AccountId: 011433970860
ContactId: c6d338be-c5de-415d-b8d3-538f713344ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 359029 ms
Total Talk Time (AGENT): 147690 ms
Total Talk Time (CUSTOMER): 173374 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/c6d338be-c5de-415d-b8d3-538f713344ae_20250520T15:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, [PII], um,
[CUSTOMER][NEUTRAL] My uh daughter's getting and has had an ultrasound and they submitted the claim and you guys put that you needed proof of whether it was subject to deductible or not. Um, I have the EOB from my primary insurance that I can send you guys, but the claim was filed by the hospital, so I guess I'm wondering, do they need to submit that to you or can I just submit it to you to make sure it gets paid?
[AGENT][NEUTRAL] Um, let me take a look at the claim and see what all um is being asked, but I can definitely assist you with the claim. Um, may I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have your policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] I'm on the website trying to download the card and it's giving me an error so.
[CUSTOMER][NEUTRAL] Hold on, give me a minute.
[CUSTOMER][NEUTRAL] Let's see why. I have the claim number.
[AGENT][NEUTRAL] OK, that's fine, that's fine too.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I got the text this morning.
[CUSTOMER][NEUTRAL] 3602864
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, here it is.
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] Yes, and I just need you to verify your
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Date of birth, the mailing and email address on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mailing address or the email?
[AGENT][NEUTRAL] Both.
[CUSTOMER][NEUTRAL] The mailing address is [PII].
[CUSTOMER][NEUTRAL] The email is either [PII] or [PII].
[AGENT][NEUTRAL] All right, it was the first one and thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. And um you said this was, this is under you or one of your dependents?
[CUSTOMER][NEUTRAL] The claim that was filed was a dependent, [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Here we go.
[CUSTOMER][NEUTRAL] And I don't, she's, she's had two ultrasounds. They've only submitted.
[CUSTOMER][NEUTRAL] Well, that's fine we'll just deal with this claim and I'll talk to them about why they haven't submitted the other claim.
[AGENT][NEUTRAL] Oh, I see what's happening. OK, so they're asking, so we received the explanation of benefits, but it does, it has zeros listed for the deductible, co-pay and co-insurance. So we just need a detailed explanation of benefits. Um, you can submit it if you like the um like if you have access to the
[AGENT][NEUTRAL] You know, like your primary's online portal, you can submit the explanation of benefits or the provider, um, whichever you prefer, or, you know, whoever gets it in first really, but the provider filed the claim, so it may be easier to just keep it all under the provider, um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] But they were sent
[CUSTOMER][NEUTRAL] It's, I'm seeing two claims, and I'm wondering if maybe the second one they submitted properly or the second one could be the physician's charges. Are you able to look at that other one?
[AGENT][NEUTRAL] Let me see. The one that was paid for $51.93 or is there another?
[CUSTOMER][NEUTRAL] Oh, was it paid already?
[AGENT][NEUTRAL] Yeah, what two are you showing?
[CUSTOMER][NEUTRAL] No, there's two claims for [PII].
[AGENT][NEUTRAL] Right, one was paid and one was, oh, but the one that was paid just finished processing today, so I don't know.
[AGENT][NEGATIVE] And the other one was denied.
[CUSTOMER][NEUTRAL] OK, that's why I haven't seen that one. I was looking at it last time. So that's the physicians though, the one that is the one that you guys that that it says 0, that one I got a bill and an EOB for $800 and something dollars. So that's the one that I'm concerned about because I don't want them to come after me for it, um.
[AGENT][NEUTRAL] That might be why.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Wait a minute, they sent you a bill?
[CUSTOMER][NEUTRAL] United sent me an EOB.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] My primary insurance, uh,
[AGENT][NEUTRAL] But not a bill.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I just want to
[CUSTOMER][NEUTRAL] You know, I'm not sure if I got a bill or not.
[AGENT][NEUTRAL] OK, I'm, I'm just
[CUSTOMER][NEUTRAL] Now I can't remember.
[AGENT][NEUTRAL] I just want to make sure because um they're not the the the hospital should not be billing until, you know, they get like a definite denial we're not paying it and they've tried to collect like it's a, it's a whole process. I just, I just didn't want you to receive a bill because we're the insurance companies are still answering. But if you have the explanation of benefits there from [PII] from United Healthcare, you can upload that if you like.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Oh, I just uploaded onto the portal?
[AGENT][NEUTRAL] Yes, ma'am. You can put it on the online service center and then um that goes straight to claims, so they'll go ahead and uh continue processing.
[CUSTOMER][NEUTRAL] you
[AGENT][NEGATIVE] The denied claim.
[CUSTOMER][POSITIVE] Oh, OK, OK, perfect, I'll do that. OK, all right, thank you so much. I appreciate your help.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help with?
[CUSTOMER][POSITIVE] No, that's it. Have a great day.
[AGENT][POSITIVE] All right, thanks for calling APL. You also. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.