AccountId: 011433970860
ContactId: a67bd3b5-8b25-485f-91e7-5fee3848ca45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 496750 ms
Total Talk Time (AGENT): 230130 ms
Total Talk Time (CUSTOMER): 186328 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/a67bd3b5-8b25-485f-91e7-5fee3848ca45_20250102T22:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, good afternoon. I'm calling because I have to, to file a claim, um, but I have not done it before and I'm not sure what the procedure is.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. Do you have your policy number available?
[CUSTOMER][NEUTRAL] Yes, yes, I do. Um, I have, I have two numbers, the inpatient and the, the outpatient. It's um.
[AGENT][NEUTRAL] Either one.
[CUSTOMER][NEUTRAL] It's 205-953-0.
[CUSTOMER][NEUTRAL] ML 7
[AGENT][NEUTRAL] All right, thank you. Do you mind verifying your name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII], [PII].
[AGENT][NEUTRAL] All right. Thank you, Ms. [PII]. And can you verify your current mailing address, email, and phone number?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. And my cell phone is [PII]. You may have on record my husband's dog.
[AGENT][NEUTRAL] OK, and what is the mailing address?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII].
[AGENT][POSITIVE] All right, thank you. And it would be my pleasure to assist you with how to file a claim. Ms. [PII], there's two options that you can, if, if you haven't paid for that medical service, you can call the provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And provide your APL information and they can file the claim for you, we can pay them direct.
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Uh, oh, OK, yeah, no, they told me, they told me at the time of service, they told me that they do not process APL and that I have to do it on my own.
[AGENT][NEUTRAL] OK. And was this for, what type of service? Was it a hospitalization or an outpatient procedure or what type of service?
[CUSTOMER][NEUTRAL] It, it was an outpatient procedure. It was a biopsy.
[AGENT][NEUTRAL] OK. And it was performed in an outpatient facility, correct? Not in a doctor's office.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It it was uh at the doctor's office. It was a gynecological service. It was um a biopsy of my uterus.
[AGENT][NEUTRAL] OK, so if they.
[AGENT][NEGATIVE] Performed it in the doctor's office and they bill as a doctor's office, it would not be covered.
[AGENT][NEUTRAL] Now, if they bill as an outpatient facility, like they may have a surgical facility.
[AGENT][NEUTRAL] Attached to the office and they bill that as outpatient.
[AGENT][NEUTRAL] Then you would have benefits on your plan for that.
[AGENT][NEUTRAL] Procedure, but it has to be billed as an outpatient facility.
[AGENT][NEUTRAL] Do you know how they might build that?
[CUSTOMER][NEUTRAL] Um, no, how can I find out that? Is there a code or something on the invoice that probably will help determine?
[AGENT][NEUTRAL] So we're gonna need an itemized bill from them with the diagnosis codes and procedure codes. You can call and ask them for that itemized bill and ask them if they bill as an office.
[AGENT][NEUTRAL] Or if it is in the outpatient facility.
[AGENT][NEGATIVE] If they say that they bill as an office, then it would not be covered.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So I need an itemized bill and um whether they bill as an office.
[AGENT][NEUTRAL] That's right, or an outpatient facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did your primary insurance provide any benefits?
[AGENT][NEUTRAL] Did they apply anything to your deductible?
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] Uh, yes, I applied towards the deductible because it was my full responsibility to pay for the full amount of the, of the service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, check with the place where you had that biopsy performed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if they feel as an outpatient facility.
[AGENT][NEUTRAL] Please ask them for a document called a U as umbrella.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] B as in Bravo.
[AGENT][NEUTRAL] 04.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And they should know that you know if it's an outpatient facility that's the form they're going to be able to provide.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Ah, OK, so you'll be 04, uh, if, if they are able to give me that form, that means that they're billing as an outpatient facility.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I'm taking a note.
[AGENT][NEUTRAL] It kinda sounds like that, but I don't, you know, I can't say for sure.
[CUSTOMER][NEUTRAL] Yes. And in case that uh I get that form, uh, then I have to fax it to you or or email it?
[AGENT][NEUTRAL] Mhm and you can actually upload it online. I see that you have an active portal account with APL.
[CUSTOMER][NEUTRAL] Uh, my husband, yes, I can, I, I can, yes, do it through his portal or I have to have one for my own?
[AGENT][NEUTRAL] No, it's the same and the username is [PII].
[AGENT][NEUTRAL] That's the username. [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ah, OK.
[CUSTOMER][NEUTRAL] So that's my username.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And the password will be the same as he's using, right?
[AGENT][NEUTRAL] So I would not, I can't see the password you would either need to check with him or.
[AGENT][NEUTRAL] You can reset the password.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So we'll need to
[CUSTOMER][POSITIVE] Perfect. And then a little load.
[AGENT][NEUTRAL] I'm sor[PII], go ahead. Mhm.
[CUSTOMER][NEUTRAL] I'm, I'm sorry, then I upload the document in there.
[AGENT][NEUTRAL] That's right. And we'll also need a copy of the explanation of benefits from your primary insurance, how they process the claim, and what they applied to your deductible.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So we'll need those two documents.
[AGENT][NEUTRAL] So you would contact United?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then see if they have.
[AGENT][NEUTRAL] Process the claim, and if they have, you'll need a copy of the detailed explanation of benefits for that service.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Perfect and that I have to upload as well.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And, and that will be just those two documents.
[AGENT][POSITIVE] Yes, ma'am. That'll be fine.
[CUSTOMER][POSITIVE] Ah, OK. Perfect, perfect. So then I'll, I'll contact the doctor's office tomorrow.
[AGENT][POSITIVE] All right. And if you have any further questions, Ms. [PII], don't hesitate to give us a call.
[CUSTOMER][POSITIVE] Thank you so much. Mhm.
[AGENT][POSITIVE] It's been such a pleasure and thank you for calling APO. You have a wonderful day.
[CUSTOMER][POSITIVE] Thank you, you too, [PII]. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.