AccountId: 011433970860
ContactId: ce26f378-a213-4888-9f97-50d9b304fddf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 595950 ms
Total Talk Time (AGENT): 232821 ms
Total Talk Time (CUSTOMER): 284478 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/ce26f378-a213-4888-9f97-50d9b304fddf_20250205T19:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII], and I have an account with, um, APL and I
[CUSTOMER][NEUTRAL] uh, one of my, um, I had a couple of procedures done at a podiatrist's office and I had given them my, um, regular insurance card, which is United, but I also gave them my APL card, but it doesn't look like they've been using um the APL card as, um, during my appointment. So,
[CUSTOMER][NEGATIVE] I was wondering if you'd be able to look into that for me just to make sure because I did get a statement from them and um there's no um nowhere on the statement that it says that they use APL that they had just used my United Insurance.
[AGENT][NEUTRAL] OK. May I have a policy number?
[CUSTOMER][NEUTRAL] Uh, sure. It is um.
[CUSTOMER][NEUTRAL] Uh, is, would it be a group number?
[AGENT][NEUTRAL] Is your outpatient benefit certification number.
[CUSTOMER][NEUTRAL] Oh, OK, it's 02235729 M as in Mary, L as in Larry, and 8.
[AGENT][NEUTRAL] May I have your date of birth, please, and mailing address?
[CUSTOMER][NEUTRAL] Sure, it's [PII] is the birthday and mailing address is [PII].
[AGENT][NEUTRAL] OK, and also could you verify a callback number and the email address on file?
[CUSTOMER][NEUTRAL] Uh, sure. The callback number is [PII] and then email is [PII].
[AGENT][POSITIVE] And thank you so much for verifying that. And do you have a date of service for a claim?
[CUSTOMER][NEUTRAL] Um, it's, it's a whole bunch of, um, different dates, um.
[CUSTOMER][NEUTRAL] Would you need all of them?
[AGENT][NEUTRAL] I can check a few, but if not, you do have the option to go on to the secured portal to see if those claims have been received and filed.
[CUSTOMER][NEUTRAL] Yeah, that's what I, I did log on before I gave you a call. I didn't see anything on there, so I didn't know if there was like a certain time period that it takes for the claims to be uploaded um because it is my gap insurance, so I'm, I'm just, I'm not quite sure.
[CUSTOMER][NEUTRAL] Um, I do have.
[AGENT][NEUTRAL] If, if they're listed in our system, they will be listed on the secured portal as well.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um, OK, so for instance, I do have, um,
[CUSTOMER][NEUTRAL] Alright, let's see, um.
[CUSTOMER][NEUTRAL] Um, uh, uh, [PII] was one of my procedures.
[AGENT][NEUTRAL] Now, is that the procedure day or is that a statement date?
[CUSTOMER][NEUTRAL] Um, it, it says it, that was the actual day of the procedure, but the statement that I'm looking at is actually all of my visits, um, that I've had for this specific, um,
[CUSTOMER][NEUTRAL] For this specific doctor, starting back in September, which was [PII]. That was the first appointment.
[AGENT][NEUTRAL] OK, now I do have a [PII] date.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But I don't have a [PII] or [PII] date.
[CUSTOMER][NEUTRAL] OK, and what um
[CUSTOMER][NEUTRAL] Yeah, I, it looks like, yeah, I only see on here the United Healthcare Adjustment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So how would I go about
[CUSTOMER][NEGATIVE] Submitting this, but I just submit the entire statement to you or is that like I'm just, I'm not sure how to handle this.
[AGENT][NEUTRAL] OK, so the way that the claims will have to be received, you can submit a statement, but that statement would have to have the exact date, exact total bill, the provider name that rendered the services. We will have to have a diagnosis code which will be the reason of those services and your primary insurance EOB showing that you had a patient's responsibility.
[CUSTOMER][NEUTRAL] OK, I believe that's what it does show on this statement, um.
[AGENT][NEUTRAL] Now if it's just your statement for, is that coming from your primary insurance or is that a statement from the provider?
[CUSTOMER][NEUTRAL] From the provider.
[AGENT][NEUTRAL] So that statement is not.
[CUSTOMER][NEUTRAL] Or from the doctor.
[AGENT][NEUTRAL] OK, so the statement is not your primary EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your EOB comes from your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't think I've gotten that yet.
[AGENT][NEUTRAL] So you may have to go on.
[CUSTOMER][NEUTRAL] So I would send over not the.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Oh, I was just gonna say I don't, so then I wouldn't be submitting to you the statement from my doctor. It would be from my health insurance.
[AGENT][NEUTRAL] So what you were submitting is the statement.
[AGENT][NEUTRAL] With the dates of service and total bill, your primary insurance EOB that shows those dates of service with the total bill showing your patient's responsibility.
[AGENT][NEUTRAL] And the diagnosis codes. So there's gonna be 3 types of 33 or more items that you will have to submit in. And the most important is your primary EOB and that diagnosis code for each date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and the EOB, I'm sorry, what does that stand for?
[AGENT][NEUTRAL] Explanation of benefit and that will come from your primary insurance. So you may have to go onto their website if you have access to that and you have to pull up each individual date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I see. OK, I can do that and then um I just submit everything on the APL website, correct?
[AGENT][NEUTRAL] Yes, now did you want me to look at that one that was for the date of service of [PII] to see if that is for one of the services rendered?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, that'd be great, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I was gonna say if this is the provider, if you wanted to contact them, you may be able to contact them and just have them to submit the documentation and if need be. Cause you're going to have to call that provider to get their diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now this claim came in from [PII], if I'm pronouncing it right.
[AGENT][NEUTRAL] Where
[AGENT][NEUTRAL] I don't know if
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So, the provider, it says on my statement from my doctor, it's [PII].
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Oh, but you know what, that was a um
[CUSTOMER][NEUTRAL] Wasn't it, I think it was an MRI.
[AGENT][NEUTRAL] Yes, this was at the radiology.
[CUSTOMER][NEUTRAL] And it was
[CUSTOMER][NEUTRAL] Yes, yes, that was in [PII], yes, that was, um, yeah, that was my MRI correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so is this the one that you were inquiring about or is another claim for that data service as well?
[CUSTOMER][NEUTRAL] Oh, there's, there's a whole bunch more after that. That was just my first appointment. And um I think what happened was it's because that was um
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A different office, they took my APL card, whereas, where I was getting the rest of my procedures done was at a different office um where my doctor actually is, not the radiologist's office, so they probably, I think what happened was they, they just weren't using the APL card um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Is it better if I call my doctor who did not use my APL card and kind of reaffirm that I need them to use um to submit using that card as well, or should I just go ahead and do this myself?
[AGENT][NEUTRAL] Now, if it's, it's either or, now it can be easier if the provider is going to submit the documentation in and they will submit all the needed information or if you would like to do the leg work where you will go in and download all the EOBs, make sure you get the diagnosis code for the data service and submit all that information in.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, I, I guess I can do um.
[CUSTOMER][NEUTRAL] I'll, I'll log into my United and make sure I can get the um explanation of benefits. And then um if there's no diagnosis code on there, then I'll call my actual doctor and see what they can do.
[AGENT][NEUTRAL] OK. And if they don't wanna submit it, just ask them for those diagnosis and you can write that on either the EOB or any anything that you're gonna submit in, just write it out and make sure that you put this for that date span that is listed that you're trying to get because if it just says, if it's just on there, we can assume that it's for each date of service if it's different ones.
[CUSTOMER][NEUTRAL] Got it. OK.
[AGENT][NEUTRAL] OK, and is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, that was all for now. Thanks so much for your help.
[AGENT][POSITIVE] You're welcome, thank you so much for calling American Public Life, have a great day.
[CUSTOMER][POSITIVE] All right you too bye.
[AGENT][POSITIVE] Thank you. Bye.