AccountId: 011433970860
ContactId: beec2753-3e65-46fa-8076-244df3a6edfc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 530530 ms
Total Talk Time (AGENT): 218970 ms
Total Talk Time (CUSTOMER): 273886 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/beec2753-3e65-46fa-8076-244df3a6edfc_20250319T17:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I told you, I can't believe I still got back to you.
[AGENT][NEUTRAL] Oh goodness. I'm glad that you did, Miss [PII]. I could hear you, but you couldn't hear me and I didn't understand.
[CUSTOMER][NEUTRAL] How, how often?
[CUSTOMER][NEUTRAL] Yes, it is how often that happens that he gets to the same person. Yes.
[AGENT][NEUTRAL] Exactly, exactly. OK, Ms. [PII], what I'm gonna need to look up your claim is your policy number first.
[CUSTOMER][NEUTRAL] OK, so the policy number, OK, uh, it's basically the benefit certificate number in hospital or outpatient. That's what you need, right?
[AGENT][NEUTRAL] Yes ma'am, either one of those numbers will work.
[CUSTOMER][NEUTRAL] OK. So it's 02219206 M for Mary, L for Larry, and 7.
[AGENT][NEUTRAL] OK, let me pull up your policy real quick.
[CUSTOMER][NEUTRAL] Yeah, so this is from last year. I know I don't have you guys anymore, so this is a bill from last year in April, so this is what I'm mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. OK. And we're gonna need to verify your, your, um, policy. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] Of course, [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, phone number, and email address that we have on this policy for you?
[CUSTOMER][NEUTRAL] So, it's [PII].
[CUSTOMER][NEUTRAL] And the phone number is [PII]. And what else do you need?
[AGENT][NEUTRAL] Your email address.
[CUSTOMER][NEUTRAL] Oh, it's either [PII] or [PII]. Any of those emails, I don't know exactly which one you guys have, but these two are my emails.
[AGENT][POSITIVE] OK, I have the [PII] and thank you so much for verifying your policy. OK, so, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you, yes, go ahead.
[CUSTOMER][NEUTRAL] I want to know kind of
[CUSTOMER][NEUTRAL] Yes, yes. I wanted to know like what was the last claim that was made because this is about a gastro bill that I have from last year, obviously from April, and I have an account number if you, if you need that or, or I don't know what else do you need?
[AGENT][NEUTRAL] OK, so I've got um a claim that was submitted on the last submitted claim was for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed on [PII], yes.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] [PII] this year.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it is for Quest Diagnostics.
[CUSTOMER][NEUTRAL] Quest Diagnostics. Mhm.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, they put a mark on it that it's a duplicate claim, so.
[AGENT][NEUTRAL] Let me look and see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What the original claim was.
[CUSTOMER][NEUTRAL] Yeah, but this is not the one that I needed, OK.
[AGENT][NEUTRAL] What was the date of service?
[CUSTOMER][NEUTRAL] The date of the service, I'll tell you one second because I'm looking here into the bill.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] The day of the service was [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's on the value of 14,870.
[AGENT][NEUTRAL] 14,870. OK, that will let me try to look it up that way.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm showing that we had um one from.
[AGENT][NEUTRAL] Only one from the data service of [PII].
[CUSTOMER][NEUTRAL] Mhm, because there were two initially and then they submitted one but they never submitted this one with you guys in the [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, and I don't see the 14,870. Um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] That one has not been submitted.
[CUSTOMER][NEUTRAL] OK, so that this is 100% sure, right?
[AGENT][NEUTRAL] Right, because you gave me the date of service.
[AGENT][NEUTRAL] So it pulls it up by that day. It pulls it up by that day and looking on that day, I do not have a claim for the amount of 148.70.
[CUSTOMER][NEUTRAL] Mhm. Yeah, that's the date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK, perfect. Yeah, I'm gonna have to call them back. This is, believe me, like if I don't call them at least 10 times, I didn't call them at all, so.
[AGENT][NEUTRAL] Oh my.
[CUSTOMER][NEUTRAL] So most probably, yeah, so most probably what I'm gonna have to do, I'm gonna have to now like ask you all the information from that I need to provide you in order to submit this myself.
[CUSTOMER][NEGATIVE] Because it seems like these people are not doing their their thing. And I know at some point, at some point I spoke with somebody else and they told me itemized bill that I need, right? What else it's what I need.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Yes, you need that
[AGENT][NEUTRAL] You need the itemized statement with the diagnosis and procedure codes on it and then you're also going to need your.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] OK, and where do I get these explanations of benefits?
[AGENT][NEUTRAL] From your primary insurance, you'll have to call your primary insurance carrier and ask them for it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, so they can give it to me, OK, OK.
[AGENT][NEUTRAL] And then um you'll also need a claim form.
[AGENT][NEUTRAL] For the Medlik.
[CUSTOMER][NEUTRAL] OK, and then I put.
[CUSTOMER][NEUTRAL] Mhm claim form that I can find online, right?
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] So this is basically what I, the, the 3 things that I need. So an item and statement bill with the procedure and the codes, explanation of benefits from primary insurance, and then, uh, claim form from online.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, and
[CUSTOMER][NEUTRAL] And then I have to submit this to you. Mhm.
[AGENT][NEUTRAL] Yes, ma'am. And the claim form, the name of the claim form you need is Medin at M E D L I N K.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that's how the form it's called?
[AGENT][NEUTRAL] Yes, it's a Medlink claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm, I'm, I'm if I Google it like that, I'll find it meddling claim form.
[AGENT][NEUTRAL] No, you'll have to go to our our website at [PII].
[CUSTOMER][NEUTRAL] OK. [PII]. OK. So you said A from uh uh A from, um, I don't know, A from [PII] and M from, from uh [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]. OK, yes.
[AGENT][NEUTRAL] Yes ma'am, when you get on our website in the top right hand corner you'll see a link for claims and forms and you'll click on that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And it'll pull up the claim form and you look for it until you find Medlink.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once you find the med link you can download that claim form.
[CUSTOMER][POSITIVE] And I fill up that and I send you all this information and I can, I can also fax it to you, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, OK, perfect.
[AGENT][NEUTRAL] Would you like the fax number?
[CUSTOMER][NEUTRAL] Mm, I have it here on the card. It's [PII], right?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK. Perfect. Thank you so much for your help. Thank you. I appreciate this.
[AGENT][POSITIVE] You're very welcome. Well, you're so very welcome, Miss [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] Thank you, thank you.
[CUSTOMER][POSITIVE] No, that's all. Thank you so much. I wish you a great day.
[AGENT][POSITIVE] You have a blessed day too, Ms. [PII], and thanks for calling APL.
[CUSTOMER][NEUTRAL] Bye bye, bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.