AccountId: 011433970860
ContactId: 9e37c08e-1326-45c6-a729-037897923678
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391959 ms
Total Talk Time (AGENT): 178232 ms
Total Talk Time (CUSTOMER): 135789 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/9e37c08e-1326-45c6-a729-037897923678_20250423T13:05_UTC.wav
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[AGENT][NEUTRAL] I'm contacting you. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I was calling because um I wanted to check about a claim. Um, I had just got off the phone with um one of the uh doctors because I request that I received the bill, and they said that they sent twice uh the claim over to you all and nothing was done, and they were gonna send another request. So I just wanna make sure.
[AGENT][NEUTRAL] OK, well
[AGENT][NEUTRAL] Yes, of course, we can certainly look that up. And what is your policy number, please?
[CUSTOMER][NEUTRAL] It's 0107.
[CUSTOMER][NEUTRAL] 0755
[AGENT][NEUTRAL] Thank you. If I could verify your name, and date of birth, and a phone number, please, so I can make sure I get the correct uh policy.
[CUSTOMER][NEUTRAL] OK. My name is [PII] My date of birth is [PII]. And what phone number you needed?
[AGENT][NEUTRAL] Please, yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is the data service that we're looking for that for that claim?
[CUSTOMER][NEUTRAL] It was a date, um,
[CUSTOMER][NEUTRAL] Service date was [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] I'm just checking. I don't see that I ever got anything for [PII], um.
[AGENT][NEGATIVE] OK, it doesn't look like you received this.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Check one other place. Excuse me just a moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I received something for [PII], and that's the only thing um.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] That I received. Uh, what, what is the name of the provider? Maybe we can look it up that way.
[CUSTOMER][NEUTRAL] Well, it's under quest.
[CUSTOMER][NEUTRAL] Um, the, my physi referring phys you need my referring physician?
[AGENT][NEUTRAL] Oh, no, no, you're, it's Quest Diagnostics. OK. All right.
[CUSTOMER][NEUTRAL] Yeah yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] It doesn't look like they submitted it to us, uh, but [PII], your, your policy doesn't cover independent labs anyway. Um, so the, first of all, we, we never, no, um, we never received it, um, so we, we never received the, the, uh, the claim. But even if we had the, the things that are covered on your secondary insurance are inpatient and outpatient hospital, um, and physicians, uh, uh, co-payment for the physician.
[CUSTOMER][NEUTRAL] Oh, it doesn't.
[AGENT][NEUTRAL] So the independent labs are not going to be covered, uh, but we never received quest, uh, Quest um uh claim anyway. Now, we do receive lots of claims from them all the time. It's just I didn't, I didn't get yours, so, but it wouldn't have been uh covered anyway, I'm afraid.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK. Um, can you check on another one cause I got a bill from, uh, the orthopedic center and the date of service, um, was [PII].
[AGENT][NEUTRAL] OK, I haven't received that one either. It's, if they're telling you that they have submitted it, uh, generally, we have found that what they um are thinking of is that they submitted it to your major medical rather than to us. um, but I don't have this claim either.
[CUSTOMER][NEUTRAL] OK, well, I had to leave a voice message, so I figured I'd want to check with you first to see if you had received anything.
[AGENT][NEUTRAL] Now I
[AGENT][NEUTRAL] Uh, now, we changed a couple of years ago, we changed our, uh, PO box address, so I'm, I'm wondering if they didn't send it to the wrong address. I can give you our fax number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, or they want to fax it to us.
[CUSTOMER][NEUTRAL] Um, OK, let me.
[CUSTOMER][NEUTRAL] OK, let me just get a pencil, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, what, is that how they process, how they do things just send you guys back?
[AGENT][NEUTRAL] Yes, they could send it by fax, certainly. Now, our fax number is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And if you want to, uh-huh.
[CUSTOMER][NEUTRAL] So it's [PII] OK this is verify. I'm sorry, I was just verifying [PII].
[AGENT][NEUTRAL] That's correct, yes. And if you wish to submit the claim yourself, you can also do that through that fax number.
[AGENT][NEUTRAL] We also have an online service center um at uh [PII] if you want to submit it that way. But um if, if there's any of these claims that are coming up that, that you're not, uh, you know, that, that you aren't, uh.
[CUSTOMER][POSITIVE] OK. OK, great.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They're saying that they haven't submitted to us you can always submit them yourselves and then what we do is we pay the benefit to you and then you can turn around and and send it to the provider but so far we haven't gotten the the claim from October.
[CUSTOMER][NEUTRAL] OK. OK, no problem. Now, if, if you, if, uh, question I have for you is, would you pay for blood work if it's going through the doctor's office like they do it?
[AGENT][NEUTRAL] Yes, you do have that physician's uh um.
[AGENT][NEUTRAL] Uh, rider on your um
[AGENT][NEUTRAL] So that's is the office is it co-pay or treatment within the physician's office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, it's good to know cause I, I have some, you know, I've
[CUSTOMER][POSITIVE] I, uh, I don't recall having to pay out of pocket on that. So, and also could be because I've done it through the doctor's office, so. OK. Well, I appreciate the information. Thank you so much.
[AGENT][NEUTRAL] OK, well, there's nothing else to help with. Thanks for contacting AP have a good.