AccountId: 011433970860
ContactId: ac63348f-a0b4-48d4-9055-5e19fd75ce7a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 825349 ms
Total Talk Time (AGENT): 339552 ms
Total Talk Time (CUSTOMER): 283562 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/ac63348f-a0b4-48d4-9055-5e19fd75ce7a_20250228T20:59_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um,
[CUSTOMER][NEUTRAL] I, I could be wrong, but um my name is [PII]. I think I talked to you a little bit ago.
[AGENT][NEUTRAL] Uh, with the baby?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mr. uh, let's say if I'm. Is it [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Oh wow, yeah, hey, it's [PII] again.
[CUSTOMER][NEUTRAL] OK. Um, I think I found what you were talking about.
[AGENT][NEUTRAL] Strict on
[AGENT][NEUTRAL] OK. What's the policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] My policy number is 02279404.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], we don't have to go through that verification since I spoke with you earlier.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so did you find the explanation of benefits or the diagnosis codes from Quest?
[CUSTOMER][NEUTRAL] Um, I found it on my insurance, the claim number and.
[CUSTOMER][NEUTRAL] I'm sorry, I'm heading back to it right now.
[AGENT][POSITIVE] OK, take your time. I'm so glad you got me back.
[CUSTOMER][NEUTRAL] OK, so 15908.
[CUSTOMER][NEUTRAL] Sorry, it's actually, I'm on my computer now, it's a little different than on my phone.
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] You're fine. You take your time. I just.
[AGENT][POSITIVE] Hope we can get that information, get it taken care of for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I have the diagnosis code that's Z34.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then the claim number, so is the claim number on here just, is that through the primary insurance or is that the claim number just like in general?
[AGENT][NEUTRAL] Is that the 35, let's see.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Is that the um
[CUSTOMER][NEUTRAL] I have uh this one is 946-717-64.
[AGENT][NEUTRAL] That's probably with [PII]'s claim number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] How much was that the, the other bill for?
[AGENT][NEUTRAL] I think it was 66, that, that's from memory, so hang on, let me get, let me get everything pulled back up.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Go back to the notes cause I think I put it in the notes and everything.
[AGENT][NEUTRAL] So that Quest Diagnostic claim that we paid was for a total billed amount of $66.83 but that's the one, the one that we have on file and that was paid.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And what was that claim number?
[AGENT][NEUTRAL] Claim number 3551775, that's the APL claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess this is the [PII] claim number.
[AGENT][NEUTRAL] Yeah, probably
[CUSTOMER][NEUTRAL] But I have the Z34.01 for that one.
[AGENT][POSITIVE] Perfect. Mhm.
[CUSTOMER][NEUTRAL] OK, so I see that one and I see the other one which is for $59.08.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Does that one have a diagnosis code on it?
[CUSTOMER][NEUTRAL] Yes, it's Z34.01.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And you can just upload that.
[CUSTOMER][NEUTRAL] So if I.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] If I upload that, what do I upload it to so I'm on APL's website.
[CUSTOMER][NEUTRAL] And is it mail paper form or fax documents?
[AGENT][NEUTRAL] So if you're on the website, do you see where it says upload claim form or upload claim documents? Would you like to file a claim?
[CUSTOMER][NEUTRAL] Yeah, I, I almost feel like it'd be easier just for me to send it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So if you can look at that.
[CUSTOMER][NEUTRAL] So do I need do I need to, do I need to print off?
[CUSTOMER][NEUTRAL] The anthem.
[CUSTOMER][NEUTRAL] Bill or the anthem.
[CUSTOMER][NEUTRAL] Um, explanation of benefits.
[AGENT][NEUTRAL] Right, if you, if you have got that online, you can save that explanation of benefits from Anthem.
[AGENT][NEUTRAL] To your computer?
[AGENT][NEUTRAL] And then on your APL website where it says, would you like to file a claim?
[AGENT][NEUTRAL] You can just upload that document there.
[CUSTOMER][NEUTRAL] OK, I mean it does say on here this is not an explanation of benefits.
[AGENT][NEUTRAL] What does it say?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I, I guess this is just the claim details.
[AGENT][NEUTRAL] OK. And does that show what was applied to your deductible or co-pay or co-insurance?
[AGENT][NEUTRAL] So it should have.
[AGENT][NEUTRAL] The amount charged.
[AGENT][NEUTRAL] The amount paid or, or the um.
[AGENT][NEUTRAL] Discounted amount.
[CUSTOMER][NEUTRAL] So, so this one that I'm looking at has total bill discount allowed other insurance plan payment covered, co-insurance, co-pay, deductible not covered what you may owe.
[AGENT][NEUTRAL] But it does have how much was applied to the deductible?
[CUSTOMER][NEUTRAL] Um, it just shows me.
[AGENT][NEUTRAL] I know it's hard to understand insurance.
[CUSTOMER][NEUTRAL] It just shows what what what was what was billed total bill.
[AGENT][NEUTRAL] And does it have a column for the co-pay or deductible or co-insurance in an amount on that column?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] No, it does not.
[AGENT][NEUTRAL] OK, so what I would do is I would upload that document and then go to the explanation of benefits for that claim.
[CUSTOMER][NEUTRAL] Oh, I, I, I did, I found the explan of the explanation of benefits form.
[AGENT][NEUTRAL] OK, good. So, the EOB or explanation of benefits may not have that diagnosis code.
[AGENT][NEUTRAL] So I would upload both of those documents.
[AGENT][NEUTRAL] The one with the diagnosis code and your explanation of benefits, your EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Just trying to figure out the, the best way to get all the information so you don't have to worry about it. You need to put this needs to be taken care of so you don't have to worry about it anymore.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so I'll need those two forms and then where, where exactly do I go and claims and forms.
[AGENT][NEUTRAL] So if you go where it says on your dashboard where it says would you like to file a claim?
[AGENT][NEUTRAL] Do you see that?
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] I do not, oh, I have claims and forms. I click on that.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] I mean it says file claim online 24/7.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, let me actually.
[CUSTOMER][NEUTRAL] I guess it logged me out. Let me see.
[CUSTOMER][NEUTRAL] OK, so I'm on my page.
[CUSTOMER][NEUTRAL] I don't see anywhere that says would you like to file a claim.
[AGENT][NEUTRAL] Under my claims?
[CUSTOMER][NEUTRAL] Uh, so my claims it says upload documents.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you have documents to upload for a claim?
[AGENT][NEUTRAL] Yeah, there you go.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'll go there. So what exactly do I need to upload to that?
[AGENT][NEUTRAL] So that EOP from Anthem and then the claims details which has the diagnosis code.
[AGENT][NEUTRAL] Those two documents and then just be sure to, it'll ask you who you're submitting it for and you can put [PII]'s name there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, do I need to submit the bill, the bill for.
[AGENT][NEUTRAL] And just kind of follow the instructions.
[AGENT][NEUTRAL] You can include the claim, the, the bill, yes, so you can include that.
[CUSTOMER][NEUTRAL] Quest as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I think I
[CUSTOMER][NEUTRAL] Should be able to get that done.
[AGENT][NEUTRAL] With a question mark?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I heard that question mark.
[CUSTOMER][NEUTRAL] Um, I guess how, how long does it take from when I submit it to you guys at least receive it so that I can call back. I won't be able to do it until tomorrow or Sunday, so how long after, um, I submit it should it show up so I can confirm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. So what's gonna happen when you submit it online, you're going to receive a confirmation that it was uploaded successfully.
[AGENT][NEUTRAL] And then if you wanted to call back Monday or Tuesday to make sure that we have the claim and you know they can take a quick review of it just to make sure that everything is there that we need it normally takes between 7 to 10 days to process so in about 7 to 10 days you can go online, so once you upload it you're gonna have an open document you'll be able to see that we've received documentation.
[AGENT][NEUTRAL] But it won't have a claim number yet. Once it's processed, it will have a claim number. You can even sign up for text messaging, you know, and you'll receive a text that we've received the document you'll receive a text once it's processed.
[AGENT][NEUTRAL] With the claim number and then you can click on that claim number to view the claim decision. Now if you do sign up for the text messaging sometimes it does take up to 48 hours to be able to view.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In the portal, you know, you'll see the claim number sometimes our EOB will not be available up to 48 hours. So if you click on it and there's no EOB, you're gonna get a message, you know, stating that it's not available. Please allow 48 hours or up to 48 hours to view, or you can call us back once you get that claim number and we can check the status for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect um.
[CUSTOMER][POSITIVE] I think that's all I need and hopefully I should be able to get this figured out now.
[AGENT][POSITIVE] Yes sir, hopefully we can get that information and get it paid for you and then you can pay Quest and.
[AGENT][NEUTRAL] Put that one to rest.
[CUSTOMER][POSITIVE] I, I will be so glad when I can finally do not have those anymore. I will probably get I will, I will go.
[AGENT][NEGATIVE] You know, it's just been too long.
[CUSTOMER][NEGATIVE] Somewhere else because I've heard nothing but bad about billing.
[AGENT][NEUTRAL] Yeah.
[AGENT][MIXED] It it's, it, it gets a little rough sometimes, but hopefully we can get this taken care of for you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Perfect. I appreciate it so much. I do have one other question. Um, it has nothing to do with this though. um, I'm just confirming APL has, uh, for pharmacy, um, APL has nothing to do with prescriptions. Correct.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] That, that is correct. That is through your uh prescription provider.
[AGENT][NEUTRAL] And it could be through Anthem.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not sure
[CUSTOMER][NEUTRAL] Yep, yep, I just, it is, I just wanted to make sure I just we got new cards at the beginning of the year and I just needed to make sure which one I was gonna give them.
[CUSTOMER][NEUTRAL] So all right, that's all I have.
[AGENT][POSITIVE] Well it's my pleasure to assist you again, and I'm so glad you got me. I knew what was going on and we didn't have to go through the thing, but I hope you and your family have a lovely weekend.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][POSITIVE] You too have a good one.
[AGENT][POSITIVE] Thank you, Mr. [PII]. Take care.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.