AccountId: 011433970860
ContactId: 87ec48aa-5875-4ed9-9400-24c667feff66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 337540 ms
Total Talk Time (AGENT): 160852 ms
Total Talk Time (CUSTOMER): 108160 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/87ec48aa-5875-4ed9-9400-24c667feff66_20250530T16:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Uh, I was going to submitted a claim about, um, uh, a visit to the ER and, and also a test that I had done, and I received a response. I'm not quite sure what extra information should I need need from, from me. I was wondering if you could help me out.
[AGENT][NEUTRAL] OK, I can help you out with that, [PII]. um, can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, yeah, it would be [PII].
[AGENT][POSITIVE] Thank you so much. And what's the policy number?
[CUSTOMER][NEUTRAL] It's 01681882.
[AGENT][NEUTRAL] OK, give me just a second while I look that up.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Can you verify your date of birth for me?
[CUSTOMER][NEUTRAL] Uh yeah, [PII].
[AGENT][NEUTRAL] And the mailing address that we have on file and the phone number?
[CUSTOMER][NEUTRAL] Uh, yeah, [PII], and the phone number should be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And let me see.
[AGENT][NEUTRAL] Do you have the claim number?
[CUSTOMER][NEUTRAL] I do, uh, it's 00 let me see.
[CUSTOMER][NEUTRAL] Uh, confirmation number or is there a
[AGENT][NEUTRAL] Um, you can do that one. It should give you a claim number as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 00, here it is, uh, 359-712-1.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] So it looks like the supporting documents that we will need um it could be something like an itemized bill uh sometimes when you go to the hospital they will give you a bill but it's not itemized with procedure codes uh so you'll need to send in an itemized bill with procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, if there's any office notes or if there's a hospital admission and discharge summary, that would be um what we're needing for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And, and for the, the test, the CT CT scans.
[CUSTOMER][NEUTRAL] Uh, same thing.
[AGENT][NEUTRAL] Uh, yes, you'll want to bring, right, you'll want to bring in or submit uh the diagnostic testing results.
[AGENT][NEUTRAL] And it looks like we also.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Because this is secondary gap, so it looks like we need the explanation of benefits from your primary insurance as well, um, because we file through your primary insurance first, and this one helps pick up afterwards. So we need to have the explanation of benefits showing that they paid a certain amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, and I can get that through, is it just the my policy?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Or how would I get that from from my from my insurance uh OK.
[AGENT][NEUTRAL] Typically they they send it to you in the mail. You might want to call them and ask them if they can um send it to you through email or um how they send it to you. They, they typically send it through the mail.
[CUSTOMER][NEUTRAL] But it's just the, the uh summary of the, of my coverage, right?
[AGENT][NEUTRAL] Um, well, the explanation of benefits, the, the explanation of benefits, um, will be basically it's not quite like a bill, it just shows that they received the claim that you had something done and that they paid partial or all of it for you, um, so after they had paid it, they should have sent you something. It's, it's kind of like a receipt but not really it's hard to explain.
[CUSTOMER][NEUTRAL] Or just a specific to this?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] But um yeah it'll show that they paid a certain amount towards certain procedures.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK, uh, perfect, and, uh, to submit that it would be through through the website same same thing?
[AGENT][NEUTRAL] Yeah, you should be able to submit it through your portal account just like how you submitted the claim. You should be able to add it through there, um.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I don't know how your um online service center looks like but you might want to include if it doesn't already give you the option to you'll want to include that claim number that you gave. Did you give me the claim number 359-712-1? Yeah, you'll wanna include that in there just in case.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][POSITIVE] Perfect. Uh, I will do. And is there a, a time limit for this?
[AGENT][NEUTRAL] Uh, no, sir, we don't have filing, uh, timely filing limits.
[CUSTOMER][NEUTRAL] OK. OK. All right.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, no, that was all.
[AGENT][POSITIVE] All right. Well, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Alright bye.