AccountId: 011433970860
ContactId: b90e46fd-4c1b-40e9-b526-6197fd37a57b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401570 ms
Total Talk Time (AGENT): 197481 ms
Total Talk Time (CUSTOMER): 148076 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/b90e46fd-4c1b-40e9-b526-6197fd37a57b_20250310T18:02_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I need to, I need to know what I need to do to send you some uh paperwork for a claim.
[AGENT][POSITIVE] OK, well, I can definitely help you with filing a claim. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02357209
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[CUSTOMER][NEUTRAL] My mailing address is [PII].
[AGENT][POSITIVE] Thank you, and then just your email.
[CUSTOMER][NEUTRAL] Um, I'm not sure what email that you have. Um, I have 3.
[AGENT][NEUTRAL] This one is [PII]. Does that help?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Yes, right, and thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. So to file your claim, um, you can send it three ways. You can mail it, you can fax it, or you can upload your documents onto the online service center.
[AGENT][NEUTRAL] Um, you'll need the explanation of benefits from your primary insurance. You'll need the Medlink claim form, which can be found on our website.
[AGENT][NEUTRAL] And then you'll also need the itemized bill with the diagnosis codes, procedure codes, and all the charges from the provider.
[CUSTOMER][NEUTRAL] OK, so I have, I have a bill from the provider that shows the amount due of shows the amount due on it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I scanned that into my email.
[CUSTOMER][NEUTRAL] And I need, I need what else?
[AGENT][NEUTRAL] So not your patient bill. It needs to be the bill from the hospital. Your patient bill just shows the treat, it has coding on it, but that's the procedure code. So it shows the treatment and the charge for the treatment, basically what you're paying for.
[AGENT][NEUTRAL] We need the the hospital or the doctor, whoever the provider is that you're filing the claim wherever you went. We need their billing because it shows the diagnosis, which is how we proved the medical necessity, the diagnosis and then the treatment.
[CUSTOMER][NEUTRAL] OK, so this was sent to me because they didn't file.
[CUSTOMER][NEUTRAL] When I was there,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] They didn't file um.
[CUSTOMER][NEUTRAL] They didn't, so this this is probably for my copay is probably what this is for.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they didn't file anything towards APL or uh for APL with my, my main insurance so that I wasn't out of pocket anything.
[CUSTOMER][NEGATIVE] And instead they expect me to pay the copay.
[AGENT][NEUTRAL] Wait a minute, hold on. You said they didn't bill your primary insurance?
[CUSTOMER][NEGATIVE] No, they did build my primary insurance, but now they're sending me this.
[AGENT][NEUTRAL] Oh, they did, OK.
[CUSTOMER][NEUTRAL] And I'm guessing that this is for the copay.
[CUSTOMER][NEUTRAL] Which I don't, I never, I never have to pay a copay because all the other.
[CUSTOMER][NEGATIVE] Doctor's offices usually file everything between my primary insurance and you guys, and then I never pay anything.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] What's the data service on the bill that you have? I'm gonna see if they, if they filed anything with us.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, date of service.
[CUSTOMER][NEUTRAL] was [PII].
[AGENT][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] And I just got this bill.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] OK, so yeah, they, um, there's no claim on file for [PII]. So the good thing is we don't have a timely filing. So as long as your policy is active on the data service, you can file it at any time. So you, you're not like gonna run out of time or anything, but I would definitely check with them about the, the itemized bill because I don't want it, it can be denied without.
[AGENT][NEUTRAL] Having all three things. So I just want to make sure.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] So first of all, I don't, I don't feel like it's my job to fill out all this paperwork and send all this stuff to you guys. I feel like.
[AGENT][NEUTRAL] Yeah, you shouldn't have to.
[CUSTOMER][POSITIVE] I feel like I should just call them and be like, hey.
[CUSTOMER][NEUTRAL] Um, here's my APL information. You need to file this additional that's due within.
[AGENT][NEUTRAL] Yeah, you definitely do have that option. I thought, um, you said they said to call us. I thought they were like saying they wouldn't do it because some providers do.
[AGENT][NEUTRAL] Do do that like they just say they're not going to build to secondary. I didn't know if it was one of those types of things, but yes, you most definitely can call them and tell, give them our policy number.
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEGATIVE] OK, all right, I, I'm gonna do that because I, I don't, I don't wanna, I'm not trying to get into this whole filling out forms and mailing forms and doing all that stuff. That's not my job. They have people that do that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's right. And there, um, so when you give them your, I don't know if you're gonna give them a copy of the card or or if they'll take just the policy number over the phone. Either way, just give them our phone number if they need to verify benefits or, you know, anything because sometimes they try to say they won't take, they don't take our insurance and they're just not familiar with the secondary insurance.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, yeah, I've run into that before as well.
[AGENT][NEUTRAL] So they can definitely call too and we'll verify the insurance and tell them how to file the claim and everything if they need to.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, all right, thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, ma'am, that's all.
[AGENT][POSITIVE] All right. Well, thanks for calling [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.