRAL] Uh, it could be, um, and you're trying to do it as a provider, an insured group?
[CUSTOMER][NEUTRAL] No, uh, the insured, I'm, I'm trying to make, I'm trying to see if if claims have been filed on my behalf from my doctor and the labs because they keep sending me a bill and I keep telling them to bill you folks and I need to see if they did that.
[AGENT][NEUTRAL] OK, I can verify that for you. Um, give me a moment.
[AGENT][NEUTRAL] Uh, do you happen to have your policy number?
[CUSTOMER][NEUTRAL] Uh says 02559255.
[AGENT][NEUTRAL] 02559255.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Give me one moment, please.
[AGENT][NEUTRAL] OK, and Mr. [PII], verify your date of birth, mail address and email address for me, please.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] And where did you, what do you want my address?
[AGENT][NEUTRAL] Uh, mail address and email address, please.
[CUSTOMER][NEUTRAL] Uh my address is [PII].
[CUSTOMER][NEUTRAL] Um, my email is, I'm not sure if you use my work email, I assume maybe that's the one you use.
[CUSTOMER][NEUTRAL] Uh, [PII]. If not, I, I per OK, that's the one alright.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, and I don't show we received any claims. Were they supposed to mail or fax those to us?
[CUSTOMER][NEUTRAL] Well, when I talked to the lab lady, she, I was under the impression she did it online.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEGATIVE] But I don't know if she did or not, and then my PC, my doctor's office keeps sending me a bill for my copay, and I keep thinking that they were, I was my understanding was you guys cover that.
[CUSTOMER][NEGATIVE] And they keep sending me a bill and I keep telling them just to how are they supposed to be submitting claims to you folks?
[AGENT][NEUTRAL] Uh, they can submit by mail or fax.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but yeah, we hadn't received any claims for you, um.
[AGENT][NEUTRAL] And let me
[CUSTOMER][NEUTRAL] And my account was effective in on [PII] am I is that correct?
[AGENT][NEUTRAL] Yes, sir. [PII].
[AGENT][NEUTRAL] And let me see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, and office visits are covered under the policy. Um, I would say, um, you can let them know your secondary insurance has not received the claim and give them our fax number and ask them to submit that to us so we can go ahead and process those claims.
[CUSTOMER][NEUTRAL] Now would they need to fax that along with the EOB from my primary?
[AGENT][NEUTRAL] Yes, since we are secondary, yes, sir.
[CUSTOMER][NEUTRAL] OK, so they'll just fax you my EOB from the primary and then what their bill or their invoice?
[AGENT][NEUTRAL] The bill, yes, sir. There's um a specific bill they use when submitting claims for insurance companies is called a HICA 1500.
[CUSTOMER][NEUTRAL] Well, I mean Hick for, yeah, I mean, yeah, I wasn't sure if they have to submit the Hickford to you or not. I work in insurance billing actually under under medical for workers' comp, but I used to do commercial insurances too, so that's why I'm kind of confused why these folks can't seem to get it together.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And send you both the claim.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Exactly. Well, I understand, but yes, sir, um, and if they want to submit it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then the fax number on my card, the fax on my card says [PII]. Is that the fax number that they would submit their claims to?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Alright, alright, I will, I will physically go to my doctor's office and see if I can't make somebody understand how this works. OK, thank you very much. I just wanna check to make sure that no claims have gone through yet, meaning they haven't submitted them.
[AGENT][NEUTRAL] Yes, sir. And if they need to, they can give us a call and we can verify your benefits and eligibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK excellent thank you very much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL Mr. [PII]. Have a great day.
[CUSTOMER][NEUTRAL] Alright you too bye bye now.
[AGENT][NEUTRAL] Bye.