AccountId: 011433970860
ContactId: b5aa7acb-81a4-4166-9fa8-cb78f664013c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 534280 ms
Total Talk Time (AGENT): 264161 ms
Total Talk Time (CUSTOMER): 114554 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/b5aa7acb-81a4-4166-9fa8-cb78f664013c_20250324T15:03_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] Hey [PII], um, I have a question for you. I have this from my, um, employer, and I've been submitting or I guess, uh, I have my therapist that submits the co-pay reimbursement, and she said that APL hasn't, um, paid her back for the copays yet, so now she's billing me for them.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, let me look into the claim and see what's going on, but I can definitely check for you.
[CUSTOMER][NEUTRAL] I'm trying to figure it out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][POSITIVE] You're welcome. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[CUSTOMER][NEUTRAL] And my cell is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the, um, may I have your policy number?
[CUSTOMER][NEUTRAL] Uh, sure, one moment, and.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 06454
[CUSTOMER][NEUTRAL] M as in Matthew L
[CUSTOMER][NEUTRAL] And then it's 7 for in hospital or 8 for outpatient?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] All right, now I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And you said email?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, I think it's my work one. It's [PII].
[AGENT][NEUTRAL] So this one is is your personal one's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. So, um, let me take a look at your claims.
[AGENT][NEUTRAL] What's the name of the facility?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's Doctor [PII].
[CUSTOMER][NEUTRAL] Let me see, well she has a thing uh.
[AGENT][NEUTRAL] I can also look the claims up. Do you have the dates of service that you went to? Oh, I see how it's listed.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Peaceful journey canceled.
[AGENT][NEUTRAL] Let me see if this might be it. Yeah, it's coming over UMHC, so I'm trying to get something to match that. Does that sound familiar? Let me look at the documents.
[AGENT][NEUTRAL] I'm pulling up the documents to see what was um received so I can try to see if this is the correct claim. If so, there's a few with this provider, but they were all paid. Uh, let me
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See that now.
[AGENT][NEUTRAL] Get with the doctor.
[CUSTOMER][NEUTRAL] Yeah, Doctor [PII].
[AGENT][NEUTRAL] Really I'm trying to see if I can see her name anywhere.
[AGENT][NEUTRAL] No, this is a glossary. Hold on one second.
[AGENT][NEUTRAL] You don't list the doctor's name on the.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Claim form that can't be. Hold on one second, [PII].
[AGENT][NEUTRAL] The doctor's name is not on here. Let me try another one. Hold on one second.
[AGENT][NEUTRAL] Maybe this is just a continuing cause there's 2 here. I hope so.
[AGENT][NEUTRAL] Hold on one moment, I'm just waiting for the documents to populate here.
[AGENT][NEUTRAL] See, so there's no so when we search for claims, we search with the data service, but you only have a few claims here, so I'm just clicking on each of them, but like,
[AGENT][NEUTRAL] There's no claim here with your doctor's name, so I went to see like the documents that were submitted. Usually they'll have like the doctor's name on the claim form, but I don't even see that and all it says for provider is UMHC, so I, I don't know how to figure out if this is for you.
[CUSTOMER][NEUTRAL] I have, she sent me like an invoice.
[AGENT][NEUTRAL] OK, so what's the date of service on the invoice?
[CUSTOMER][NEUTRAL] There's 5 different ones.
[AGENT][NEUTRAL] OK, what's all, uh, you want me to search for all 5 of them right?
[CUSTOMER][NEUTRAL] Um, the [PII].
[CUSTOMER][NEUTRAL] Uh, sure, maybe you find one that makes it easier to find the rest though. The first one was [PII].
[AGENT][NEUTRAL] Let's see, hold on one second.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. There's nothing on file for that date. Um, what's the next one?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is, OK.
[AGENT][NEUTRAL] Hm, so now I'm wondering if they're filing them. OK, there's nothing on file for the [PII]. What's the next day?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] I don't think they're filing these claims to your secondary insurance.
[AGENT][NEUTRAL] Because that's the 3rd 1 that's not here. What's the next one?
[CUSTOMER][NEUTRAL] Is there a special thing they got to do with it?
[AGENT][NEUTRAL] Well, so
[CUSTOMER][NEUTRAL] Uh, the [PII].
[AGENT][NEUTRAL] [PII] hold on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Nothing for the [PII]. Let's try the last one.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yeah, they're not filing to your secondary. So this is what they're gonna have to do, um, because we're second to United Healthcare only. Do they have your, do they have the APL like policy information?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Like your policy number?
[CUSTOMER][NEUTRAL] Like, I gave her my card, yeah.
[AGENT][NEUTRAL] Yeah, OK. So they were supposed to bill United Healthcare, United Healthcare will apply, you know, based on your policy with them.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEGATIVE] They're going to send back the explanation of benefits, um, and whatever the decision was to the provider and then at that point, they're supposed, the provider is supposed to automatically bill us. Does it doesn't look like they're billing your second because there's nothing on file for any of those days. The good thing is there's no timely filing limit.
[CUSTOMER][NEUTRAL] So, does she need to share the estimation of benefits or?
[AGENT][NEUTRAL] So I was gonna say the good thing is there is no timely filing limit, so they can file the claim at any time. So they would need the claim form that they like they have their own claim form for a provider and then just the explanation of benefits from United Healthcare and there.
[CUSTOMER][NEUTRAL] How does that work?
[AGENT][NEUTRAL] Whoever the provider is their itemized billing.
[AGENT][NEUTRAL] And then we can process the claim. Or you can just give if they already have our card, they should.
[CUSTOMER][NEUTRAL] Is there, did they send it by email?
[AGENT][NEUTRAL] So I was gonna say if they have our card, they can just give us a call and we can let them know how to file claims and help them. Um, they can't send it through email, but they can send it electronically or um fax it or mail it. The easiest thing to do is probably just have them call us because
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] They definitely didn't submit anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty. Thank you so much.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Nope, that's all. Thank you.
[AGENT][POSITIVE] All right. You're welcome. Thanks for calling APL. Have a great week.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] OK.