AccountId: 011433970860
ContactId: b318c9de-0a33-471e-a69e-e90dddb804c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 545000 ms
Total Talk Time (AGENT): 150027 ms
Total Talk Time (CUSTOMER): 347213 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/b318c9de-0a33-471e-a69e-e90dddb804c9_20250116T20:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, I have a quick question. I am trying to submit a claim or I'm going to submit a claim, um, via the portal, and, um, I know one of the things I need to submit is the itemized bill with diagnosis code, um.
[CUSTOMER][NEUTRAL] The the place where I went through, um, to get this is actually asking me to fill out an attachment 46 what they call, uh, which is like a disclosure for third party of um bills and um um they're gonna basically send it directly to.
[CUSTOMER][NEUTRAL] To APL, so I just wanna make sure I have like the correct information of where to send that, um, because it's not that I'm sending it this basically the hospital where I got the procedure done.
[CUSTOMER][NEUTRAL] So I need like an email and like an attention person like or a fax that I can give them so they can send this info.
[AGENT][NEUTRAL] OK, may I have your name please?
[CUSTOMER][NEUTRAL] Sure, my name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], may I please have your policy number?
[CUSTOMER][NEUTRAL] Yes, uh 02377436.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And could you please verify your date of birth and the mailing address for me?
[CUSTOMER][NEUTRAL] Uh, it's [PII], and the address is [PII].
[AGENT][NEUTRAL] Thank you and I also need to get a call back number and then verify the email address listed on file.
[CUSTOMER][NEUTRAL] Sure, um, [PII] and the email is [PII].
[AGENT][NEUTRAL] Thank you. And if I understood your question correctly, are you trying to submit it via our portal or you're trying to get the provider to submit the information?
[CUSTOMER][NEUTRAL] No, um, I am gonna submit the claim via the portal, but I know one of the things that, um, I have to submit is the itemized bill with showing the diagnosis code which I don't have. I have just like a laboratory bill.
[CUSTOMER][NEUTRAL] Which only shows like the data service in the description, and then I have the explanation of benefits, but I don't have that out in my bill. So I requested that from the hospital where I got the, basically when I went to the visit. And what they told me is that they're gonna send that information directly to you.
[CUSTOMER][NEUTRAL] So, if I have to submit like an attached, like a, like a, like a third party disclosure request. So, um, so you can receive the records. So I need like an email. I just wanna make sure I have the correct information.
[CUSTOMER][NEUTRAL] To where he needs to go.
[CUSTOMER][NEUTRAL] So you receive it and when you receive it, you know, it's for the claim I'm submitting.
[AGENT][NEUTRAL] OK. So in regards to that, when we receive medical records, if we hadn't received the medical records, we, we basically don't view those. If a provider is submitting in anything to us, it will have to be that claim itself and the primary EOB.
[CUSTOMER][NEUTRAL] Right, um, it's not a medical medical record. It's an item I feel with the diagnosis code which is basically.
[CUSTOMER][NEUTRAL] What I need to submit. So when I'm submitting the, the, the, the claim, I'm submitting, of course, the form that we have to submit the form, um including a copy of the, like the, the invoice or the bill that I have that I'm um basically claiming for that I'm doing and I'm also um submitting an EOB from my major insurance.
[CUSTOMER][NEGATIVE] But I don't have like the bill I'm submitting is only a data service and a description. It doesn't have like the actual diagnosis code on it.
[CUSTOMER][NEUTRAL] So that's why I'm trying to get that from.
[CUSTOMER][NEUTRAL] Basically where I got the procedure done, I'm trying to get that copy and what they told me is that they're gonna send it directly to the gap insurer like you to APL.
[AGENT][NEUTRAL] Yes, but if they're just submitting the itemized bill, the itemized bill will have to from the provider, it's going to have to come with the claim and the primary EOB. If you're trying to submit it, we can receive just an itemized bill, but we can't just receive the itemized bill from the provider.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Because if we receive any information from the provider that is meaning that we would process and make payment to that provider.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] But if we don't have the correct information, then that claim is not gonna be reviewed and processed.
[CUSTOMER][NEUTRAL] OK, um, I, I mean, I just don't know what else to do because it, it's, it's a whole mess because, right, so I'm just trying to explain like where I went is, you know, my my my gynecologist, which is you health, OK? And then it's a laboratory that I actually, what I'm claiming is a lab, um, that I did, OK? The lab is completely separate unit, like it's lab corp.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So what, so the way that
[CUSTOMER][NEUTRAL] Labor doesn't have or doesn't give like out of my field, just give you like a balance due invoice with like what like the description.
[CUSTOMER][NEUTRAL] And I do have my medical records. I mean, I can submit my medical records, but I don't know if that will show like, you know, the diagnosis calls and whatever, because I don't have that from the, from my gynecologist. When I call my UHealth, which is where I go, they told me that they were, I mean, the only way is sending it directly from them, like Uealth to APL.
[CUSTOMER][NEUTRAL] So I don't know if it's, it's something that I, I mean, just submitting my medical records will be enough besides everything else I'm submitting or is the explanation of benefits that I'm submitting for my major will be enough to process the, the, the, the claim.
[AGENT][NEUTRAL] So when you, the, you're trying to submit in the lab claim. Now, the provider that that
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, submitted that sent you over to get the lab done, that provider will actually have that diagnosis code because they did refer you over to get that done.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So whoever your individual
[CUSTOMER][NEUTRAL] So what I need to tell them is to
[CUSTOMER][NEUTRAL] To make a note on the claim number when they send it over, is that what it is when I submit the claim just give them a claim number and just.
[CUSTOMER][NEUTRAL] Um, ask him to
[CUSTOMER][NEUTRAL] Make a reference to a claim number, is that what it is?
[AGENT][NEUTRAL] The only way that you would have a claim number is if we've already processed that claim before. Is there a claim that we've already processed previously?
[CUSTOMER][NEUTRAL] No, it's something that I'm submitting like today, again, it's not gonna have that out of my field because I don't have that, that's the provider has that and that's what they're sending you.
[AGENT][NEUTRAL] OK. So, when you call the provider, are you asking them just to give you the diagnosis code over the phone so you can write that down?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I do have the diagnosis code over the phone. I mean, I have it because they gave it to me, but I'm asking for a copy of the out of my bill.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, but the only information that we're needing would be your primary EOB.
[AGENT][NEUTRAL] That shows you have a patient's responsibility of your deductible co-insurance or co-pay. And if you have the diagnosis code, you can write that on that EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I have that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we would need the claims form.
[CUSTOMER][POSITIVE] Alright perfect so yeah I do have it.
[AGENT][NEUTRAL] The claims form will have to be signed and dated, and that's the information that we're needing. The only reason we would need an itemized bill is if you weren't able to get that diagnosis code.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] OK, got it. I just wasn't sure whether I need to get like a copy of the actual um bill, but OK, with the item, the diagnosis code on it, but I do have the diagnosis code, so I'll do that. Um, thank you. I appreciate your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life, [PII]. Have a great day.
[CUSTOMER][NEUTRAL] OK, bye. Bye-bye.
[AGENT][NEUTRAL] Bye.