AccountId: 011433970860
ContactId: 9a35479f-58bc-400d-b958-df01aca16886
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 950830 ms
Total Talk Time (AGENT): 421705 ms
Total Talk Time (CUSTOMER): 437498 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/9a35479f-58bc-400d-b958-df01aca16886_20250310T15:03_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] Hey [PII], I was just calling because um.
[CUSTOMER][NEUTRAL] Because my daughter had a bill from, I think sometime last year in March. Um, the hospital should have sent a claim, but I just received their bill, um, I guess an updated bill because we've gotten in previous bills that were 0 and then now we have a balance on it. I did call them to see if they, um, they sent it over to you guys, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they didn't um I think they said that I had to go ahead and um submit this claim with you guys so I wanted to see how could I move forward with that.
[AGENT][NEUTRAL] OK. Well, I can definitely help you with filing a claim. Um, may I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, it's uh [PII]
[CUSTOMER][NEUTRAL] Last name is [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Number is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I hang out somewhere.
[CUSTOMER][NEUTRAL] Um, I have a group number.
[AGENT][NEUTRAL] OK, what's your group number?
[CUSTOMER][NEUTRAL] 15391.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And is the policy under your name or would it, is there a policyholder?
[CUSTOMER][NEUTRAL] Um, it'll be my husband, [PII].
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] Uh, my date of birth is [PII], and then it's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And you said this is for your daughter, [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And do you have the data of service um for the claim?
[CUSTOMER][NEUTRAL] Um, I'm trying to find that.
[CUSTOMER][NEUTRAL] Um, you details.
[AGENT][NEUTRAL] I just wanna make sure there's not one here.
[CUSTOMER][NEUTRAL] I know it's for March. I'm trying to see if it was [PII], um.
[AGENT][NEUTRAL] Oh, it's OK. You don't have to because there's no claims here. OK, so, to file a claim, you have three options. You can mail it, you can fax it, or you can upload it, um, upload your documents onto the online service center, which is a secure portal. Um, you'll need 3 things, so you'll need the explanation of benefits from your primary insurance.
[AGENT][NEUTRAL] You'll need
[CUSTOMER][NEUTRAL] Uh, give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, information needed.
[CUSTOMER][NEUTRAL] For claim
[CUSTOMER][NEUTRAL] OK and then um explanation.
[CUSTOMER][NEUTRAL] Oh really.
[AGENT][NEUTRAL] Mhm. For United Healthcare.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So during that time, I had Aetna, um, when she had this
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] When she had the surgery done.
[CUSTOMER][NEUTRAL] We don't have access.
[CUSTOMER][NEUTRAL] To that unless, will I have to give them a call to try to get that?
[AGENT][NEUTRAL] Well, so this secondary policy is second only to United Healthcare.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] one day.
[AGENT][NEUTRAL] Let me see if the policy before that. Hold on one second.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, because we were under with Aetna during that time.
[AGENT][NEUTRAL] So then you might have to file it under this one. Hold on one second, 2134.
[CUSTOMER][NEUTRAL] Yeah, cause I, I told them I'm like, why did you guys take a whole year to
[CUSTOMER][NEGATIVE] I mean, send me this bill because I mean I don't know how insurance claims work and until recently they're sending me this and I'm like it's a whole year later.
[AGENT][NEUTRAL] Well, OK, so the good thing is we don't have a timely filing limit, so you can file at any time as long as the policy was active on, you know, whatever data service you went.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So you don't have to worry about that part. My concern is this, are you sure that Aetna was the only insurance you did you had at the time, because I even went to the old policy to see, cause sometimes they, the groups do change primary insurances, but this is through his job and they only this United Healthcare is the only one that's listed as major for this.
[AGENT][NEUTRAL] Even on the policy.
[CUSTOMER][NEUTRAL] Uh, no, yeah.
[CUSTOMER][POSITIVE] No, yeah, I'm totally for sure on this because we've, I've, I've had so many medical bills and I mean this is my secondary, um, that we have used for all of them, and I mean I even have hospital bills that I mean have this under um with my Aetna so.
[AGENT][NEUTRAL] Were you working at a time and had Aetna? Because you can have more than one. I'm just asking because
[CUSTOMER][NEUTRAL] And I mean that's the only thing.
[CUSTOMER][NEUTRAL] Oh no, girl. I have been.
[CUSTOMER][NEGATIVE] I've been a stay at home mom for about 3 years. Um, yeah, no, I, we don't qualify for any other benefits. I wish we did, but no, no Medicaid, no, um no government assistance. I wish we did because it pays for everything, but no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I've gone through, the only reason, the only reason I'm asking is because I've gone through all, y'all have had three policies with us since [PII], but I went through all of them and it says United Healthcare.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, even for what date of service was this?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me look at this bill, even for [PII] it says United.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] 10, what, what's the date of service?
[CUSTOMER][NEUTRAL] So this date of service is for the year of [PII], so [PII].
[AGENT][NEUTRAL] [PII]. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, but I don't think they submitted this one.
[CUSTOMER][NEUTRAL] Um, but even I went to the hospital back in [PII], which was what last year? Yeah, I was at the hospital last year, um, and they applied my, my insurance.
[AGENT][NEUTRAL] It's OK, so.
[CUSTOMER][NEUTRAL] With Ana.
[AGENT][NEGATIVE] Yeah, we have claims, but this isn't Aetna.
[CUSTOMER][NEUTRAL] Really
[AGENT][NEUTRAL] So like even when I go under you.
[AGENT][NEUTRAL] So like it's broken down into each person on the policy. So when I go to you to like see your claims for last year.
[AGENT][NEUTRAL] Like I, the last claim we paid to a hospital was [PII]. So we're paying your claims, but it's not Aetna, it's United Healthcare, I mean as primary to us.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Where I was, I did have, you know, I've been to the hospital so many times.
[CUSTOMER][NEUTRAL] And I probably didn't go during that time.
[CUSTOMER][NEUTRAL] Um, and I know that it changed to mid year.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so I'll figure that part out. Um, so all we need is an explanation of benefits. Um, what would the other two parts be?
[AGENT][NEUTRAL] So the explanation of benefits from primary, so you're gonna, um, the explanation of benefits, the itemized bill from the hospital or the doctor's office, wherever she went, you're going to ask them for an itemized bill.
[AGENT][NEUTRAL] They may call it a universal bill, you know, UBO4.
[AGENT][NEUTRAL] As long as it has the diagnosis codes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The procedure codes?
[AGENT][NEUTRAL] And then all the charges.
[CUSTOMER][NEUTRAL] Diagnosed.
[AGENT][NEUTRAL] Because the
[AGENT][NEUTRAL] Depending on what facility they might call it one or the other, but it's the same thing.
[CUSTOMER][POSITIVE] Cool.
[CUSTOMER][NEUTRAL] OK, so you said they can.
[CUSTOMER][NEUTRAL] I have an update on my phone so now it just wants to type in Spanish so we said diagnose code, um, provider's code.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Procedure.
[CUSTOMER][NEUTRAL] Oh, procedure or procedure code.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what would the next one be?
[AGENT][NEUTRAL] Diagnosis code, procedure code, and then all the charges.
[CUSTOMER][NEUTRAL] All the charges, OK.
[CUSTOMER][NEUTRAL] So I have on here, um, have on there the explanation of benefits itemized receipts, um, and then which could also be called universal bill.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] itemized bill or or a universal bill. Mhm.
[CUSTOMER][POSITIVE] Brilliant. OK, and then it should have the diagnosis code, the procedure code and all charges.
[AGENT][NEUTRAL] Yes, and then the last thing you're gonna need um is the Medlink claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Paying for.
[AGENT][NEUTRAL] And the claim form can be found on our website.
[AGENT][NEUTRAL] And that's [PII] like [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] M like Mary,
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then as soon as the page populates to the top right, you'll see where it says claims and forms, you'll click on that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then scroll down the page till you see um the forms and documents. It'll say 123 at the bottom is 3 pages of documents. It'll most likely be on page 2 because it's alphabetical order.
[CUSTOMER][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] OK, let me get on here and.
[CUSTOMER][NEUTRAL] American [PII].
[AGENT][NEUTRAL] Oh, and since you're on the, um, since you're going to the website, would you, when you file the claim, would you most likely do online or would you fax it or mail it? Because I can show you how to do the portal too if you want to sign up for it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, let me see if y'all have one.
[AGENT][NEUTRAL] Which, um, which way would you probably want to send it?
[CUSTOMER][NEUTRAL] I'll probably wanna upload it to be honest, because since I'm the one, yeah, um.
[AGENT][NEUTRAL] Online, OK.
[AGENT][NEUTRAL] I thought so.
[CUSTOMER][NEGATIVE] Yeah, cause no, I, it's, I don't have a fax. I don't even know how to fax things. Um.
[CUSTOMER][NEUTRAL] I mean, I used to, but I had to work, but I'm like, mm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I don't need to do this anymore, OK, um, so I'm on this thing it says, so I'm supposed to get on the claim forms and policy change documents.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on, I'm gonna pull it up too so I can look with you. Hold on one second.
[AGENT][NEUTRAL] OK, so you clicked on claims and forms and then what did you say? Yeah, what did you see?
[CUSTOMER][NEUTRAL] OK, so there's claims and forms. I'm scrolling down and then it says file a claim online, other ways to submit a claim and then it says download and complete the appropriate forms and mail. So then it gives me like download and complete the appropriate claim forms. They click that little thing.
[AGENT][NEUTRAL] Mhm. Keep scrolling.
[CUSTOMER][NEUTRAL] I'll keep scrolling.
[AGENT][NEUTRAL] Mhm. And you'll see it says um claim forms and policy change documents.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, yes.
[AGENT][NEUTRAL] And then keep scrolling down till you see the 123 and then click on number 2.
[CUSTOMER][NEUTRAL] I don't let me see what oh, I see. OK.
[AGENT][NEUTRAL] And then Medlink is the 12 3rd 1 on the page.
[CUSTOMER][NEUTRAL] Oh, I see. OK. Um.
[CUSTOMER][NEUTRAL] I look for, let me send this to my husband.
[CUSTOMER][NEUTRAL] Print this for me, please.
[CUSTOMER][NEUTRAL] OK then I'll send that over to him.
[AGENT][NEUTRAL] And then if you want to download and save it to to your um computer whenever you file the claim, you'll have it there and then you'll just upload it with your other, whatever documents you're sending for your claim.
[CUSTOMER][NEUTRAL] OK, let me take that.
[CUSTOMER][NEUTRAL] See that's true you.
[AGENT][NEUTRAL] And then after you save it, let me know and I'll show you how to get to the portal.
[CUSTOMER][POSITIVE] OK, we're good.
[AGENT][NEUTRAL] You're good. OK. So then scroll all the way back up to the top, um, where you saw that claims and forms, but you're gonna click on sign in.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I just create a new user.
[AGENT][NEUTRAL] Well, actually, I looked to see if y'all have a um a policy to see if you have an account and you do. So you um where it says log in, the username is [PII]. It has a capital D, but I don't know if that matters or not.
[CUSTOMER][NEUTRAL] OK [PII].
[AGENT][NEUTRAL] And it's all together.
[CUSTOMER][NEUTRAL] Oh like a feeling.
[AGENT][NEUTRAL] And then for the password, if you don't know it or remember it, it will be the forgot forgot password reset and then it'll let you in once you reset it.
[CUSTOMER][NEUTRAL] Ask [PII] about login.
[CUSTOMER][NEUTRAL] OK, I'm just gonna wait on him cause.
[CUSTOMER][NEUTRAL] It has his stuff so I'm like mm I ain't gonna mess with with his login.
[AGENT][NEUTRAL] So once, OK, so once you get in, um, you're looking for your dashboard will populate and then you're looking for, um, it'll say upload documents and you'll click on that and then just follow the prompts, it'll take you step by step till you get to the upload part.
[CUSTOMER][NEUTRAL] This.
[CUSTOMER][POSITIVE] Perfect. OK. And then I think I'm all set. I?
[AGENT][NEUTRAL] I think you are. Um, make sure when you call um United Health.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] When you call United Healthcare.
[AGENT][NEUTRAL] So, like, do you have a United Health, you have an Aetna ID card, you don't have anything United Healthcare?
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] No, I do. I have you right now we're on United Healthcare. So United Healthcare is a, yeah, like that's our primary um insurance, um.
[AGENT][NEUTRAL] OK, OK, OK.
[AGENT][POSITIVE] OK, OK, good.
[CUSTOMER][NEUTRAL] Yeah, so I mean we're under we're covered with the primary for sure.
[AGENT][NEUTRAL] Yes, OK. So you'll just um call the member services number on the back and just let them know you need an explanation of benefits for that [PII] date, and they usually email it to you or if you have access to their portal, um, they usually have the explanation of benefits on there too.
[CUSTOMER][POSITIVE] OK, um, I have that up here. OK, perfect. OK, thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, no, that should be all. Um, I just have to call around and start getting paperwork.
[AGENT][POSITIVE] Alrighty, well, thank you so much for calling APL Soledad. I hope you have a great day.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] OK.