AccountId: 011433970860
ContactId: c5278b82-14c5-48fa-be47-fd1db5404cf7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297779 ms
Total Talk Time (AGENT): 121806 ms
Total Talk Time (CUSTOMER): 136085 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/c5278b82-14c5-48fa-be47-fd1db5404cf7_20250318T17:34_UTC.wav
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[AGENT][NEUTRAL] APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Um, yeah, I was just calling, um, because like I, I use you guys as like a supplemental insurance plan through my, um, through my work and I put in, um, for a scan that I had to get done and at the time they told me everything was covered and that you guys took care of the rest of it and I'm getting a bill in from them.
[CUSTOMER][NEUTRAL] Um, saying that you guys wouldn't cover it, I think.
[AGENT][POSITIVE] OK, well I'm sorry for that inconvenience. I'd be happy to assist. Um, may I have your policy number please?
[CUSTOMER][NEUTRAL] Um, yes.
[CUSTOMER][NEUTRAL] Um, it's uh 025.
[CUSTOMER][NEUTRAL] 453-22
[AGENT][NEUTRAL] Your name and date of birth?
[CUSTOMER][NEUTRAL] Is [PII] and then it's [PII].
[AGENT][NEUTRAL] And Mrs. [PII], if you can verify your email address.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Now is this a claim for yourself or a dependent?
[CUSTOMER][NEUTRAL] Um, this is for myself. It's through Simon Med imaging that's saying I had a payment due, but I ran this through you, and the day I was there she told me it was covered, but now I keep getting a bill in the mail for what they originally told me was taken care of.
[AGENT][NEUTRAL] OK, I'm not sure we received any claims, so they didn't send it we can't.
[AGENT][NEUTRAL] Process the claim if they don't send it.
[CUSTOMER][NEUTRAL] Um, so I can't give you like the information on the paper.
[AGENT][NEUTRAL] Now if you want to file for yourself, you, you can file yourself, but I'm just letting you know no one filed a claim with us, so.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] You know, we
[CUSTOMER][NEGATIVE] Oh that's so weird because when I went in she told me what it was gonna be so I gave you I gave her the information, all this information on here and she told me everything was taken care of, but now I'm getting a bill and they told me that I needed to call you.
[AGENT][NEUTRAL] OK, well they should have let you know, and normally if they're not gonna file with us they require you to pay them so that's kind of weird too you're right but you know I mean it's fine if they want you to file we'll pay whoever files I mean but I just wanted you to understand we didn't get a claim from anyone so there was nothing for us to pay.
[CUSTOMER][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] Um, but I can give you the instructions on how to file the claim and what you'll need to file the claim.
[CUSTOMER][NEUTRAL] Got you, um.
[CUSTOMER][NEUTRAL] OK. Um, yeah, that's fine. I can do that. Um, let me just grab a pen real quick.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so how do I go about putting this through?
[AGENT][NEUTRAL] OK, so, um, are you registered with the online service center?
[CUSTOMER][NEUTRAL] Um, through them or with you guys?
[AGENT][NEUTRAL] With us.
[CUSTOMER][NEUTRAL] Uh, I am not or I've never used it before, so.
[AGENT][NEUTRAL] OK, because there's 3 ways you can file the claim. You can either upload it online at the online service center or you can fax it or you can just regular paper mail the claim.
[CUSTOMER][NEUTRAL] Probably not, no.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, how do I do it online, I guess.
[AGENT][NEUTRAL] OK, so you'll go to [PII] website.
[AGENT][NEUTRAL] And you go under file a claim and you'll just need to register with the online service center uh using that um email that you verify with me and your social.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but the information that we're going to need is the diagnosis code for the visit, and we also need the EOB from your primary for that visit.
[CUSTOMER][NEUTRAL] What is it the B.
[AGENT][NEUTRAL] EOB explanation of benefits. It's that thing that they send you every time they get a claim that says this is not a bill and your patient responsibility. That's what we need from your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the provider can get you the the diagnosis code for that. So that's all we need, the diagnosis code and the explanation of benefits from your primary insurance.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] What's up
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much. I will take care of that and I will get everything sent over to you guys.
[AGENT][NEUTRAL] OK, was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Um, no, I think that's all.
[AGENT][POSITIVE] Well thank you for calling APL. You have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.