AccountId: 011433970860
ContactId: a3e34ce2-ccb5-486f-854a-03745b3573ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 770450 ms
Total Talk Time (AGENT): 338863 ms
Total Talk Time (CUSTOMER): 471171 ms
Interruptions: 9
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/a3e34ce2-ccb5-486f-854a-03745b3573ed_20250204T15:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII]. My name is [PII]. My um uh certificate number is 02145414 M as in Mary, L as in liquid uh 8. I don't know what liquid, that's a weird name. It's a weird word to you.
[AGENT][NEUTRAL] Got it. That's fine.
[CUSTOMER][NEUTRAL] I'm looking at water, so that's what came to my mind, sorry, I.
[AGENT][POSITIVE] That works. I liquid. That's fine. I got it.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, um, was that really quick if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, thank you. And what can we help you with today?
[CUSTOMER][NEUTRAL] So I just downloaded a few explanation of benefits. I've been trying to work with Quest for the longest time to try and get these properly to you so that you get to process them and there's a couple that there were issues with, um, which I'm trying to figure out. So uh let me give you first a claim number that I'm, uh, the first one that I want to talk about is 3558628.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then.
[CUSTOMER][NEUTRAL] And it basically says that um, so please provide copies of your explanation of benefits from your primary insurance carrier to make sure that, you know, it's covered by the insurance which I have in front of me. So I just need to know where I would need to send that to you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course, OK, and before we go any further, listed, I'm just gonna verify some information. Um, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you. Uh, looks it's [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Perfect. OK, thank you for verifying that. OK, so you have the primary EOB um and let me take a look here. There's a few different ways you can send that to us. um, have you created an online account with us on our online portal with that?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, yes, as a matter of fact, that's where I downloaded those from.
[AGENT][NEUTRAL] You have, OK.
[AGENT][NEUTRAL] OK, so on our portal, um, now do you have access to a desktop or a laptop computer?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK perfect. OK, so if you go to our online portal, um, you can just use the, you know, of course, um there should be a spot where you can upload uh documents and I will say because there can be some confusion, the online portal is different from our public website so our public website is of course [PII]. The online portal is secured. [PII].
[CUSTOMER][POSITIVE] I'm on it right now.
[CUSTOMER][NEUTRAL] OK, yeah, I'm on that and I actually see it right now it's a green button that says upload upload files.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, perfect. Yes, ma'am. So I will say that's going to be the quickest and easiest way to get that information to us um you can scan it if you've got a scanner or you can just simply take a picture uh of those files as long as it is clear and legible. That's perfectly fine.
[CUSTOMER][NEUTRAL] OK, so what I'm gonna do, I'm just downloading it directly from Aetna. I'm gonna print to a PDF, yeah, so do I put claim number? Do I put as reference the claim number on the file?
[AGENT][POSITIVE] Oh perfect, even better.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You can, yes, that would, that would be, of course, make it go much quicker.
[CUSTOMER][NEUTRAL] All right, so let me go back to here, upload files, uh, enter claim details. So for me and select the coverage, OK, and then next and select the files, OK.
[CUSTOMER][NEUTRAL] And claim number, here we go. O.
[CUSTOMER][NEUTRAL] Are you able to see it right away if you, if I submit it right now?
[AGENT][NEUTRAL] It should be pretty quick, yes, it might take a few minutes um let me know uh did you submit it already?
[CUSTOMER][NEUTRAL] Yeah, it's submitting right this second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, cool, give me just a moment um might need to just refresh it and then again it can take a couple minutes to reflect but it it does get to us very quickly let's see.
[CUSTOMER][NEUTRAL] It does still say submitting is taking a little bit of time, OK.
[AGENT][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] Yeah, I mean, it's kind of just sitting there submitting.
[AGENT][NEUTRAL] That's OK. Um, it can take a minute.
[CUSTOMER][NEUTRAL] But, but that's OK.
[AGENT][POSITIVE] Yeah, that's perfectly fine.
[CUSTOMER][NEUTRAL] OK, so then once you once you receive that and I've, I've referenced the claim number, it should be just, you know, should I need to then call you back once it's, it's, you know, all set to, you know, uh, like I said right now it still says submitting. I don't wanna keep you necessarily on the phone while it actually submits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Of course, no, no, you're fine, um, so I will say, uh, on the portal you should be able to view the status, um, once we get it, it can take about 7 to 10 business days for claim information to process doesn't generally take that long, so I would say with today being Tuesday, um, you can either check on the online portal or you can give us a call, um, maybe Thursday or Friday.
[AGENT][NEUTRAL] Um, and then we can have an update for you by then, um, you know, it very well could still be in line for processing, but we could have some, you know, an actual update for you.
[CUSTOMER][NEUTRAL] OK, so that brings me to my next question. So the, I have two that says that I need to submit the explanation of benefits from my primary that I'm gonna do that. There's another one that basically has, you've paid most of it except for one line item from Quest, and it says it's because again the same thing with the medical provider, and the insurance, the, the major medical, uh.
[AGENT][POSITIVE] Because that's completely up to you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, explanation of benefits actually does say that it's not covered, which is weird because they've covered. I do this test every 3 months from with the, uh, with this particular doctor every 3 months I have to, you know, follow up with her to make sure that everything is kind of status quo. So they've always paid it. I don't know why they would have this particular one, so I'll have to talk to Aetna first about that one and then submit it.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Absolutely yeah see what's going on with that mhm and there's no timely filing limit so it's not like you have to get it to us within a certain time frame just whenever you've got it you can send it to us and we'll get it processed.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, now there is another one that I remember I've had this conversation already with somebody there from, from APO um the particularly it was uh another uh bill from Quest that the Quest submitted to you and apparently it was submitted minus a line item. So like let's say that there's uh different uh codes for the, for the different blood tests or whatever, um, one of them.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Wasn't paid and it wasn't that uh at least the, the explanation of benefits didn't say that it wasn't uh covered or for any reason it was just missing from the explanation of benefits from you guys. So when I called uh a quest and I said, hey, listen, you know why, you know, because what I was told is, is like, OK, you have, I'm looking at the Quest bill and the quest bill, let's say has 11 line items and your explanation of benefits only has.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] 10, so when I spoke to you guys, I was told that your, your, uh, what they submitted meaning Quest submitted to you only had those 10 line items, right? So when I called back to Quest, they're, they're telling me no, all of the line items were there and so they can they're telling me and so I said, can you just try and submit it again? I'm sure they'll see that most of them are duplicates, but obviously one was missing.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they said that they can't do that so I'm trying, so what they've asked me to do is to call you guys and let them know that uh that this is a situation they've asked me to fax or or email over their laboratory bill, the explanation of benefits from Aetna, the explanation of benefits from APL, and they want somebody from APL to contact them so that they can figure out how to get you.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You know how to get paid for that line item but I don't know if that's gonna be, if that's something that you guys are able to do that.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] We don't typically contact providers like that um but they are more than welcome to give us a call we talk to providers all the time um we don't typically reach out to them though they would have to be the ones to call us because they have to be able to verify your information so that we can speak with them um but we can absolutely um so if they keep giving you a run around like that, have them give us a call so we can get it straightened out for you that's the worst you being stuck in the middle trying to get on both and.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] I literally told them.
[CUSTOMER][NEGATIVE] No, and, and I know, and then you're telling me that and, and Quest is telling me the exact same thing that they don't contact that that you guys have to initiate the call and I'm like, well, you're not gonna initiate it. You guys aren't gonna initiate it. I'm stuck in the middle saying, OK, how do I fix this because I'm, I know exactly what's going on mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Well, another potential
[AGENT][NEUTRAL] Uh, another potential solution I'm sorry to interrupt, um, is that if they've given you that information, that, uh, statement, the autoized statement that shows all of those codes that you were saying, um, and you've got that explanation of benefits, you can submit that to us, um, you can do it the same way that you just did through the portal. All we would need is that itemized statement that shows those codes that you were talking about and then of course the explanation of benefits from your primary.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And so yeah like you said some of them might register as duplicate but if there's one that was not of course we'll be able to get that one processed.
[CUSTOMER][POSITIVE] Oh, OK. Well, let me try that way. Um, maybe we can do it faster that way if that's uh possible. So let me try that way and that way if that doesn't work, you know, because I already told my husband, and my husband's like, OK, yeah, just pay it. I mean, I, I just honestly, on, on, uh, uh, on principle, it's not a lot of money and I would not have a problem paying it, but on principle because what
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] No, it's the fact of the matter. If you've got the coverage, yeah, if you've got the coverage, you shouldn't have to. That makes sense. So yeah, let it, we'll see what we can do to help for sure. I mean, I get, I get that solution like I can be like that too where it's just can turn into a headache, but if you've got that coverage, obviously you shouldn't have to pay that.
[CUSTOMER][NEUTRAL] Got it. OK, well, let's try it that way. I'm gonna submit it on the, on the, uh, portal like, like this one, which, by the way, is taking a long, long time. I still say submitting maybe something went wrong. Maybe I should cancel it and start it again.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEGATIVE] Weird.
[AGENT][POSITIVE] Each refreshing the page, yeah.
[CUSTOMER][NEUTRAL] Let me see, let me try refreshing the pages.
[AGENT][NEUTRAL] Just for good measure, I know you said you're on an actual computer. What browser are you using?
[CUSTOMER][NEUTRAL] I am on the uh what's this one called uh Microsoft Edge.
[AGENT][MIXED] OK, OK, I will say that our portal does have the best support for Google Chrome, but it does also have support for Edge and Safari. Some of these other browsers like um Firefox though like they don't have any support for it, so that's why I just had to ask.
[CUSTOMER][NEUTRAL] OK, you know what, maybe I, maybe I try the, uh, the Chrome. I'll log out and log back in through Chrome and try that again.
[AGENT][POSITIVE] If you got Chrome, I would give that a shot, yeah.
[CUSTOMER][NEUTRAL] If there's anything that has been uploaded on the upload confirmation that would have a file number there or like uh it would say you know how like I'm looking at this uh like the claims process right and it says process the date, the name, the applicant and all the way at the end after completed it says upload confirmation and it says no files. I would see it there if it uploaded properly.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, it would give you an actual confirmation number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, and it, it didn't give me that. So let's let me log out and let me like log back in. OK, so I'll, I'll go ahead and and log out, do it from Chrome, log, you know, send all those because then all three of them that I would have, um, I should have files to upload for you guys and you know, then we can try, uh, check next week and see if everything else is, yeah, OK, sounds good thanks so much for your appreciate it.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yeah, definitely.
[AGENT][POSITIVE] Get it all knocked out. Yes, ma'am.
[AGENT][NEUTRAL] Uh, did you have any other questions for me? I know that was quite a bit of information.
[CUSTOMER][POSITIVE] No, no, I think it's pretty clear. Thank you so much. I appreciate the help.
[AGENT][POSITIVE] All right, glad to hear that. You're very welcome. I hope you have a great rest of your day with that.
[CUSTOMER][POSITIVE] You too. Take care.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.