AccountId: 011433970860
ContactId: 733c330c-9bd9-4f49-98de-ab9f0537fe8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 650909 ms
Total Talk Time (AGENT): 262863 ms
Total Talk Time (CUSTOMER): 275277 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/733c330c-9bd9-4f49-98de-ab9f0537fe8b_20250106T14:25_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] I'm calling because um I took my son to an orthopedic, and I had to pay, I, I believe, uh, $536 on his uh leg brace, and, um, my company told me that I had this, this benefit, so I would like to know how can I submit this claim.
[AGENT][NEUTRAL] OK, I can help you. Can you spell your first name for me?
[CUSTOMER][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] OK, and what's your policy number?
[CUSTOMER][NEUTRAL] Um, is it the payer's ID?
[AGENT][NEUTRAL] It's the policy cert number?
[CUSTOMER][NEUTRAL] So number is 0215659 ML 7.
[AGENT][NEUTRAL] OK, and what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] OK, and you gave me a policy number of 0215659. I think I missed one digit.
[CUSTOMER][NEUTRAL] It was M as in Michael, L.
[CUSTOMER][NEUTRAL] As Liam and then 77.
[AGENT][NEUTRAL] OK, repeat the entire number for me.
[CUSTOMER][NEUTRAL] It's 02156559 M.
[CUSTOMER][NEUTRAL] L. 7.
[AGENT][POSITIVE] OK, I missed one of the fives. Thank you for that. Give me one moment.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Can you tell me?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] In.
[CUSTOMER][NEUTRAL] OK vacuum vacuum.
[CUSTOMER][NEUTRAL] Where he's at home, he's at Lowe's go to Home Depot.
[CUSTOMER][NEUTRAL] And no the same [PII] and my address [PII].
[AGENT][NEUTRAL] Yeah, right, can you verify your date of birth and your mailing address for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is the state and zip code?
[CUSTOMER][NEUTRAL] Uh uh [PII].
[AGENT][NEUTRAL] OK. And what is a good email address for you on file?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] Yes, uh huh.
[AGENT][NEUTRAL] OK. So [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][POSITIVE] Thank you for that.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. And you said that someone presented to the doctor's office, uh, did you say it was [PII] or [PII]?
[CUSTOMER][NEUTRAL] My son, and I was [PII].
[AGENT][NEUTRAL] OK. And did you pay out of pocket?
[CUSTOMER][NEUTRAL] Yes, I paid out of pocket twice. I paid last like last year, I paid for it as well, but my, I didn't know about this insurance, so my supervisor suggested me to submit it.
[AGENT][NEUTRAL] OK, so you're, you're now.
[AGENT][NEUTRAL] Mhm. And what type of service was it?
[CUSTOMER][NEUTRAL] Cause I made the comment. It was uh orthopedics.
[CUSTOMER][NEUTRAL] Or orthotics prosthetic something like that.
[AGENT][NEUTRAL] It was
[AGENT][NEUTRAL] So is that durable medical equipment?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK, give me a second. Let me pull up your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And see what's covered under the policy.
[AGENT][NEUTRAL] OK, so I do show under the outpatient benefit that durable medical equipment when when recommended by a physician is covered. And I show the maximum outpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's up to $6000 per covered person per calendar year.
[AGENT][NEUTRAL] And then a maximum of 18,000 per calendar year for all covered persons combined.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so if you're submitting the claim yourself, um, we do require 3 documents from you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you may wanna write this information down uh the APL claim form.
[CUSTOMER][NEUTRAL] And what are those?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, that form. OK. I'm gonna give you the, the website.
[CUSTOMER][NEUTRAL] OK, give me one second.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh, which is the name of the company, American Public Life. So I'm gonna give you the name of the website so you can download the Medlink claim form. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh-huh, I'm ready.
[AGENT][NEUTRAL] OK, so it's [PII].
[CUSTOMER][NEUTRAL] Hold on. Is, is uh [PII]?
[AGENT][POSITIVE] [PII]. Correct.
[CUSTOMER][NEUTRAL] OK, so I just put in my information and then I'll I'll upload the documents, right?
[AGENT][NEUTRAL] So you'll complete that claim form.
[AGENT][NEUTRAL] Um, and the first page of that claim form will tell you what documents we need, um, and so it should say that we need, uh, the APL claim form, uh, you'll need to obtain an itemized bill from the orthopedic office.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I have everything, I have everything here.
[AGENT][NEUTRAL] OK, and then a copy of your primary insurance explanation of benefits?
[CUSTOMER][NEUTRAL] I need a copy of that too.
[AGENT][NEUTRAL] Correct, because that determines what amount we pay.
[CUSTOMER][NEUTRAL] Of the
[CUSTOMER][NEUTRAL] Oh, OK. How do I get that?
[AGENT][NEUTRAL] OK. Who is your primary insurance?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Who is your primary insurance?
[CUSTOMER][NEUTRAL] My primary? OK.
[AGENT][NEUTRAL] Who was your primary insurance carrier?
[CUSTOMER][NEUTRAL] Um, it's uh UnitedCare.
[AGENT][NEUTRAL] OK, so you would call UHC.
[AGENT][NEUTRAL] And or you may go online and download it from their website. Mhm.
[CUSTOMER][NEUTRAL] Go online
[CUSTOMER][NEUTRAL] OK, OK, and then I, I have to submit it to you guys as well, right?
[AGENT][NEUTRAL] That's it, that's the 3rd document that is required on the itemized bill that you have in your hand, can you tell me what's on there? Because we'll need, of course the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It says the name, it says the name of the of the person, the address, the phone number and the amount that was deducted from the, from the account.
[AGENT][NEUTRAL] OK, so we would need an itemized bill, yeah, does it have the diagnosis code and procedure codes on there?
[CUSTOMER][NEUTRAL] That was charged.
[CUSTOMER][NEUTRAL] Uh, I have the, the delivery receipt.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] And the explanation of of the.
[CUSTOMER][NEUTRAL] And the after visit sum summary, I have it as well.
[AGENT][NEUTRAL] OK, the after visit summary, does it tell the diagnosis, which is the reason that you went?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What does it say?
[CUSTOMER][NEUTRAL] It says uh.
[CUSTOMER][NEUTRAL] Uh, hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It says about his current allergies, your medical bill, um.
[AGENT][NEUTRAL] I mean, does it give a diagnosis description like torn ligament, um.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] What did he get
[CUSTOMER][NEUTRAL] It said diagnosis, yeah, it says diagnosis uh cerebral palsy.
[CUSTOMER][NEUTRAL] Um, and comments, [PII] is currently under my care, and I have determined that the prescription on this form is medically necessary.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you said cerebral palsy is the diagnosis on there?
[CUSTOMER][NEUTRAL] Yes, uh huh.
[AGENT][NEUTRAL] Yeah, does it provide any, uh, procedure codes like for the equipment or the durable medical equipment that he was uh prescribed? Is there a code or anything, or did this?
[CUSTOMER][NEUTRAL] Uh, equipment, yeah, it's um.
[CUSTOMER][NEUTRAL] The code CTPE 1399.
[AGENT][NEUTRAL] OK, yeah, that's it. And it's.
[CUSTOMER][NEUTRAL] And then [PII], something like that. So this is it, right?
[AGENT][NEUTRAL] OK, OK, now are there any charges because we'll need the bill charges on there as well.
[CUSTOMER][NEUTRAL] They gave me the receipt of what they charged me for.
[AGENT][NEUTRAL] OK, so we can't use a receipt is an itemized statement or is it a receipt?
[CUSTOMER][NEUTRAL] It's a, it's like a receipt. It says uh sale and then total visa name on the card.
[CUSTOMER][NEUTRAL] And then it says the company's name on the top inte integrity, prosthetics and Udon or something like that, LLC.
[AGENT][NEUTRAL] OK, you can send that in, but that's, but, but that's not gonna be sufficient. Um, I can give you the form to, I, that's not gonna be sufficient, that receipt. I can give you the form to request from the orthopedics office if you would like.
[CUSTOMER][NEUTRAL] OK and then uh.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You let me know when you're ready.
[CUSTOMER][POSITIVE] OK, you can, I'm ready.
[AGENT][NEUTRAL] OK, it's an acronym. It's C Charlie Elm, Mary S Sam.
[AGENT][NEUTRAL] 1500 so you'll request the CMS 1500 form which is the itemized bill for professional services.
[CUSTOMER][NEUTRAL] And where do I request that?
[AGENT][NEUTRAL] From the orthopedics office.
[CUSTOMER][NEUTRAL] From the orthopedics?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So, can you repeat the, the name again?
[AGENT][NEUTRAL] Uh, C Charlie, M Mary S Sam.
[AGENT][NEUTRAL] 1500 so you'll request the uh CMS 1500 form is what you'll request.
[CUSTOMER][NEUTRAL] So CMS?
[CUSTOMER][NEUTRAL] OK, so I'll, I'll give him a call.
[AGENT][NEUTRAL] OK, and that's an itemized bill.
[CUSTOMER][NEUTRAL] So they can email it to me.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] All righty. Any other questions I can assist with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, that'll be all. Thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.