AccountId: 011433970860
ContactId: 9001b04b-ad11-4799-ad13-7dbecd72281d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 452559 ms
Total Talk Time (AGENT): 180734 ms
Total Talk Time (CUSTOMER): 139167 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/9001b04b-ad11-4799-ad13-7dbecd72281d_20250509T14:33_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 [PII], this is [PII] with Broker Resources. How are you doing?
[AGENT][POSITIVE] Hey [PII], I'm good. How are you doing?
[CUSTOMER][NEUTRAL] Good, um, I have, I think her name is [PII] from Financial Design, um, and she's calling in regards to Frost administrative Services, um, group number 21,340, um, and she is with Medlik, but when I tried to call Medlink claims I called them twice and they said that there was no representative available, um, and I was curious if you would be able to, um, discuss Medlik.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] In terms of like is it like a particular policy or they have a claim?
[CUSTOMER][NEUTRAL] Claim
[CUSTOMER][NEUTRAL] Um, she is the claims coordinator, so I believe she will be discussing the claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK, sure.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Let me put you on a brief hold and then I'll join you guys together.
[AGENT][POSITIVE] Alrighty.
[AGENT][NEUTRAL] Hi, this is [PII] with um the care team. Is this [PII]?
[CUSTOMER][NEUTRAL] Anarchy, yes.
[AGENT][NEUTRAL] Hi [PII], um, so the representative was letting me know that you wanted to speak about claims. She gave me a little, can you tell me the reason for the call? She said it might be in reference to claims, but I'm not sure and Medlink.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. It's OK. Um, so my name is [PII]. I'm calling with Financial Design, the broker's office. I'm just calling to confirm that you guys have a claim on file for a member.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK. Sure, I can check for you. And um Ms. [PII], may I have a good phone number in case we're disconnected and then the member's policy number?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][POSITIVE] Thank you, and then the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Oh, and the policy number, sorry.
[AGENT][POSITIVE] Yes, ma'am, you're fine.
[CUSTOMER][NEUTRAL] Let me give you the number. It's 2304091.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. I have her here. Can you verify the member's um first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. It's uh [PII] and [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and the claim is for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and may I have either the date of service or when it was sent in?
[CUSTOMER][NEUTRAL] The data service is, uh, let me tell you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And is it, are they for labs?
[CUSTOMER][NEUTRAL] Yes, from Quest Diagnostics.
[AGENT][NEUTRAL] OK, yes. OK, so this is it. Alright, so we did receive the claim. Hold on one moment, let me get all the information for you.
[AGENT][NEUTRAL] Alright, so we received the claim on [PII]?
[AGENT][NEUTRAL] That claim number is 3.
[CUSTOMER][POSITIVE] OK, OK, awesome.
[AGENT][NEUTRAL] Oh, you just want to know if we have it?
[CUSTOMER][NEUTRAL] Uh, yeah, you can give me the claim number as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, sure. So the claim number is 358.
[AGENT][NEUTRAL] 0619.
[CUSTOMER][NEUTRAL] Thank you. And the payment, was it sent to the provider or the member?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] So there was no payment and we finished processing on [PII]. Um, it was denied requesting um supporting documents. So we're trying to figure out the diagnosis, um, if they can submit.
[AGENT][NEUTRAL] The itemized bill, it could be a doctor's note, just something with the diagnosis code so we can prove medical necessity.
[CUSTOMER][NEUTRAL] OK. So, it was denied due to um supporting documents. You just need proof of diagnostic, so either an itemized bill or a letter from the doctor.
[AGENT][NEUTRAL] It could be um an itemized bill or super bill, um, it could be office notes, just something showing the diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And question, do you guys receive the, the EOB from the primary insurance?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see, hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, it's not coming up for me. I have to go the long way. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Explanation of benefits from primary.
[AGENT][NEUTRAL] OK, so the documents are populating now. Um, so it looks like we received.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] So this is just like um
[AGENT][NEUTRAL] This is just the patient bill. It like I seeuest Diagnostic Laboratory bill, it has a patient's name on it. This is like a copy of the patient's bill. Um, they do have CPT codes on it, but we need diagnosis.
[CUSTOMER][NEUTRAL] OK. So they didn't send the EOB to you guys.
[AGENT][NEUTRAL] Let me see what this is right here.
[AGENT][NEUTRAL] Wait a minute, on the, on, yes, so we did receive the explanation of benefits from United Healthcare.
[AGENT][NEUTRAL] Um, but there's no codes on here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. So I'll, I'll, I'll work on it for you then, OK? You said your name was [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you so much [PII] do you have a reference number for the location?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK. And the first mention to my last name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that was all. You've been great. Thank you so much.
[AGENT][POSITIVE] You're welcome. I'm glad I could assist you and thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you. Bye bye.