AccountId: 011433970860
ContactId: c18475e4-0c05-4093-857f-e9d474bd80cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 526130 ms
Total Talk Time (AGENT): 328545 ms
Total Talk Time (CUSTOMER): 288883 ms
Interruptions: 16
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/c18475e4-0c05-4093-857f-e9d474bd80cd_20250311T18:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon, [PII]. My first name is [PII], and I want to see if you've received a claim um as a secondary from last year for a, from a provider.
[AGENT][NEUTRAL] Sure, I can see if we've received that claim. Uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's fine. Uh, my direct line is [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, I do. Um, my no, outpatient would be 02187247 M as in Mary, L as in Larry, number 8.
[AGENT][NEUTRAL] All right, thank you. And uh what was your last name, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Got it, thank you. Just gonna verify a couple of pieces of information real quick. Um, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you. uh, looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Alright appreciate you verifying all of that. OK, um, you said this was from last year uh do you happen to have that date of service?
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] We did not, um, actually, let me see.
[CUSTOMER][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] Bear with me just a moment.
[AGENT][NEUTRAL] OK, that might be why. OK, the policy number you gave me, um, it actually terminated in May of last year, so you do have one that is currently active. It's just a different policy number. Um, let me check there. Give me just a moment. No, that's OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, I picked up the wrong card. So, let me cross this. So this is an old card.
[AGENT][NEUTRAL] Yes, yes, um, if you need a new one, I can send that to you, um, or I can give you that policy number.
[CUSTOMER][NEUTRAL] Put lines through it.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Um, I do have another card in the other room. I just thought I'd grabbed the right one. what is the correct
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh no, that's OK.
[CUSTOMER][NEUTRAL] Uh, what's the correct number? Cause I'll go and double check it.
[AGENT][NEUTRAL] It sure it's uh 02489439.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Can I request um a new card while I'm on the phone, just in case I don't have that one. And, and then is it M as in Mary, L as in Larry, and then what, an 8 or a 7 at the end, right? Would it be the same? Yeah.
[AGENT][POSITIVE] Absolutely, yes, of course. Yeah, that's perfectly fine.
[AGENT][NEUTRAL] Right, yes, so for inpatient would be 7, outpatient is 8, OK, and so I can email you a copy, I can send you a paper copy in the mail or I can do both. Uh, what would you prefer?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Uh, just a paper copy by in mail. That'd be great, please. Thank you. That's nice.
[AGENT][NEUTRAL] Sure, OK, alright, I will get that sent to you and then let me try to find this claim. Give me just a moment.
[AGENT][NEUTRAL] OK, and that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes, yeah.
[AGENT][NEUTRAL] OK, no, we have not received any claims for that date of service.
[CUSTOMER][NEGATIVE] Mm. I've got this doctor's office that are giving me the runaround, and they keep saying, yes, we've heard back from them and you still owe them money. I'm like, I've, I've just been on the phone with United Healthcare for about half an hour, and we did a three-way call to the woman about another issue, and she said, well, I'll have to get back to you, and she hung the phone up to United Healthcare. You don't do that.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Oh my gosh, OK.
[AGENT][NEGATIVE] Oh my gosh, wow, no, you don't. That is so unprofessional. Um, well, shoot, let's see, so.
[CUSTOMER][NEUTRAL] Oh my God.
[CUSTOMER][NEUTRAL] OK, so let me, so if I get from her, because I don't, I don't, I think this doctor's office, they don't, the ladies don't know what they're doing in the billing department. It's quite clear. So, if I can try and get from them, yeah, I can find my EOB from United, because that's what you're gonna need. And then um do you need anything from, no, you just need the EOB don't you? But you need the diagnosis codes and the CPT codes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] That seems like it
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, so
[AGENT][NEUTRAL] You know the, yeah, you've got it down yes so I was like, OK, OK, I was like, wow, I used to have to explain all of this, um, so yes, the EOB from your primary and then the itemized statement that shows the diagnosis and procedure codes, um, so if it's easier for you to get that, yeah, you can.
[CUSTOMER][NEUTRAL] I do, I do medical billing.
[CUSTOMER][NEUTRAL] I do it for a living.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, the itemized statement would be from, who would I get the itemized statement from? This, hm.
[AGENT][NEGATIVE] Unfortunately the provider um but hopefully.
[CUSTOMER][NEGATIVE] The one that's being nasty to me. OK, I do my statement, OK.
[AGENT][NEUTRAL] Yes, I'm sorry and if there's any I don't know if this is gonna be helpful at all um but they are more than welcome to call us as well um if they if there's.
[CUSTOMER][POSITIVE] No, don't worry.
[CUSTOMER][NEGATIVE] They, they're, they're not helpful. No, don't even go there. But thank you very much. That's very sweet of you. But it's been a nightmare and they're so rude to me on the phone. It's just ridiculous. So I'm think, because I know that the visit went towards my deductible, and I paid $50 at the time of service, and she's asking for the remaining balance, the 3197. I said, but did you send it? So I think
[AGENT][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Oh yeah, of course, definitely.
[AGENT][NEUTRAL] Oh, it sounds like it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, APL, uh, if, in August of last year you were paying my deductible, you will pay the whole 80 odd dollars.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, so your outpatient benefit is on a per calendar day basis, so it pays up to $500 per calendar day. Yes ma'am.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Yeah, per day, yeah.
[CUSTOMER][NEUTRAL] And you only pay you don't pay, I know you don't pay copays, but you'd pay deductibles.
[AGENT][NEUTRAL] We do pay copays. It is co-pay, deductible and co-insurance, and of course you know some providers will make you pay it right there on the spot, um.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEGATIVE] Yeah. I've been paying co-pays. Uh yeah, yeah, I'm gonna have to dig out everything. I'm gonna have to, yes, I will. I'm like, oh, yeah, yeah. When did it change? Because when the, my doc I work for a doctor's office, when he first signed up with you guys for us, which was lovely, um, we were, you weren't covering co-pays for us at that point. Do you know? Well, I'm not gonna go back. Yeah.
[AGENT][NEUTRAL] Yeah, but then
[AGENT][NEUTRAL] Oh, send that to Escrow.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can see when this started, let's see.
[AGENT][NEUTRAL] Cause as long as
[CUSTOMER][NEGATIVE] Not that I'm gonna go back and find all the Gopays now.
[AGENT][NEUTRAL] No, no, that's OK. So your policy with us started, uh, [PII]. Um, I couldn't tell you exactly when it changed QE, um, I just know that I mean I started last year, so I know it's, it's been that way for since then, um, but yeah, copay, uh, deductible and coinsurance is what that all goes towards.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Wow. Cause I'm getting you, I'm getting, OK, I've got some work to do this weekend.
[AGENT][NEUTRAL] Oh yeah, I mean it might be tedious but yeah you can definitely get reimbursed now I will say this might be where some of the confusion is I'm not sure um under your policy office visits are not covered.
[CUSTOMER][NEUTRAL] For myself.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I might get some money back.
[AGENT][NEUTRAL] However treatment received in office is, so if you went for like a consultation or something like that where no treatment was received, we wouldn't be able to pay that benefit so those copays um we wouldn't be able to reimburse but any treatment received in office we could so if you had to get like an X-ray or something like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So there would still be a co-pay for the office visit?
[AGENT][NEUTRAL] If that's what they charged again each provider is very different most of the time they wouldn't charge an office fee unless that's all you went in for was just like a consultation um most of the time they would just file for um whatever the procedure was or treatment that you received.
[CUSTOMER][NEUTRAL] It's different. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] OK. Yeah, I'll, I'll do some homework. But um I think what I'm gonna try and do is get all the paperwork and send the claim in myself, and then you'll pay me, hopefully, and then I'll just go ahead and pay them the 31, because they're not, they're not gonna, they're not gonna be nice to you either.
[AGENT][POSITIVE] Yes, yes, no that's exactly how that works, yes.
[CUSTOMER][NEUTRAL] OK, so I can find the itemized bill.
[AGENT][NEUTRAL] I always like to offer that just you know easier on you but um if this is the easier way I understand just getting it done um now I will have you created an account on our online portal Key?
[CUSTOMER][POSITIVE] No, that's very kind. Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, yes, I think I have.
[AGENT][POSITIVE] Perfect. OK, so yes, I was gonna say that's the quickest and easiest way to get claim information to us. um, if you haven't already, you can sign up for direct deposit, um, that way it'll get to you really quick, otherwise we would just send a paper copy in the mail.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and can I um upload documents on that site? I can't remember.
[AGENT][NEUTRAL] Absolutely yes so on that, um, yes, so you would just fill out of course the correct claim form. This is your Medlink policy and then right on that main page you can upload documents.
[CUSTOMER][POSITIVE] I can. OK, lovely.
[CUSTOMER][NEUTRAL] Yeah, I think that's what I'm gonna do. So now I can dig out the EOB or I can print that off of the website on United. It's the itemized statement I'm gonna have to.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, I know. I'm sorry. I wish there was an easier way.
[CUSTOMER][NEUTRAL] Signed. Um, I'll, I'll do it.
[CUSTOMER][MIXED] No, I, it's just a nightmare today. But don't worry. But thank you for, thank you for being there and telling me that it hasn't, you haven't received that claim because I didn't wanna double, double it. Um, yeah, and I'll just take care of it because they're upsetting me too much.
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Yes, ma'am. Absolutely, yeah, at least you know now.
[AGENT][NEUTRAL] I understand, I understand.
[CUSTOMER][POSITIVE] And, yeah. Well, have a nice afternoon and thank you again for being there for me.
[AGENT][POSITIVE] You too, of course if you have any other questions, don't hesitate to give us a call back. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I will do. And to you. Take care. Bye-bye.
[AGENT][POSITIVE] Thank you you too bye bye.
[CUSTOMER][NEUTRAL] Bye.