AccountId: 011433970860
ContactId: 7de3670b-af9c-4e3b-a3d6-2551604094d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 580900 ms
Total Talk Time (AGENT): 298123 ms
Total Talk Time (CUSTOMER): 239352 ms
Interruptions: 3
Overall Sentiment: AGENT=1.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/7de3670b-af9c-4e3b-a3d6-2551604094d6_20250109T17:36_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, um, good afternoon. Um, my name is [PII]. I have an, um, adapt insurance with you guys, and I have some questions. I, can I give you like my number or something so you can
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, absolutely. I'd love to look at that. And what's the policy number?
[CUSTOMER][NEUTRAL] Search it.
[CUSTOMER][NEUTRAL] OK, post number is 2541.
[CUSTOMER][NEUTRAL] 624.
[AGENT][POSITIVE] Thank you and let me get that pulled up for you real quick. One second.
[AGENT][NEUTRAL] And [PII], can you verify for me please your last name and date of birth?
[CUSTOMER][NEUTRAL] My last name is um [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, absolutely, thank you, and I'm just gonna verify some additional information with you if you could verify your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Zip code [PII].
[AGENT][POSITIVE] Perfect. And if you'd be able to verify the email and address on I'm so sorry, the email and phone number on file?
[CUSTOMER][NEUTRAL] Uh, I don't know if you guys have my, uh, my email, maybe my husband's.
[AGENT][NEUTRAL] OK, yeah, what's his email?
[CUSTOMER][NEUTRAL] And my email address is
[CUSTOMER][NEUTRAL] His email is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful and then the phone number on file as well my friend?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful thank you and then uh Miss [PII], is there a a good call back number I can get from you just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, then it's uh my phone number it's gonna be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful. I appreciate that so much. And so you were just calling to learn a little bit more about this policy, is that correct?
[CUSTOMER][NEUTRAL] Yes, because I've been using, I'm currently pregnant.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I'm, I've been using the gap insurance then to cover the cost of pregnancy.
[CUSTOMER][NEUTRAL] Alongside my other insurance.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] So I just wanna, I, yeah, I just wanna, because all, all the places that I have been.
[CUSTOMER][NEUTRAL] I see all all all uh the claims on my account and and.
[CUSTOMER][NEGATIVE] I see that, like I owe a lot of money.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, I don't know if those offices did the claim because all, all the places that I went, I showed the, the APL.
[CUSTOMER][NEUTRAL] Uh, and the last one was, um, a claim that we did for an ultrasound.
[CUSTOMER][NEUTRAL] That I have in October.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's the only one that I see in the portal, in your portal.
[CUSTOMER][NEUTRAL] The one with
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $195.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] OK perfect yeah so um it looks like we only have two claims on file for you. One was that one from October, um, and that one did end up getting paid. The other claim we have on file for you, um, was from the same group, the VitalMed Vital MD Group Holding.
[AGENT][NEUTRAL] Uh, for a visit [PII], and for this one it's denied, but it's not like fully denied it's just requesting more information. It looks like they did not send us the explanation of benefits from the primary insurance and because we're your secondary insurance we have to have that EOB from primary insurance before we can make a decision on a claim. So we just requested for them to send us that EOB and once we have it we can reprocess and file the claim.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then we get the money back or how does it work?
[AGENT][NEUTRAL] Um, yeah, so because the provider, um, because the provider started the claim, any benefits payable would go to the provider, but I wouldn't be able to tell you like how much you would have like I would have to have that information from your primary insurance.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And this is the only game they have made, like, because I have had since then.
[CUSTOMER][NEUTRAL] 2 ultrasounds.
[AGENT][NEUTRAL] Yes, I do not have anything else on file. It is only these two claims that have been submitted to us.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Because I, I always give my insurance in the gap, so I, I assume that they run both.
[AGENT][NEUTRAL] Yeah, so it, it doesn't look like they've sent us any claims since, since [PII].
[CUSTOMER][NEUTRAL] Or does it work? How does it work?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Because every ultrasound is 300, so it's not.
[CUSTOMER][POSITIVE] It's not cheap.
[AGENT][NEUTRAL] Yeah, I understand that.
[CUSTOMER][NEUTRAL] Um, so because I have the United Healthcare, I can see all the other ones that I have that I see like amount old and old. So it looks like they didn't use the gap.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] I would definitely recommend having them send us a copy of your explanation of benefits or if you can see your explanation of benefits from uh from United Healthcare like on their portal you're more than welcome to upload that, the one from [PII], and you, you're more than welcome to upload that and send it into us and then as far as the rest goes with your group, I mean.
[CUSTOMER][NEUTRAL] So what can I do?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I don't, I can't really tell you what to do, but like I would recommend being like, hey, I'm not gonna pay anything until you submit claims with my secondary insurance, um, and I would.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] You know, kind of try to see if you can strong arm them a little and let them know like you can see that they have not submitted the claim that you don't have it on file and you need them to submit the claim and then worst case scenario is if you're really struggling with them to submit claims and it's not coming through, you are so welcome to submit claims on your behalf and the money will be sent to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so the um explanation of benefits, where can I find it like I'm in the claims section.
[AGENT][NEUTRAL] I actually
[CUSTOMER][NEUTRAL] And I see the plane.
[AGENT][NEUTRAL] Don't, I'm so sorry. I, I could help you like if you were on the APL portal but I don't know I don't even have United Healthcare like I have no idea what their portal looks like or how to help you through it, um.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Because if I find the one the [PII], like I, I see.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Yeah, if you find that explanation of benefits you can send us a PDF of it on your portal and we'll be able to start reprocessing it for you, OK?
[CUSTOMER][NEUTRAL] The amount billed.
[CUSTOMER][NEUTRAL] OK, let me try to, to see how I can find it and then I can send it to you.
[AGENT][POSITIVE] Perfect and you might even, I don't know if United Healthcare does this, but like we can email out explanation of benefits here and they might be able to do the same thing. You might even be able to call them and have them email it straight to you um as well so.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][POSITIVE] That's a good question. And the explanation of benefits for everything is like just the whole explanation of everything.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So the explanation of benefits typically it'll be like one based on each date of service or like each claim submitted and I'm but again like I, I've only ever worked for APL so I know how it looks when it comes through for us. I don't know what it looks like when it comes through for other insurance companies, but my thought would be is it would just be one for that one date of service and visit that you went to.
[CUSTOMER][NEUTRAL] Or specific.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I'm gonna contact them. Maybe you can send me the one of APL so I have it on file.
[AGENT][NEUTRAL] Yeah, um, the, the explanation of benefits we sent from that latest claim.
[CUSTOMER][NEUTRAL] Yeah, or, yes.
[AGENT][NEUTRAL] OK, and I
[CUSTOMER][NEUTRAL] Or where can I find it?
[AGENT][NEUTRAL] That should be on your online portal um and it should be under my claims and then you should be able to open it up from there in my claims um you should be able to click on your claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] In my claim, like the one that processed and the date.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And it looks like on my side I'm seeing that we processed that 10, actually I lost the page. I'm so sorry.
[CUSTOMER][NEUTRAL] OK, the number.
[AGENT][NEUTRAL] It looks, oh, you found it?
[CUSTOMER][NEUTRAL] No, it's OK. I'm, I'm.
[CUSTOMER][NEUTRAL] Yes, I found the claims here.
[CUSTOMER][NEUTRAL] It's just the internet is a little bit slow. OK, it's downloaded.
[CUSTOMER][NEUTRAL] But I, yes, I think, yes, I received it also via mail.
[AGENT][POSITIVE] Yes, you should have.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Alright, one is 0 and the other one was 195.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Correct, yeah, the one.
[CUSTOMER][NEUTRAL] And this was for
[CUSTOMER][NEUTRAL] For 20.
[CUSTOMER][NEUTRAL] Yeah, I think that was my last ultrasound maybe. I'm not sure.
[CUSTOMER][NEUTRAL] And no, that's the date, your date. OK, let me find out and, and if anything I, I will call back.
[AGENT][POSITIVE] OK perfect um and then yeah like if there's anything else you need don't hesitate to reach out to us we're gonna do our best to take care of you.
[CUSTOMER][POSITIVE] OK, thank you so much I appreciate that.
[AGENT][POSITIVE] Yeah my pleasure thank you so much you take care.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.