AccountId: 011433970860
ContactId: b63777ee-1cd1-4bdf-a4f8-fd023a877726
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471570 ms
Total Talk Time (AGENT): 167358 ms
Total Talk Time (CUSTOMER): 274265 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/b63777ee-1cd1-4bdf-a4f8-fd023a877726_20250519T16:30_UTC.wav
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[AGENT][NEUTRAL] For calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, my name is [PII], and, and my husband works for a company that has a group APL for the, with the company. Uh, and so he has insurance and I need to send a claim for uh an appointment. I'm his wife, and I'm trying to send a claim. Um, I believe this will be the second claim, but I never got the first one.
[AGENT][NEUTRAL] OK, um, you didn't get an explanation from us that it was processed, or?
[CUSTOMER][NEGATIVE] Nothing, nothing. I didn't get a letter. I didn't get anything. I, I thought I sent it. I, I believe I sent it by mail. I may have a copy if I have to search through my paperwork. I kept a copy.
[AGENT][NEUTRAL] OK, um, do you have your policy number?
[CUSTOMER][NEUTRAL] Policy number, yeah. 02611435.
[AGENT][NEUTRAL] OK, and then can you verify your address for me, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh yeah, I'm, I'm thinking now that maybe you don't. Uh-huh.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] But and the plane was for him, is that right?
[CUSTOMER][NEUTRAL] No, it was for me.
[AGENT][NEUTRAL] Oh, it was for you, OK. Uh, let me get a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. I need to know also if if if I could, I, I would like to be able to go into your website. I, I it looks like we've had APL before, so I must have had a login that's old because it won't let me in.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, your, um, husband would have to request that since he's the policyholder?
[AGENT][NEUTRAL] Is he available?
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] No, no, no, he, he's at work and I'm home.
[AGENT][NEUTRAL] OK, um, yeah, it looks like we don't have a claim on file for you. We haven't received anything.
[CUSTOMER][NEUTRAL] What I
[CUSTOMER][NEUTRAL] No, you're right, you're right, because I'm, I just realized that the um one that I have in my hands here, it says 47. I believe that your this uh insurance started on [PII], so I need to send a claim for 47.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you wanna fax it
[CUSTOMER][NEUTRAL] I need a uh how do I get, can you, can you send it to me via email or do you want me to I can fax it. I have a fax number all I have to do is send this and and that's it.
[AGENT][NEUTRAL] So you'll have to send the primary explanation of benefits. Who is your primary insurance through?
[CUSTOMER][NEUTRAL] The primary. The primary is uh uh United.
[AGENT][NEUTRAL] OK, so we'll need the EOB from United that shows how they process the charges.
[AGENT][NEUTRAL] And then we'll need the claim information for what you're trying to submit.
[AGENT][NEUTRAL] So it'll have to include like.
[CUSTOMER][NEUTRAL] What is an EOB? What is an EOB? I mean, I, do I have to go to AA to get, get another form and one from APL?
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] So, so you'll need to go to, is United Healthcare your insurance?
[CUSTOMER][NEUTRAL] Yeah, the group insurance through the through the company, yes.
[AGENT][NEUTRAL] OK, so you'll need an explanation.
[CUSTOMER][NEUTRAL] All I all I have in my hands, all I have in my hands is, um, it's, it's uh, uh, um, I guess an explanation of benefits and not, not an explanation of the bill like the date, the what they did, all I'm, I'm wanna get is a co-pay paid for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, so we have to see how did UnitedHealthcare process the claim. Does it show how what United Healthcare paid and the deductible and co-insurance, etc.
[CUSTOMER][NEUTRAL] Mm mm let me see, hold on, hold on. It says fe uh.
[CUSTOMER][NEUTRAL] Total
[CUSTOMER][NEUTRAL] Yeah, I think so, yeah, I mean, let me see office but it doesn't say.
[CUSTOMER][NEUTRAL] No, if this is just the, the, the, the description of what was done. It doesn't have so I have to do I have to wait until I get something from the insurance company?
[AGENT][NEUTRAL] Yes, cause we have to, we have, since this is a secondary policy, we have to see how did United Healthcare process the claim. What did they pay and what was left over.
[AGENT][NEUTRAL] So we have to see that
[CUSTOMER][NEGATIVE] But I thought you guys only paid, I thought you guys only pay the copay. If you guys get into the bill also you pay more than just the copay?
[AGENT][NEUTRAL] Well, it depends on the services that were rendered, um, but we, we always have to see how did United Healthcare process the claim.
[AGENT][NEUTRAL] Cause, or else we can't pay the claim if there's, if there's any expenses eligible. So we have to see how did United Healthcare process the claim, what did they pay, what's left over, and then we have to see what, you know, what were the charges? What did they bill for, what was your diagnosis, what were you seeing for? Was it an office visit? Where was it at?
[CUSTOMER][NEUTRAL] Right, I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Etc. So,
[CUSTOMER][NEUTRAL] OK, yeah, the where it was that I was there the day of the, the that I went there and the copay that they charged office visit, yeah, 135 and injection 100, so yeah, and then, but then the total 65 I'm guessing.
[CUSTOMER][NEUTRAL] I don't know. Tax medi medicine. I said Vic[PII].
[AGENT][NEUTRAL] Yeah, you can, you can also ask your doctor's office to file this for you, um, cause you can provide them with the card and then ask them if they'll file it for you when they get the United Healthcare explanation.
[CUSTOMER][NEGATIVE] I, I ended up having to pay this myself, so I, you guys owe me, let me see, payment, payment credit. I charged $170.70 dollars for the, so the insurance itself paid for some of these things, but I paid for for the the $70 for the copay and $100 for an injection that's probably not covered by insurance.
[AGENT][NEUTRAL] OK, so if it, like I said, we will have to see how to United Healthcare process the claim.
[AGENT][NEUTRAL] Now, if they deny it, then we won't have anything left to pay, so they do have to consider it. They can't deny it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so you said, you said UnitedHealthcare won't cover the injection?
[CUSTOMER][NEUTRAL] Like, like, well, yeah, this is, uh, hair growth. My hair, my hair, I'm in menopause, my hair started falling.
[CUSTOMER][NEGATIVE] I went in, they had to do some blood work to find out what was going on. It looks like I have some kind of lupus or some some something. So they, but you know, I told them I understand, I gotta go to rheumatologist, but in the meantime, my hair is falling too much. I need to have some. So they put an injection that they told me this is not covered by uh by insurance, and I did it. So that I don't understand 100, I'm not gonna get it back, but I was trying to get the, the, the co-pay that I had to do for the visit for the office visit.
[AGENT][NEUTRAL] OK, um, like I said, we'll just, we'll have to have the explanation of benefits from United Healthcare along with the claim information that shows what was the date of service, bill charges, diagnosis, and, um, you know, that it was an.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I have done IPL before and I have never had to do that, but I will do it. I will have to go search because I don't have the paperwork. That part I don't have. I went to the visit, I requested the receipt today and I went in October in uh in [PII], so I, I have to search for that other stuff from United and see if I can get it. OK, thank you so much. I'll call back or I'll fax it.
[AGENT][POSITIVE] OK, thanks.
[AGENT][NEUTRAL] OK, thank you for calling APL. Anything else I can help with?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, thank you so much. Have a great day.