AccountId: 011433970860
ContactId: c6ac4b68-78ad-4dce-b248-0ac33249aa1c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 778710 ms
Total Talk Time (AGENT): 147005 ms
Total Talk Time (CUSTOMER): 495822 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/c6ac4b68-78ad-4dce-b248-0ac33249aa1c_20250423T19:54_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is, um, [PII]. um, I think I actually spoke to you yesterday, so I'm glad I got you again. I'm calling in reference to one of my claims. um, I have all my information for you. uh, let me know what you need first.
[AGENT][NEUTRAL] Um, I'll take your policy number, [PII].
[CUSTOMER][NEUTRAL] OK, policy number is 02494804.
[CUSTOMER][NEUTRAL] [PII], I remember.
[AGENT][POSITIVE] Oh, yep, that's right.
[AGENT][NEUTRAL] Um, do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Yeah this is uh [PII].
[AGENT][NEUTRAL] OK, just need to verify a few pieces of information. What is your birth date?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] And then your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then lastly your email address.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, perfect. And how can I help you today?
[CUSTOMER][NEUTRAL] Um, so there was a, um, claim for data services August, uh, yeah, [PII] [PII] from Quest Diagnostic.
[CUSTOMER][NEUTRAL] Um, I resubmitted the claim report from my medical insurance and AMed. It's a GHT plan and um with all the quotes because that was what they were requesting, but now I just got an EOB and it's saying that the.
[CUSTOMER][NEUTRAL] Uh, from APL, sorry, I should have clarified that, um, that they received the documentation, but it doesn't show what's applied to deductible. The plan doesn't have a deductible. It's a GHT plan, so they do not have. It's a zero deductible.
[AGENT][NEUTRAL] OK. Did, do you have a, does it have a claim number on it?
[CUSTOMER][NEUTRAL] Oh yeah sorry sorry sorry I should have told you that. OK 30 sorry 359.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0456.
[AGENT][NEUTRAL] OK, let me see what we have.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And this was sent I'm trying to see.
[CUSTOMER][NEUTRAL] Um, it, I don't know if it was, I don't think it was sent. I mean, maybe it was sent.
[CUSTOMER][NEUTRAL] I don't know. I I resubmitted stuff on the [PII]. I don't know if this, oh yeah.
[CUSTOMER][NEUTRAL] It says 4:17 so.
[CUSTOMER][NEUTRAL] It was after I, I don't know if they.
[AGENT][NEUTRAL] OK, and so let's see.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Or sickness supporting OK.
[AGENT][NEUTRAL] OK, was this for the 27067?
[CUSTOMER][NEUTRAL] Um, I'm trying to see because it doesn't have amounts on here on this, oh yeah, sorry, yes, 270 67, sorry.
[AGENT][NEUTRAL] OK, I see the, let me look at both submissions here. I see one that has your diagnostics, uh, notice for payment, and then I see the.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Attached is the uh claim details for your from your primary shows how it processed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't see a diagnosis code anywhere. Let me look at the other thing that we.
[CUSTOMER][NEUTRAL] Yeah, it's a 4
[CUSTOMER][NEUTRAL] Let me open.
[CUSTOMER][NEUTRAL] 823 right here.
[CUSTOMER][NEUTRAL] Bill claim detail.
[AGENT][NEUTRAL] Other submission we have is
[AGENT][NEUTRAL] Let's see this is for.
[AGENT][NEUTRAL] I'm sure.
[AGENT][NEUTRAL] OK, this has REOB attached to it and then.
[AGENT][NEUTRAL] There is 1400 bills.
[AGENT][NEUTRAL] But that that's 2.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 123
[AGENT][NEUTRAL] 810
[CUSTOMER][NEUTRAL] I think that's the infectious disease and might, that might be the infectious disease maybe.
[AGENT][NEUTRAL] It looks like we don't have anything that indicates a diagnosis anywhere. Um, we do see some
[CUSTOMER][NEUTRAL] Mm let me.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, I think that, so that's what I'm finding. I don't see any diagnosis listed because we have to have a diagnosis to indicate was this a
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Accident or illness, um.
[AGENT][NEUTRAL] To process
[CUSTOMER][NEUTRAL] No, it was, uh, yeah, I had um I had a brain tumor removed and my, the infectious disease was because my incision became infected. So they had to put me on um
[CUSTOMER][NEUTRAL] And um what do you call that a um.
[CUSTOMER][NEUTRAL] An antibiotic, um, uh, what is it, the line that they permanently put in your arm, or semi permanently. PICC line. I had to have a PICC line put in.
[AGENT][NEUTRAL] OK. OK. Um, yeah, that, that's what's, that's what we're missing. Do you by chance know if they provide you like the, uh, CMS 150?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm gonna go into, yeah, I'm gonna go into my AMA member portal because the reports usually show the codes. I'm not sure why it didn't download that way so I'm actually gonna go in right now and see if I can because I see that the thing says more details but it's not um you can't manipulate it so I'm gonna see if I can.
[CUSTOMER][NEUTRAL] Get it and I'll go ahead and send it in um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, just make sure that it.
[CUSTOMER][NEGATIVE] This is frustrating. The EOBs used to include that, you know, those details, and I don't know why now the medical EOBs do not, so that's why I even tell our clients like go in and download the actual claim report because otherwise you're kind of left without all the information that you need so um.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so I'll go ahead and look for that and um.
[CUSTOMER][NEUTRAL] And I'll, I'll resubmit it, I guess with the hopefully it has, it should have.
[CUSTOMER][NEGATIVE] It should have it, so I'll look for let me see, you are so frustrating.
[AGENT][NEUTRAL] Yeah, if they can if you have something that either spells out the ICD 10 or has like ICD 10 number code or whatever so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah unfortunately I don't know why but the in the infectious disease office they never submitted it to you guys. I had to go in and submit it even though I kept giving them all the information they kept.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, they wouldn't do it. I kept checking in and I would never see it submitted by them, so, uh, I just decided forget it, I'm gonna do it because this is getting ridiculous.
[CUSTOMER][NEUTRAL] And of course you know you get those final notices and things like that and it's, you know.
[AGENT][NEGATIVE] Yeah, it's not pretty.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, let's see if it does it this time. OK, and it does have codes. I'm looking at the quest one.
[CUSTOMER][NEUTRAL] OK, this time it did open uh with all the codes information for that Quest diagnostic that 270 67 so I will.
[CUSTOMER][NEGATIVE] Save this and resend it.
[CUSTOMER][NEUTRAL] I'll know now to make sure when I download these that it comes through, right?
[CUSTOMER][NEUTRAL] Uh, to do.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] detail.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Inostic
[CUSTOMER][NEUTRAL] OK, I'm gonna.
[CUSTOMER][NEUTRAL] All right, I'll make sure to submit this one and then the other one was for the infectious disease, uh, which was [PII]. Let's see if that one has.
[CUSTOMER][POSITIVE] They did what they were supposed to do, um.
[AGENT][NEUTRAL] Yeah, be the same.
[CUSTOMER][NEGATIVE] It's always a crapshoot unfortunately.
[AGENT][POSITIVE] Yeah, I totally understand.
[CUSTOMER][NEUTRAL] Um, hm.
[CUSTOMER][NEGATIVE] I don't know if you guys have been noticing it, but I will tell you as an insurance agent I that is constantly having to troubleshoot issues for our clients. It just seems like the doctor's offices staff that they've hired since COVID are really.
[CUSTOMER][POSITIVE] You're already laughing.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] Are just not um as equipped.
[CUSTOMER][NEUTRAL] With uh abilities.
[AGENT][NEUTRAL] I, I, I feel that.
[AGENT][POSITIVE] Well, also it's like I, you know, it's like customer service. I mean, at least try to try to sound upbeat and somewhat happy, you know, I mean, I think so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well, what I find is over and over again, especially like with the gap insurances, which is really frustrating because gap insurance as I have found out firsthand is so it's such an amazing benefit it's great, OK, so it's, it's, it's there's no comparison like honestly I tell people all the time like our clients like the ones that I'm, you know, friendly with I'm like think of APL as your sugar daddy and make them.
[AGENT][POSITIVE] Oh, absolutely.
[AGENT][POSITIVE] I like that.
[CUSTOMER][NEUTRAL] So once
[CUSTOMER][NEUTRAL] It's true. It's like, you know, like, so I tell them because at first they're kind of like, well, how does this work? I'm like it, you literally just give them the card. So what we've had issues with are a lot of doctor's offices telling the clients or just billing the patients and not even putting the claims through through the through the gap, which is I find ludicrous because they're gonna get paid immediately. You guys are really quick on the on the turnaround, you know.
[AGENT][NEUTRAL] Hey.
[AGENT][POSITIVE] Yeah, exactly.
[CUSTOMER][MIXED] So again I I don't understand it's asinine to me and I have had to call a couple doctor's offices and say hey um you know there's a phone number and it's not a long way and their customer service reps are really really nice and they will talk you through it if you're not, you don't know how to submit a claim, which I'm sure most of them actually do know but again they just prefer.
[CUSTOMER][NEUTRAL] To bill the client and.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEGATIVE] It's ridiculous. OK.
[CUSTOMER][POSITIVE] So I have these already. I'm going to send both because they're both have the all the codes so hopefully that'll take care of that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And um [PII], thank you so much. I'm gonna go ahead and get these over.
[CUSTOMER][POSITIVE] Again and um hopefully this time you'll have you know you guys will have everything that you need.
[AGENT][POSITIVE] OK, that sounds good, [PII]. And anything else I can help with today?
[CUSTOMER][POSITIVE] No, that's it thank you. I hope you're the rest of the week goes by quickly and without any massive.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Right, thank you so much. I hope the same for you.
[CUSTOMER][POSITIVE] Thank you, I appreciate that. You have a great day.
[AGENT][POSITIVE] Thank you for calling APL. You too. Bye bye.
[CUSTOMER][NEUTRAL] Alright bye bye.