AccountId: 011433970860
ContactId: 86b173fc-4626-45b9-9a00-51accc01d162
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 575429 ms
Total Talk Time (AGENT): 138591 ms
Total Talk Time (CUSTOMER): 260188 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/86b173fc-4626-45b9-9a00-51accc01d162_20250113T18:01_UTC.wav
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[AGENT][POSITIVE] Thank you for calling. This is. How may I help you?
[CUSTOMER][NEUTRAL] Hello, I, I cannot hear you a little weird. Um, is there any point of your mind?
[AGENT][POSITIVE] I'm fine. I haven't had any problems with it all day.
[CUSTOMER][NEUTRAL] Now I hear you better. I don't know. I maybe at the beginning of the call. Um hi, my name is [PII].
[AGENT][NEUTRAL] Can you spell your name for me?
[CUSTOMER][NEUTRAL] [PII]. My last name and the last name is [PII]
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, what's your policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Oh boy.
[CUSTOMER][NEUTRAL] I have the policy number for outpatients is 0251.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 8608 letter M as in Mary, L as in Larry and number 8.
[AGENT][POSITIVE] Thank you, [PII]. And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] 1.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. And how can I help you today?
[CUSTOMER][NEUTRAL] I'm calling because I just got a bill from the hospital about an endoscopy that I, that I had done um in September of last year, and uh I just wanted to see if you guys have received that bill first because um it was supposed to first go to you guys, which is my gap insurance, and then later for me to review if anything.
[AGENT][NEUTRAL] OK, so it should go to your primary insurance first. Let me get you verified. What's your um date of birth, your?
[CUSTOMER][NEGATIVE] Because it should have been covered.
[CUSTOMER][NEUTRAL] No, no, they, they already, they already billed my primary insurance. It's just that the instead of billing you guys, they, they just pay a bill me, so I just wanted to see just in case if it is in your system regardless.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's your date of birth, your mailing address and email address please?
[CUSTOMER][NEUTRAL] [PII]. My email address is [PII]. My address is [PII].
[AGENT][NEUTRAL] Thank you for that and what's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And is it a hospital claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What's the total charge?
[CUSTOMER][NEUTRAL] It's for outpatients.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, it should be like 3200 something. Let me see if I can find it.
[AGENT][NEUTRAL] OK. I see it. I see it.
[AGENT][NEUTRAL] And so we did issue a payment of $1,405.39 on [PII].
[AGENT][NEUTRAL] Is this Baptist Surgery and endoscopy Center?
[CUSTOMER][NEUTRAL] So there's that one, but there's another one that, that is for the same day, but for the, what's it called, um, they have done the, the lab, the labs that they did is what they, what they're telling me now.
[AGENT][NEUTRAL] OK, so the only claim that we've received for the date of service of [PII] is the hospital charge.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We've not received any other claim for this date of service?
[CUSTOMER][NEUTRAL] Oh, OK, OK. So I should be bearing this to you guys then.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So I should go ahead and, and build this claim to you guys then, or I should contact the hospital for them to
[CUSTOMER][NEUTRAL] They really can see to you guys as a secondary.
[AGENT][NEUTRAL] I mean it's, it's up to you but I mean if you ask the provider to submit it, you, you won't have to do anything with the claim but it the cho it's up to you how you choose to proceed and you said that it was for lab charges is it for independent lab or?
[CUSTOMER][NEUTRAL] I think the one specific doctor. Let me see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] My goodness, so sorry. It's just so hard to run the phone here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is the name on the bill that you're receiving maybe?
[CUSTOMER][NEUTRAL] Let me see because I don't have a system. I'm gonna have to log into the website and for some reason my my internet's just because I'm at work, so like the, the internet is just not as fast.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] No worries.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No rush.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] It's loading.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] No, no that's not even like it's coming to my child, OK, I know.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Almost there. I'm learning all of the games. I have several.
[AGENT][NEGATIVE] OK, no response.
[CUSTOMER][POSITIVE] Oh my goodness. Why?
[CUSTOMER][NEUTRAL] 911. OK.
[CUSTOMER][NEUTRAL] You also have a ther name.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Is the
[CUSTOMER][NEUTRAL] It should be the one on the, the doctor name [PII].
[AGENT][NEUTRAL] Spell spell the last name?
[CUSTOMER][NEUTRAL] [PII] sorry, sorry. [PII].
[AGENT][NEUTRAL] The last letter is [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's the first name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, um, I think.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, I just wanted to
[CUSTOMER][POSITIVE] Yes, it was like a special thing, tissue exam.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, it was just that that came.
[AGENT][NEUTRAL] Alright, so I do not show that claim on file, but I did want to document the name of the provider in notes.
[CUSTOMER][NEUTRAL] OK. No, I understand that.
[AGENT][NEUTRAL] Alright, and do you have any other questions?
[CUSTOMER][NEUTRAL] Um, to file this claim on my own.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, to find now I just do it online, right? Or I have to fill it out, print it out and fill it out by hand and then send it to you guys by mail?
[AGENT][NEUTRAL] So the uh claim form will need an itemized bill, so you would need to contact that office and request a copy of their itemized bill, not the balance due statement that you're looking at that's not sufficient.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then, um, since this policy is secondary to the major medical plan,
[AGENT][NEUTRAL] We'll need a copy of your primary insurance. Who is your primary insurance?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ahmed.
[AGENT][NEUTRAL] We'll need a copy of AdMed's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, so the ISP and the primary will be.
[AGENT][NEUTRAL] And the APL claim form which can be downloaded from our website.
[CUSTOMER][NEUTRAL] Nothing.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Um, no, CAP.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Oh, thank you so much for your help. You have been really helpful.
[AGENT][NEUTRAL] All [PII]. Did you have any other questions, Ms. [PII]?
[CUSTOMER][POSITIVE] No, no, we're all. Thank you, bye.
[AGENT][POSITIVE] OK, thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] Yeah.