AccountId: 011433970860
ContactId: 829d398a-1293-46d6-a979-0bce09f873ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 667489 ms
Total Talk Time (AGENT): 254667 ms
Total Talk Time (CUSTOMER): 256281 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/829d398a-1293-46d6-a979-0bce09f873ef_20250205T14:46_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], my name is [PII], and I'm looking to uh upload a claim online from [PII]. We are currently not um members with APL anymore, but we were at the time of this claim. Um, and unfortunately, it just went through UnitedHealthcare last month and was cleared. Um, so now I need to, I think I need to send my EOB to y'all.
[CUSTOMER][NEGATIVE] I'm having trouble getting logged in online. Um, I at one point had created an account, but it's, it's not showing that it like the password that it's.
[CUSTOMER][NEGATIVE] Um, populating that I thought I used is not correct and so then when I try to create a new user it's not even allowing me to do that because I think we're not current um policy holders. Does that make sense?
[AGENT][NEUTRAL] Yeah, I don't think, I think if you're not current, it's not gonna let you. Can you fax it to us?
[CUSTOMER][POSITIVE] Yeah, I'd be happy to fax it to you.
[AGENT][NEUTRAL] OK. Do you have a phone number I can get in case we get disconnected? I can call you back.
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] I do. It is 02212862.
[AGENT][NEUTRAL] And your name was?
[CUSTOMER][NEUTRAL] My name is [PII]. My husband is [PII].
[AGENT][NEUTRAL] OK, and what's your date of birth?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII] and you were trying to upload a claim?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On the online service center.
[CUSTOMER][NEUTRAL] Well, I have an EOB, yeah, that's what I'd like to do is I have an EOB from United Healthcare. I just like to see if APL would cover any more of the cost of the procedure.
[AGENT][NEUTRAL] OK, I can help you with that. It's still showing active, so you should be able to log in.
[CUSTOMER][NEGATIVE] I know that's what I'm having trouble with. I don't know if I need to like reset the whole thing and try again, but it won't let me.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] Um, use the password that I thought was the password. Does that make sense? And then I try to like reset the password and it won't even let me use my the user name I thought I had.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, um, hold on just a moment and let me see. Usually, uh, when it's active, you should be able to get in.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][NEUTRAL] And I'm still showing the policy is still active as of right now.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh it is OK, well that's good to know.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I don't know if you can see my user name and my password, and maybe I can if you can give that information to me I could try, but I realized you might not be able to do that.
[AGENT][NEUTRAL] I cannot, but I can transfer you to customer service and they would probably be able to reset it for you. In claims, I don't think I can reset the password.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] But yeah, I'll transfer you to customer service and see if they can get help you get logged in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for that claim?
[CUSTOMER][NEUTRAL] Do you wanna give me the fax number? Oh yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And on that claim, we will need an itemized bill that has a procedure code and diagnosis code.
[AGENT][NEUTRAL] And your explanation of benefits.
[CUSTOMER][NEUTRAL] OK, so you said a procedure code and uh what other code?
[AGENT][NEUTRAL] Diagnosis code.
[CUSTOMER][NEUTRAL] Diagnosis
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What date of service was it for?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] APL paid a 40, yeah, there's, it shows that y'all paid a 40, yeah.
[AGENT][NEUTRAL] $45.
[CUSTOMER][NEUTRAL] Um, and what happened, apparently the, so the doctor was, I thought an in-network doctor, but
[CUSTOMER][NEUTRAL] Because of our United Healthcare plan being with the River Valley, whatever that means, they were not in network. And so we had a pre-authorization done.
[CUSTOMER][NEUTRAL] And they were gonna bill it as in-network, the allowable services, and UnitedHealthcare determined the allowable amount was $964.
[CUSTOMER][NEUTRAL] It was listed as an office visit and so APL covered the $45 co-pay.
[CUSTOMER][NEUTRAL] But then the over the overage amount that was not allowable by insurance was $2600.
[AGENT][NEUTRAL] Let's see. On that EOB, what does it show as applied to the deductible co-pay or co-insurance? That's the only thing we're gonna pick up.
[CUSTOMER][NEUTRAL] And so,
[AGENT][NEUTRAL] Does it have anything?
[CUSTOMER][NEUTRAL] Just one second, I'm looking at the EIB.
[AGENT][NEUTRAL] That is applied to the deductible co-pay or co-insurance?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I have my total amount owed.
[CUSTOMER][NEUTRAL] I'm looking at what it says and then then my balance for my.
[CUSTOMER][NEUTRAL] Deductible.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Plan a allowed amount that's for 9:27.
[CUSTOMER][NEUTRAL] Yeah, let's see, applied the deductible of $0.
[AGENT][NEUTRAL] Let me see if I can pull that up.
[CUSTOMER][NEUTRAL] The provider billed 3649.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And this is for [PII] provider.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] For $3,649.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And the EOB we got only shows $45 to the co-payment.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] You can send it in and let us look at it, but if there's nothing else, they applied to the deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] And that's all we pick up.
[CUSTOMER][NEUTRAL] Even with a gap plan.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Whatever your primary applies to your deductible copay or co-insurance. Those are the only three columns that we pick up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Man.
[AGENT][NEUTRAL] So it looks like they charged 3,649. They allowed.
[CUSTOMER][NEUTRAL] It's real.
[AGENT][NEUTRAL] 1,962 and they only applied $45 to the copay co-insurance.
[CUSTOMER][NEUTRAL] I know, isn't that weird?
[AGENT][NEUTRAL] And that's the 45 we paid.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But I can transfer you to customer service if you wanna still wanna get on the online service center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, if I, if I was to just fax this into you.
[CUSTOMER][NEUTRAL] I would need to fax in the itemized bill with all those codes and then also this EOB is that correct?
[AGENT][NEUTRAL] Well, since we already have the claim.
[AGENT][NEUTRAL] You can just fax that EOB over.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Just write your policy number on it.
[CUSTOMER][NEUTRAL] OK, you don't need.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can write this claim number and put in reference to this claim number.
[AGENT][NEUTRAL] 343-3015.
[CUSTOMER][NEUTRAL] 343-301-5
[AGENT][NEUTRAL] 15. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, that would be great and then yeah, I, I might as well I need to make sure I can get online so it would be helpful if I could talk to them.
[AGENT][NEUTRAL] OK. Hold on one moment, OK?
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII]. I have a [PII] and the insured on the phone.
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Her phone number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number is 022.
[AGENT][NEUTRAL] Hold on, let me start over. 02212862.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And she's trying to get on the online service center, but it's not letting her reset her password. Can you help her with that?
[CUSTOMER][NEUTRAL] OK, I sure can. Yes, this is [PII] on the phone?
[AGENT][NEUTRAL] Yes, uh-huh, she was trying to upload a claim, but it wouldn't letting her reset her password, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, got you.
[AGENT][POSITIVE] And I already helped her with the claim and all and gave her the fax number so she can fax it in case she can't get in.
[AGENT][NEUTRAL] But it's still showing as long as it's showing active, she should be able to get in, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She should, yes.
[AGENT][NEUTRAL] A question of mine, this is just my question. If it's policy is lapsed, can they no longer get in it?
[CUSTOMER][NEGATIVE] That's right, they can't.
[AGENT][NEUTRAL] That's what I thought. OK. That's what I told her, but that's what I thought of their policy, but hers is still showing active, she should be able to get in.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, she should. Yes, I was just looking. It is active.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. I'll let you help her with that then.
[CUSTOMER][NEUTRAL] OK, OK. Yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You are welcome. Thank you.
[AGENT][NEUTRAL] Bye bye.