AccountId: 011433970860
ContactId: 8f0b4dfa-9c70-4c73-bca8-4f877ea78021
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 547520 ms
Total Talk Time (AGENT): 230841 ms
Total Talk Time (CUSTOMER): 243448 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/8f0b4dfa-9c70-4c73-bca8-4f877ea78021_20250326T13:41_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII], and I had a question about a check I received for a claim.
[AGENT][POSITIVE] It would be my pleasure to assist you, Ms. [PII]. What is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And do you happen to have your policy number available?
[CUSTOMER][NEUTRAL] Yes, 02515497.
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And your date of birth and current mailing address, please, ma'am.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] All right, thank you. And was this check amount for $271.86?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right. I do have that claim pulled up. How can I help you?
[CUSTOMER][NEUTRAL] Um, so I, this is my first time having secondary insurance and working with you guys, so I wasn't sure who I'm supposed to send this check to.
[AGENT][NEUTRAL] OK. So you, since you submitted the claim, that is your benefit.
[AGENT][NEUTRAL] You can
[AGENT][NEUTRAL] Um, do with it what you want.
[AGENT][NEUTRAL] Um, if you want to pay diagnostic lab with that benefit check, you can.
[AGENT][NEUTRAL] Or if you've already paid them, that is for reimbursement.
[AGENT][NEUTRAL] And then in the future, Ms. [PII], you can actually show your APL ID card with your primary insurance and providers can file claims for you, and then money would the benefit would go directly to them.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, so that was an issue with the first one, this one, because I just didn't know to do that, but the second one, which I also have questions about, I did give them my APL card, but then it still went the same way where they didn't end up filing the claim for me to you guys.
[AGENT][POSITIVE] Oh, I'm so sorry. They should do that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, they, yeah, it was kind of we went back and forth and they said they resubmitted it like two different times, um, and then they said that you guys didn't respond like that they sent it to y'all but it says that y'all didn't respond and then you guys said you've never gotten it from them so I'm not really sure what happened with DLO but.
[AGENT][NEUTRAL] Was it a lab claim, uh, for a lab claim, lab work?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, yeah, they were both for DLL. mhm.
[AGENT][NEUTRAL] OK, yeah, sometimes and, and I don't know why but sometimes on lab charges they say that they send claims and we never received them. I'm not saying they didn't send it.
[AGENT][NEUTRAL] But I'm not sure why.
[CUSTOMER][NEUTRAL] No, I, I, yeah.
[AGENT][NEUTRAL] We don't get it if you understand what I'm saying.
[CUSTOMER][NEUTRAL] Yeah, and I've heard that too that DLO sometimes uh I think it's on their end.
[CUSTOMER][NEUTRAL] So, OK.
[AGENT][MIXED] Unfortunately, because we would love to get that taken care of for you.
[CUSTOMER][NEUTRAL] Yeah. So, um, as far as this goes, so I should maybe send it to them then because I haven't paid them yet because I was waiting to um hear back from you guys on the coverage first, so I should just maybe mail this check to them.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Now you're gonna have to mail a check from your account because they won't be able to, because it's in your name.
[AGENT][NEUTRAL] So they won't be able to, to cash it. So you would just need to deposit in if you want to send them a check.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] You know, that's completely up to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, so you guys are just paying me and then I just use this money to pay them.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEGATIVE] OK. Um, and then I got the check in the mail first and then I think the next day or maybe the same day I got another piece of paper, and this was not a check and it said total benefits paid 0, so I wasn't sure if this is about the 2nd.
[CUSTOMER][NEUTRAL] One that I tried to submit and this one's not being covered or I'm just not sure what this paper is.
[AGENT][NEUTRAL] OK, let me check that.
[AGENT][NEUTRAL] That was for data service 11:25.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] This one
[AGENT][NEUTRAL] Or claim number 3576835?
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so that one is is requesting additional information. When you submit a claim under your Medlink gap policy, we always need the primary explanation of benefits as well from your primary insurance. Who's your primary insurance with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Blue Cross and Blue Shield.
[AGENT][NEUTRAL] OK, so we will need a copy of the explanation of benefits from Blue Cross Blue Shield for that data service of 1125 24 showing what was applied to your deductible co-pay or co-insurance.
[AGENT][NEUTRAL] For those services.
[CUSTOMER][NEUTRAL] So I think, I mean, I don't have my computer booted up, but I think for both of them, I did provide the explanation of benefits. So I guess is it, did it not go through on your end?
[AGENT][NEUTRAL] Well, let me check. I can pull that claim up and check it for you.
[AGENT][NEUTRAL] Give me just one second.
[AGENT][NEUTRAL] It just takes me a minute.
[CUSTOMER][NEUTRAL] And actually I was thinking that one is the one that I just got the check for, the one dated [PII].
[CUSTOMER][NEUTRAL] So maybe this paperwork is delayed. I bet that's what happened. Let me check.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] Because the um the one you just received the 271.86 payment for was for data service 8124.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So the one, yeah.
[CUSTOMER][NEUTRAL] OK, so yeah, the one at $268 balance.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK, well, so it doesn't show on your end that I submitted that?
[AGENT][NEUTRAL] That's fine.
[AGENT][NEUTRAL] Well, I'm checking the claim itself, so let me just take a quick look.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I'm only seeing the laboratory bill.
[CUSTOMER][NEUTRAL] OK, that's strange.
[AGENT][NEUTRAL] For 11:25.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can just submit it the same way, just um upload it once you receive it. It'll be just like a new claim, but they'll review the history and attach it to this 1125 data service.
[CUSTOMER][NEUTRAL] Well, I don't know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Well, that's strange. I was having some kind of technology issues whenever I was initially trying to do this and then um they made a note to contact tech support.
[CUSTOMER][NEUTRAL] So, and then it, it seems like the rest of my stuff went through, but I'll go ahead and try to send it again just since there seems to be an issue.
[AGENT][NEUTRAL] And there's
[AGENT][NEUTRAL] And there's no um time frame, so you're fine, it would just be pending until we receive that information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Well, I will upload that. Thank you so much for your help.
[AGENT][POSITIVE] Well it's been such a pleasure to assist you. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] Ms. [PII], it's been a pleasure to assist you with that claim information this morning. Thank you for calling APL and I hope you have a lovely day and let us know if we can be of further assistance.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.