AccountId: 011433970860
ContactId: ac5c6ae4-1529-41dc-8972-22e4a3c5b913
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 530320 ms
Total Talk Time (AGENT): 196733 ms
Total Talk Time (CUSTOMER): 217069 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/ac5c6ae4-1529-41dc-8972-22e4a3c5b913_20250221T16:48_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] Yes, um, I got a bill from um.
[CUSTOMER][NEUTRAL] Well, it was a
[CUSTOMER][NEUTRAL] Wellness check.
[CUSTOMER][NEUTRAL] And so those are usually covered.
[CUSTOMER][NEUTRAL] Um, you know, like,
[CUSTOMER][NEUTRAL] I'm trying to think of what it was for. It's like a mammogram. And so I'm wondering why that would have been denied.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Well, I can certainly help you with that. Do you have your policy number or claim number?
[CUSTOMER][NEUTRAL] Mm, I'm trying to think where I have that, um.
[AGENT][NEUTRAL] Well, I can look it up by your social as well if that would be OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] 720602
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your name please ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And can you verify your current mailing address and date of birth?
[CUSTOMER][NEUTRAL] Sure. Uh, date of birth is [PII]. Mailing address is [PII].
[AGENT][NEUTRAL] All right, thank you. And can you verify your email and phone number, please?
[CUSTOMER][NEUTRAL] [PII]. Phone number is [PII].
[AGENT][POSITIVE] All right, thank you for that verification.
[AGENT][NEUTRAL] And you're saying this is for a wellness. What was the data service? Do you have that available?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, I have.
[CUSTOMER][NEUTRAL] I think it, it looks like [PII] 2224.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it was for uh
[CUSTOMER][NEGATIVE] Two things with breast, mammogram and then the other. It was through uh Midwest radiology. Both were denied.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] I'm checking your policy, Ms. [PII], and I don't have a claim on file for that data service. The only data service that we have on file for you is for [PII].
[CUSTOMER][NEUTRAL] OK, so how do I get to the.
[CUSTOMER][NEUTRAL] Denied
[AGENT][NEUTRAL] It wasn't denied. We don't have a claim on file.
[CUSTOMER][NEUTRAL] It says here.
[CUSTOMER][NEUTRAL] It says that it was claim denied as patient cannot be identified as our insured.
[CUSTOMER][NEUTRAL] So, what do I need to do to fix this?
[AGENT][NEUTRAL] OK. Let me give you your policy number, and that can be resubmitted under your policy number.
[CUSTOMER][NEUTRAL] Well, I think I have that right. I'm on the um website right now.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I can go under claims and forms, is that what I need to do or?
[AGENT][NEUTRAL] If you have that document saved to your computer, you can actually um submit that online and where it says need to file a claim.
[AGENT][NEUTRAL] Do you see that where it says that on there?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, and then you can just upload the document directly on your policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Download form.
[CUSTOMER][NEUTRAL] All right, so,
[CUSTOMER][NEUTRAL] I know that in the past they've needed like specific codes and stuff like that, do you know?
[AGENT][NEUTRAL] Um, so there is a can, uh, wellness claim form that you can complete as well.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And that will give us the information needed in order to process a wellness claim, and it's just the claim form that's needed.
[AGENT][NEUTRAL] And if you go under the claims and forms section.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] There's a claim form for wellness.
[CUSTOMER][NEUTRAL] And I have to fill that out and then submit the form.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] For him
[CUSTOMER][NEUTRAL] Um, which claim form would I choose?
[AGENT][NEUTRAL] The wellness claim form.
[CUSTOMER][NEUTRAL] Probably towards the bottom.
[AGENT][NEUTRAL] Let me see where that's located, let's see.
[CUSTOMER][NEUTRAL] Wellness and screening benefits claim form.
[AGENT][NEUTRAL] Yeah, that's it. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I download the form.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And fill it out and then upload it again? Is that how that works?
[AGENT][POSITIVE] Yes, ma'am. That's how that works.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I think I can handle that.
[CUSTOMER][NEUTRAL] Let's see, I'm not real, real computer savvy, but.
[CUSTOMER][NEUTRAL] Um, so do the form and the bill, upload the bill as well.
[AGENT][NEUTRAL] You if you have that supporting document you can upload the bill as well mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I will, I will do that.
[AGENT][NEUTRAL] And it's, it's fairly easy. I mean, I'm, I'm the same with you after work I'm, I'm not the best computer person.
[AGENT][POSITIVE] But it's, it's fairly easy.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, so it looks like I can just fill it out right here, no.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I downloaded it, but
[CUSTOMER][NEUTRAL] It's not
[CUSTOMER][NEGATIVE] I'm clicking on filling in my name and nothing's happening.
[AGENT][NEUTRAL] You may have to attach it to a PDF.
[AGENT][NEUTRAL] Or save it as a PDF in order to
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Now it is.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Now it is. OK. All right, so if I have any further questions, I'll, I'll just call back.
[AGENT][POSITIVE] Oh, please do. We'll be happy to assist you anytime.
[CUSTOMER][POSITIVE] OK, all right, thank you so much.
[AGENT][POSITIVE] It's been such a pleasure to assist you. Is there anything else I can help you with today?
[CUSTOMER][NEGATIVE] So I can call this company and tell them that it wasn't submitted to the right place and that um.
[CUSTOMER][NEUTRAL] I just submitted it and please allow how much time do you think?
[AGENT][NEUTRAL] So if you submit the claim benefits are gonna come if it's payable will come directly to you.
[AGENT][NEUTRAL] Or you can call the company back mhm you can also call that company back and just let give them the correct information. I don't know if they sent it to the wrong place. I, I don't have any records of receiving a claim for that data service.
[CUSTOMER][NEUTRAL] Oh, so either way.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] So, I won't have nothing to lose by paying the bill.
[CUSTOMER][NEUTRAL] Because I, if I'm filling out this form, the check's coming to me anyhow.
[AGENT][NEUTRAL] If it's payable, yes, ma'am.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Well, what I'm saying is either way I gotta pay the bill. So if I pay it now or pay it later, it won't paying it now would be better and then I would get reimbursed hopefully from you guys.
[AGENT][NEUTRAL] That's correct. If it is a covered benefit, you would get reimbursed if you file the claim.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Either way it has to be paid so that's all I'm saying is I probably just be better off just paying it and then doing what I need to do on my end.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Be done with it, right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am, I understand.
[CUSTOMER][POSITIVE] OK, then I have a better understanding of what's going on too, so, all right, thank you.
[AGENT][POSITIVE] It's been such a pleasure to assist you. Is there anything else I can help you with?
[CUSTOMER][NEGATIVE] Nope, I don't think so. You've been quite helpful.
[AGENT][POSITIVE] Oh it's been a pleasure to assist you and I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.