AccountId: 011433970860
ContactId: 8cbfc822-6c60-412c-b2a1-79f47a840e50
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 588000 ms
Total Talk Time (AGENT): 246829 ms
Total Talk Time (CUSTOMER): 203460 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/8cbfc822-6c60-412c-b2a1-79f47a840e50_20250122T17:29_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] Yes, uh, my policy number is 674,670. It's a preventative cancer policy for [PII] and [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, uh, did I file on our preventative care for both of us last year?
[AGENT][NEUTRAL] Oh, yeah, I can help take a look at that for you, ma'am. Um, I do need to verify some information with you real quick before I dig into the policy. Is that OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Perfect. Would you be able to verify for me, pretty please, your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, thank you. And would you also be able to verify for me your mailing address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then just two more things that email and the phone number on file.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, thank you. All right, and so we wanna make sure that all your preventative and wellness claims that you could have filed for the year in [PII] were filed for both you and your spouse, right?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] All right. And if you don't mind giving me a minute, I'm just gonna start looking into that for you.
[AGENT][POSITIVE] Are you having a great week so far?
[CUSTOMER][NEUTRAL] Yes, ma'am. How about you?
[AGENT][POSITIVE] I am doing great, thanks for asking um it's better inside.
[AGENT][NEUTRAL] I don't, uh it's too cold.
[CUSTOMER][NEUTRAL] Yeah, I was here, we're in [PII] and it's, we, we got like a little snow flurries and stuff, so that's unusual for us.
[AGENT][NEUTRAL] Yeah, so same, I'm in, well, similar. I'm in [PII], so it got cold, we got some flurries.
[AGENT][NEGATIVE] I guess it was worse last week if we're being honest, but it's still too cold for me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Me too.
[AGENT][NEUTRAL] Alright, so [PII] I'm seeing that wellness expense benefit, um, I see one filed for you and you've got your full um benefit for the calendar year, but I'm not seeing one for your spouse.
[CUSTOMER][NEUTRAL] OK, OK. I just want to make sure, uh, because I didn't think I'd filed on him. I think we did the other all the other years I think we, we finally got caught up. Um, now he had, um, uh, the most procedure done again, uh, in December. Can I claim on that again? He had another.
[CUSTOMER][NEUTRAL] Guarma sale.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] Let me see, let me take a look at that for you.
[CUSTOMER][NEUTRAL] in
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The qual just in December. Yeah, it's 22. The way you said it might seem like I know.
[AGENT][NEUTRAL] All right, and
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like.
[AGENT][NEUTRAL] Your
[AGENT][NEUTRAL] It looks like it would fall under the outpatient surgical expense benefit.
[AGENT][NEUTRAL] Um, and.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] I'm not seeing where that would be limited to one particular type of procedure in a lifetime. I highly recommend submitting that claim. I can never guarantee benefits are payable, but I would recommend it.
[CUSTOMER][NEUTRAL] Mm, OK. Do we, what else do I send? Do I send the hospital bill to or what?
[AGENT][NEUTRAL] Yeah, so you'll wanna send the itemized hospital bill that has the procedure codes and the diagnosis codes and then if you have an explanation.
[CUSTOMER][NEUTRAL] Hold on, like, OK, hold on procedure.
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] Procedure and diagnosis code.
[CUSTOMER][NEUTRAL] Diagnosis codes, OK.
[AGENT][NEUTRAL] And then if you have an explanation of benefits from your primary insurance carrier, um, you can send that along with it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then yeah that's all you'll need to submit if they need any further information um they'll like send a request out for it.
[CUSTOMER][NEUTRAL] OK. And then do I send like the doctor's bill too or uh?
[AGENT][NEUTRAL] Yeah, if you have an additional uh bill from the physician, you can go ahead and submit that along with it.
[CUSTOMER][NEUTRAL] Do I see that too?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, procedure hospital and procedure codes from the doc from the hospital and then the explanation of benefits from the insurance and the doctor's bill.
[AGENT][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] OK. OK. I'll send that as well. Uh, do you need the report too that, uh, from the doctor that has the report, you know what, that it was cancer or anything like that?
[AGENT][NEUTRAL] Yeah, you might, yeah, if you, I would just go ahead if you have a new pathology report, send that along with it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, that sounds good. Thank you. I appreciate that.
[AGENT][POSITIVE] Yes it's my pleasure and then um once you send that in, give us a couple days to get it put into the system and then about another week or so to get it processed and then you'd be more than welcome at any time to call back up and check on it but typically about 14-15 days after sending it in, um, to call back in and check on that and then again if they need any more information they'll send like a a request out to you um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Now, we have Medicare and we have uh our, so a lot of times we don't get these bills. So what happens with that?
[CUSTOMER][NEUTRAL] Uh, how do I do that?
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, I guess I'll have to call the hospital then and asking for the bill, huh?
[AGENT][NEUTRAL] Yeah, if you call the hospital and ask them for, just ask them for that itemized bill with the procedure codes on it and they should be able to supply that for you. And then you can also ask them for a UB B like boy, um, U like umbrella, UB.
[CUSTOMER][NEUTRAL] You like universe, the universe boy UB, OK.
[AGENT][POSITIVE] Yep, 04 um and it's the name of the form and that's gonna have some diagnostic information on it, um, and that will help get you kind of going in the right direction from them.
[CUSTOMER][NEUTRAL] OK, that's from the hospital UBO4 form. OK, cause I don't, a lot of times that we don't get that and if it's Medicare, we gotta wait, you know, we might get it in 3 to 6 months, we may get where they paid something, they don't show you that too often and then.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] UnitedHealthcare hardly sends us ever anything, you know, so, um, because they, they pick up the rest of our bill cause, cause we get to pay so much for our insurance through them. So, um, they pick up the rest of it, but, um, OK, the hospital form youBO for that, should that take care of everything else with the hos with the hospital codes and all that? Would that take care of it too?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You know, my understanding, and I don't process the claim, so I don't wanna lead you in the wrong direction. My understanding is that form is gonna have your diagnosis code and you'll still want the itemized bill with the procedure codes as a separate form.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] An atomized, OK.
[CUSTOMER][NEUTRAL] An itemized an itemized bill, just right. That's all it. Just you for an itemized bill.
[AGENT][NEUTRAL] The UB4 and the itemized bill, the itemized bill will have that procedure code on there, but you'll wanna, you might explicitly say an itemized bill with procedure codes.
[CUSTOMER][POSITIVE] OK, OK, sounds good.
[CUSTOMER][POSITIVE] OK, thank you so much. I appreciate it.
[AGENT][POSITIVE] Hey, it's my pleasure. I'm really glad I was able to help you out today, miss, and if there's anything else you need, [PII], just give us a call back and we'll do our best to take care of you.
[CUSTOMER][POSITIVE] OK, thank you so much. Bye-bye.
[AGENT][POSITIVE] Thanks, you're welcome. Bye bye.