AccountId: 011433970860
ContactId: ce77bd94-e7fa-4387-933e-baae6a4b6cad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288950 ms
Total Talk Time (AGENT): 150111 ms
Total Talk Time (CUSTOMER): 131576 ms
Interruptions: 5
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/ce77bd94-e7fa-4387-933e-baae6a4b6cad_20250310T13:14_UTC.wav
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[AGENT][NEUTRAL] So you
[AGENT][NEUTRAL] Hello, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I'm calling in about a claim.
[CUSTOMER][NEUTRAL] That I found and uh
[AGENT][NEUTRAL] Are you the insured or the provider?
[CUSTOMER][NEUTRAL] I'm the insured.
[AGENT][NEUTRAL] Do you have a policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] Mm, I don't have it with me. I don't have it on hand. I have to go in and pull it up.
[AGENT][NEUTRAL] So what is your social?
[CUSTOMER][NEUTRAL] I'm gonna say.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your name?
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] [PII], can you verify your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And [PII], what is the email address that we have on file for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And a callback number just in case the call is disconnected is the [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the claim that you're inquiring about today?
[CUSTOMER][NEUTRAL] So, I, I, this is 2 bills.
[CUSTOMER][NEUTRAL] And then I got a message saying they needed something about um where the first insurance, you know I got my insurance through I guess the same company I thought, OK, so I'm trying to figure out what do I need to send because one of them is where my doctor ordered me to go get an MRI.
[AGENT][NEUTRAL] Mhm I see for the testing.
[CUSTOMER][NEUTRAL] I gave them the card.
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] I see it's for diagnostic testing, but let me ask you, did you submit the EOB in from your primary insurance company? Who's your primary insurance company?
[CUSTOMER][NEUTRAL] The rest.
[CUSTOMER][NEUTRAL] Yes, I gave him my card.
[AGENT][NEUTRAL] Could you repeat that?
[CUSTOMER][NEUTRAL] To rest through United Healthcare.
[AGENT][NEUTRAL] I see we only have, you, you only sent in a statement.
[CUSTOMER][NEGATIVE] I flipped it over and showed the itemized where they paid some and I gave them my card. That's what the lady told me. That's the only reason why I got the gap, you get what I'm saying. She said they, they'll kick in a portion too. So I gave them the card, they kicked it back. So then I had to submit it. They said I need to, I've been going through this for months. You get what I'm saying? I've called several times.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Because you haven't sent in.
[AGENT][NEUTRAL] You haven't sent in what we're requesting. So what we're requesting from you, so when you get off the phone with me, you need to contact your primary insurance company and request the EOB, which is the explanation of benefits for the date of service of [PII] and [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] What is
[CUSTOMER][NEUTRAL] Uh EOB
[AGENT][NEUTRAL] Explanation of benefits, but if you say EOB they'll know exactly what you're meaning, and then you will also let me see what else is requesting from you. It's not difficult at all just somebody have to explain it to you so you can know exactly what you need to go get and then you would need um contact the providers, the facility where you got the services from, the billing department and ask them for an itemized bill with the diagnosis listed.
[CUSTOMER][NEUTRAL] E O
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's the one for the ERC when I got sick.
[AGENT][NEUTRAL] Write this down.
[AGENT][NEUTRAL] For both of them, yes ma'am, for both of them. So that's why we haven't paid you yet because we need those, we need those items for both dates of services so write it down so you can make sure you contact them, contact your primary insurance provider, ask for an EOB.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][POSITIVE] Oh, I got it. I'm about to do it now, you.
[CUSTOMER][NEUTRAL] E O B
[AGENT][NEUTRAL] Then contact the facility billing department and ask for an itemized bill.
[CUSTOMER][NEUTRAL] And I then I needed to that.
[CUSTOMER][NEUTRAL] Itemized food mhm.
[AGENT][NEUTRAL] With your ICD 10 codes listed for each date of service.
[CUSTOMER][NEUTRAL] Ah, see what?
[AGENT][NEUTRAL] I see, I as in India, C as in Charlie, D as in dog, 10.
[AGENT][NEUTRAL] Codes. The reason why they sent you there to get those.
[CUSTOMER][NEUTRAL] Oh, I see DT and Coke.
[CUSTOMER][POSITIVE] OK, alright, OK, I got you.
[AGENT][NEUTRAL] And once you send that in, then we will process the claim.
[CUSTOMER][NEUTRAL] OK, alright, OK, I was wondering cause I was like, you know, at first I'm starting to feel like my, my gap wasn't, you know, ain't doing what it's supposed to do. Yeah, OK. So let me do this.
[AGENT][NEGATIVE] You're paying this for anything, right.
[AGENT][NEUTRAL] Right, but we need that information and once we receive it, you could just upload it on your online account?
[AGENT][NEUTRAL] And the claim will be processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, sounds good. I'm gonna do that now. I just needed somebody to explain what else I needed to do. OK, alright, thank you.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No, that'll be out.
[AGENT][POSITIVE] Thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] And you do the same bye bye.
[AGENT][NEUTRAL] Bye.