AccountId: 011433970860
ContactId: 722a6dc7-af60-44a0-b1f6-f69350f8cf02
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 525460 ms
Total Talk Time (AGENT): 231839 ms
Total Talk Time (CUSTOMER): 233343 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/722a6dc7-af60-44a0-b1f6-f69350f8cf02_20250218T15:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII]. Um, I am calling just because I had a son, um, in November and
[CUSTOMER][NEUTRAL] He, we're pretty sure we had him added we knew that we were gonna have him added to the APL and uh have received things that I don't think that any of it has been covered and I just wanted to check in on that.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you, Ms. [PII]. What is your policy number with APL please, ma'am?
[CUSTOMER][NEUTRAL] Uh-huh 02292679.
[AGENT][NEUTRAL] Thank you. Do you mind um verifying your date of birth and current mailing address, Ms. [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, um, [PII] and my address is [PII].
[AGENT][POSITIVE] Alright thank you and what
[AGENT][POSITIVE] OK, and a good callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Mhm um [PII].
[AGENT][POSITIVE] Thank you. And that's for [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, well y'all had him just in time for [PII], didn't you?
[CUSTOMER][NEUTRAL] We did, yeah.
[AGENT][NEUTRAL] And [PII], what.
[CUSTOMER][NEUTRAL] Yes, he was a little turkey baby.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, my son was a, um, April [PII]'s baby, so.
[CUSTOMER][NEUTRAL] Oh really?
[AGENT][POSITIVE] A turkey baby, baby is better than April [PII]'s baby.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, that's funny. Um, let's see, so I do see that we've received some claims for Owen.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And what happened is they are still pending because they did not send the primary EOB along with the claim. The one claim is from NMed pediatric Hospitalist.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's for 116 also for data service 117.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] 14118 24 and we sent them a letter and did y'all receive those EOBs as well because we also mailed one to y'all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We did, mhm, yeah.
[AGENT][NEUTRAL] that is pending for the primary EOB they've not sent that back in yet.
[CUSTOMER][NEUTRAL] OK, so do I just need to contact my primary or just or just wait and see if it'll get, I have received some EOBs from our other insurance um.
[AGENT][NEUTRAL] Have you been receiving
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] There's just a bunch of different, you know, it's a bunch of different charges for different.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Have you received any bills from Ned?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have, yes.
[AGENT][NEUTRAL] Pediatric hospitalist, that's gonna be for the doctors or whatever, the hospitalist.
[CUSTOMER][NEUTRAL] Um, I think I've received one for like his circumcision.
[CUSTOMER][NEUTRAL] And maybe something else. I can't remember I don't remember if it was from the hospital list or what.
[AGENT][NEUTRAL] So you know what you might do is uh and uh let's see if I can, I can see if there's a phone number on this claim you might just wanna call them and make sure that they understand we're secondary.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you can just tell them you called and checked on the claims and it's still pending for that primary EOP and maybe they'll get it over to us.
[CUSTOMER][NEUTRAL] OK, I will.
[CUSTOMER][POSITIVE] OK, that sounds good. I do have a question about uh.
[CUSTOMER][NEUTRAL] A bill from me in January of last year I think it was January, yes, um, it didn't seem like EBM or APL covered anything and I was like some blood work or something. I didn't know if.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, we can check that as well.
[CUSTOMER][NEUTRAL] You could check in that since I have you on the line.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Absolutely. Um.
[AGENT][NEUTRAL] I'm looking at this claim and there is no phone number for NMed Pediatric Hospitalist.
[CUSTOMER][NEUTRAL] OK, I, I have a, I have a, um, a billing office. I can, I have a contact information I can reach out to them with.
[AGENT][POSITIVE] OK, good.
[AGENT][NEUTRAL] All right. And what, do you know what the data services for that blood work?
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEGATIVE] I don't know. I just like received the bill for it, like, you know, last month, sometimes I, it takes forever to get.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And then all of a sudden you get 1000, right?
[CUSTOMER][NEUTRAL] Yeah, like I was like, why?
[CUSTOMER][POSITIVE] Yeah I mean it wasn't that much but it just I was just like you know whatever can be covered would be great let's see.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][POSITIVE] No, that's right.
[CUSTOMER][NEUTRAL] I believe it was like [PII] but I
[CUSTOMER][NEUTRAL] Uh, I could just be making that up.
[AGENT][NEUTRAL] Oh, and you said it's for blood work?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see if I can.
[AGENT][NEUTRAL] And that was
[CUSTOMER][NEUTRAL] It was for [PII], yeah, mhm.
[AGENT][NEUTRAL] Last year
[AGENT][NEUTRAL] And what was that
[AGENT][NEUTRAL] On January, not November. OK, sorry.
[CUSTOMER][NEUTRAL] It was in January. Mhm.
[CUSTOMER][NEUTRAL] I can see.
[AGENT][NEUTRAL] So I don't have any claims for [PII].
[CUSTOMER][NEUTRAL] OK, could it have been February? It was, I don't think it was them.
[AGENT][NEUTRAL] I have one
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And, but you said that was for blood work.
[CUSTOMER][NEUTRAL] Mhm, I believe so.
[AGENT][NEUTRAL] I have your ultrasound from February.
[CUSTOMER][NEUTRAL] No, I don't think it was that.
[AGENT][NEUTRAL] Claim but that was paid.
[AGENT][NEUTRAL] And I have
[CUSTOMER][NEGATIVE] It might not have just got, it might not have gotten sent, but I, it looked like it had sent to like a miss the my primary and then a miscellaneous.
[CUSTOMER][NEUTRAL] Um, on the bill, but then they had like 0.
[CUSTOMER][NEUTRAL] Amount it's not a big deal. I just.
[AGENT][NEUTRAL] Yeah, you might just wanna contact them too and make sure that that they have your APL information to submit that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Plain to us.
[CUSTOMER][NEUTRAL] I think I found the receipt from where I paid for it. Let me.
[AGENT][POSITIVE] Oh good.
[CUSTOMER][NEUTRAL] I guess it'll give me any information on when it actually.
[CUSTOMER][NEUTRAL] No, it's not gonna give me the date of.
[CUSTOMER][NEUTRAL] The service
[AGENT][NEUTRAL] What date was it? Did you pay it the day you went?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] No, I paid it. I paid it in this January.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hm. Did it have an amount?
[CUSTOMER][NEUTRAL] It was 5947 I believe.
[AGENT][NEUTRAL] So on your claims, the first claim we received was on.
[AGENT][NEUTRAL] 123 24. Let's see what that is.
[CUSTOMER][NEUTRAL] Yeah, that's what that's it is, yeah, there, that's what it was 123.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Let me look at that one.
[CUSTOMER][NEUTRAL] It was a laboratory um charge.
[AGENT][NEUTRAL] Let's look at that one.
[AGENT][NEUTRAL] Now they had a total bill amount of 574.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, yeah, it was laboratory. So they diagnosed it with the diagnosis codes.
[AGENT][NEUTRAL] It does, it's not a sickness or an injury, so that one was not.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][MIXED] Not covered, but at least we found it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, no, that's perfect. I just wasn't sure. I wanted to ask, but I appreciate you looking into that, and I will, um, give a man a call and see if we can get everything all worked out.
[AGENT][NEUTRAL] Yeah. Hopefully they'll get that right back to us and if you, if you have them, you can always submit them online, but
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we can complete the processing.
[AGENT][POSITIVE] But it's been such a pleasure to assist you with that claim status. Anything else I can help you with today?
[CUSTOMER][POSITIVE] Yes, thank you so much.
[CUSTOMER][NEUTRAL] I think that's it.
[AGENT][POSITIVE] Well, thank you for calling APL [PII]. Again, congratulations on your 2nd, and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye bye.
[AGENT][POSITIVE] Take care. Bye-bye.