AccountId: 011433970860
ContactId: 8a78ae55-d19d-481f-91c9-832560cd698f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 781530 ms
Total Talk Time (AGENT): 435642 ms
Total Talk Time (CUSTOMER): 325653 ms
Interruptions: 7
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/8a78ae55-d19d-481f-91c9-832560cd698f_20250306T21:16_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, my goal is uh.
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, my name is [PII] and I am calling because I received your EOB, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I am trying to understand what exactly are, well, you know, what more is it that you're needing that I thought I've already supplied. So I just wanna make sure before I go digging and making phone calls.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Then
[AGENT][POSITIVE] It would be a pleasure to assist you and we can see exactly what's needed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you happen to have that the claim number or policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] I see a policy number. It is 02455082.
[AGENT][NEUTRAL] Thank you. And do you mind, I just need to uh verify your information. What is your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm a [PII] girl too.
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEGATIVE] The best, right? I'm actually a cancer. I know you're not a cancer, but it's still the same month.
[CUSTOMER][NEUTRAL] Cancer or Leo?
[CUSTOMER][POSITIVE] That's OK, but I, but I love Kansas. I love Kansas. We, we get along so well.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] July is like the best month.
[AGENT][NEUTRAL] Let me, let me.
[CUSTOMER][NEUTRAL] Yeah, I used to be married to a counselor. I mean, well, it didn't work out, but anyway, he was a good person.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Oh, that's funny.
[AGENT][NEUTRAL] I haven't been married to a cancer, but my marriage didn't work out either, so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Welcome to the club.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Oh goodness. OK.
[AGENT][NEUTRAL] So what I'm checking, I see 2 claims.
[AGENT][NEUTRAL] One for
[AGENT][NEUTRAL] American Medical Response for your ambulance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So with your meddling policy, you know, it's secondary to your major medical.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we have to have the primary explanation of benefits from your primary insurance that is, you know, where they process the claim, they normally mail explanation of benefits to you.
[AGENT][NEUTRAL] Showing how the claim was processed.
[CUSTOMER][NEGATIVE] Did I not send, didn't I send that? I didn't send that.
[AGENT][NEUTRAL] I don't see that on file, but I'm still checking both claims so.
[CUSTOMER][NEUTRAL] Let me look on my computer to see what I saved and uploaded for you guys um.
[AGENT][NEUTRAL] Well, let me, yeah.
[AGENT][NEUTRAL] And that was the original claim, so I was checking that one first. That was the first claim.
[CUSTOMER][NEUTRAL] And this would have come from, what, who are they? Cigna, Allstate, something like that. Uh.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, let's see.
[CUSTOMER][NEUTRAL] Is this
[CUSTOMER][NEUTRAL] I need to start naming my documents better so that I know what I'm looking at.
[AGENT][NEUTRAL] Well, you know what, sometimes everything's.
[CUSTOMER][NEUTRAL] So this is allied right here.
[AGENT][NEGATIVE] It's so hard to keep up with stuff.
[CUSTOMER][NEUTRAL] So you need you need the, the ELB for which one? For, for the ambulance service, right?
[AGENT][NEUTRAL] Well, actually, yeah, for, mhm, and the diagnosis code. So your meddling gap policy pays towards sickness or injury. So anytime a claim is submitted, we have to have that diagnosis code and that will indicate to us that we can release benefits if it is due to sickness or injury, if it is a covered benefit under your plan.
[AGENT][NEUTRAL] So we're needing the diagnosis codes. Let's see what dates of service is this all around the same time?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's all around the same time, [PII]. So let me ask you something. Where, where does the diagnosis code? I, I don't know why I thought that's not on the EO. I thought it would be on the EOB somewhere. They don't, that's not there in the service code.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They don't put the diagnosis, yeah, they put service codes or procedure codes or they may even put maybe a revenue code, but no diagnosis codes.
[CUSTOMER][NEUTRAL] So, so who, who will give me the diagnosis code? That will come from the insurance company, right?
[AGENT][NEUTRAL] It didn't come from the insurance company. You can actually, let's see, were, were you admitted? Is that Emry Saint Joseph's Hospital? Yeah.
[CUSTOMER][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] You can actually call the hospital and there's a form that you can request from them. Well, that will have the diagnosis codes and procedures, all that listed. And it, it
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, what, what, what's the name of that phone?
[AGENT][NEUTRAL] It's called a U as in umbrella, B as in Bravo, 04.
[AGENT][NEUTRAL] UBO4.
[CUSTOMER][NEUTRAL] Yeah, you be 04.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that
[CUSTOMER][NEUTRAL] What you call me? I'm just kidding.
[AGENT][NEUTRAL] Are you, are you BO4?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] I love that. You just brightened my day.
[CUSTOMER][NEGATIVE] How dare you.
[AGENT][POSITIVE] I love it. I see it's just cans as Julie girls. We can't, we can't.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We just can't not do it, can we?
[CUSTOMER][NEUTRAL] Mm, right, right, we just, hey, nope.
[AGENT][POSITIVE] Can't help herself. We gotta have fun and enjoy life, you know, and laugh.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] That's right. So, OK, so I'll call Emery's billing department to request this you bill for, and I guess I can, I can have, I don't know if they mail it. I mean, I email it, but I ask them to mail. How much time do I have to get this to you guys?
[AGENT][NEUTRAL] Yeah, there's no time frame.
[CUSTOMER][NEUTRAL] OK. So, yeah, I will ask them to, I prefer for them to email it, but anyway, but um.
[AGENT][POSITIVE] So you're good.
[AGENT][NEUTRAL] Mhm. Now,
[AGENT][NEUTRAL] If you happen to still have it, if you're like me, there's no way I can even find it. But if you happen to still have the admission and discharge summary that they give you when you check out of the hospital.
[AGENT][NEUTRAL] OK, never mind.
[AGENT][NEUTRAL] I get it.
[CUSTOMER][NEUTRAL] I was high when I left that place. I don't know what that stuff is.
[AGENT][NEUTRAL] You don't even know what they gave you, did you?
[CUSTOMER][NEUTRAL] I don't, I don't. It was good too, whatever that was.
[AGENT][NEUTRAL] Uh, I know what you're talking about.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Like, can I have some more? Um, now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But right, but no, I don't like feeling loopy. But uh, OK, so, so that's the only thing you need, is that?
[AGENT][NEUTRAL] No, yeah. But you can also.
[AGENT][NEUTRAL] That will help. Let's see.
[AGENT][NEUTRAL] That looks like what they're needing.
[AGENT][NEUTRAL] Let me check just a couple other dates of service looks like we have in here.
[AGENT][NEUTRAL] And also just to let you know, for physical therapy.
[AGENT][NEUTRAL] We need the same thing. Now, your therapy, well, well, let me just tell you this first. Um, you can actually, if you
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Anytime you go for medical services, always show your APL card with your primary insurance.
[AGENT][NEUTRAL] And then the pro and the providers.
[CUSTOMER][NEUTRAL] I did.
[CUSTOMER][NEUTRAL] Oh, the APL card. Oh no, I didn't.
[AGENT][NEUTRAL] Right, yeah, and then the providers can file the claims and we can pay them direct. That's gonna be the easiest thing because they have all the documents needed to file claims, but.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um, and of course, you can file claims as well. Now, for your physical therapy, they're needing that itemized bill again from them, and I can tell you a form to request for your therapy from American special.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] To physical, um, they are.
[CUSTOMER][NEUTRAL] OK, now be careful now what you call me. Go ahead. What is it?
[AGENT][NEUTRAL] I'm not, you, you'd be just fine with me.
[CUSTOMER][NEUTRAL] I called that UB, OK.
[AGENT][NEUTRAL] This is gonna be a farm called C as in Charlie, M as in Mike, S as in Sam, 1500. So it's a CMS 1500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] See me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome.
[AGENT][NEUTRAL] So that's from your physical therapy.
[CUSTOMER][NEUTRAL] I was
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Slits this one.
[AGENT][NEUTRAL] And they're needing the also you know, if you can get those diagnosis, there's a data service 5124.
[AGENT][NEUTRAL] That you submitted
[CUSTOMER][NEUTRAL] That, that sounds like, that sounds like either Doctor [PII] or therapy. I don't, I was somewhere in between. OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It is Doctor [PII].
[AGENT][NEUTRAL] Doctor [PII], so we're needing the diagnosis code from Doctor [PII]. If that was a doctor, then they'll have that CMS 1500 form.
[CUSTOMER][POSITIVE] Well, you know what, actually, I don't need reimbursement for him. I kinda got him squared away.
[CUSTOMER][NEUTRAL] I went to the office and took care of them.
[CUSTOMER][NEUTRAL] Oh, I guess I can get my money back though, couldn't I? Anyway, OK.
[AGENT][NEUTRAL] Mhm. Yeah, these benefits are yours and
[AGENT][NEUTRAL] You know, I see that you uploaded these on your portal. If you ever want to view your policy benefits, if you'll go under my coverage on that portal and click on the policy number itself.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then your policy certificate will download and you can view what's covered and then make sure, you know, we want you to get your full benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Nice. Well look, thank you, look, thank you for that little hint there. OK.
[AGENT][NEUTRAL] Uh, yeah.
[AGENT][NEGATIVE] Yeah, so, you know, if you see something that you had to do during that awful time.
[CUSTOMER][NEGATIVE] No right.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Boy, that was a fall. You should have saw that. I was Superman, but a, but a woman. Oh my gosh.
[AGENT][NEUTRAL] Oh, did you file?
[AGENT][NEUTRAL] Did you, that is the
[CUSTOMER][NEUTRAL] I, I slid. It, it felt like a half a mile, I swear.
[AGENT][NEUTRAL] It
[AGENT][NEGATIVE] Does, isn't that the worst feeling? I mean, it's just like the most helpless feeling.
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] It really is.
[CUSTOMER][NEGATIVE] Oh, absolutely. And, and did a partial tear.
[CUSTOMER][NEUTRAL] Oh my God, I was, oh that was ridiculous. It's, it's funny when you think about it.
[CUSTOMER][NEUTRAL] You know, and I said, boy, I bet the company look on their video camera and saw that.
[AGENT][NEUTRAL] Were you at work?
[CUSTOMER][NEUTRAL] Yes, but not, I mean, I was, I was in front of my work building, but I wasn't clocked in yet, so I wasn't technically at work.
[AGENT][POSITIVE] Oh bless you
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Oh my gosh. So I bet you were just out there waiting for somebody to come along and help you up.
[CUSTOMER][NEUTRAL] Well, actually I did. I was a young man that was walking in front. He was walking in front with another young lady. They were talking. I was behind them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, so all of a sudden all he heard was.
[CUSTOMER][NEUTRAL] You know.
[AGENT][POSITIVE] Well, thank goodness they turned around.
[CUSTOMER][POSITIVE] Yeah, he turned around and he was like, oh my gosh, ma'am, and look, I couldn't get up to save my life. Anyway, long story short. OK, so I will get these things.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, we just.
[CUSTOMER][NEUTRAL] From Emory.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the physical therapy also. What's the name of that, that, that um that uh company again for physical therapy?
[AGENT][NEUTRAL] Physical therapy. Let me get that. American specialty physical therapy?
[CUSTOMER][NEUTRAL] Yeah, that
[AGENT][NEUTRAL] That almost sounds like a little jingle.
[CUSTOMER][NEUTRAL] Yeah, they
[AGENT][NEUTRAL] American Specialty Physical therapy.
[CUSTOMER][NEUTRAL] Oh yeah, they go up under.
[CUSTOMER][NEUTRAL] Yeah, cause I went to benchmark. That must be a bigger name for them or something. hmm.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] It may be. It looks like that might be what was on your prime, your EOB.
[CUSTOMER][NEUTRAL] Yeah, mm OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] All right, well, I promise I'll work on all this in the morning when I'm fresh cause right now, hmm.
[AGENT][NEUTRAL] You're not fresh this afternoon?
[CUSTOMER][NEGATIVE] I'm tired.
[CUSTOMER][NEUTRAL] I mean, I stay, I stay fresh man, but uh
[CUSTOMER][NEGATIVE] I don't, I don't wanna have any more conversations with anybody.
[AGENT][NEUTRAL] You know, there just comes a point in the day where you just gotta say that's enough.
[CUSTOMER][POSITIVE] that enough is enough. That's right.
[CUSTOMER][POSITIVE] I have that right.
[AGENT][POSITIVE] That's right. Exactly.
[CUSTOMER][POSITIVE] But yeah, I'll definitely get all this stuff sent out for sure and then once I get it I'll upload it um to the portal.
[AGENT][POSITIVE] OK. Well, we will be happy to review that information and if you have any questions or concerns, never hesitate to give us a call because we're here for you.
[CUSTOMER][POSITIVE] Thank you so much. You've been so nice. I hope this is being recorded. She is the nicest, sweetest person ever on your team. Promote her.
[AGENT][NEUTRAL] Oh that.
[AGENT][NEUTRAL] Oh, OK, that's you like girls stick together.
[CUSTOMER][POSITIVE] That, that's right.
[AGENT][NEUTRAL] And I'm gonna say, claims, pay this claim.
[CUSTOMER][NEUTRAL] Well, exactly, if you can, yeah.
[AGENT][NEUTRAL] Yeah. Once we, once we get that documentation, shouldn't be any problem.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. All right, well thank you so much. It's been a pleasure. I really appreciate your help.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] My, the pleasure has been mine, Ms. [PII]. Thank you for calling APL and you have a nice restful evening.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] All right you as well.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] All right bye bye.