AccountId: 011433970860
ContactId: e47b7b81-b41f-46ff-bbbf-82b573754604
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 831309 ms
Total Talk Time (AGENT): 308812 ms
Total Talk Time (CUSTOMER): 248192 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/e47b7b81-b41f-46ff-bbbf-82b573754604_20250218T21:42_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling because I am trying to get um some um blood work.
[CUSTOMER][NEGATIVE] I, I'm sorry, let me restart. I keep receiving bills from Quest Diagnostics over blood work for my wife, um, and they keep saying that they send the claim to APL, which is my secondary insurance, um, and they received no response.
[CUSTOMER][NEUTRAL] Um, so I'm, they, they just recently faxed them and they've actually faxed them in the past, which some of them have been paid but not all of them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm just trying to call and figure out if you guys have received the latest fax.
[AGENT][NEUTRAL] OK. Well, I can definitely look into the policy for you and see what's been received. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] number is [PII].
[AGENT][NEUTRAL] OK. And may I have your policy number?
[CUSTOMER][NEUTRAL] 0227
[CUSTOMER][NEUTRAL] 9404
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Email address is [PII].
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, you said this is for your wife though, right? Let me look under your wife.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, looks like the last claim that we received was received on [PII], but they've all been paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] But let me even see if this is Quest. Hold on.
[AGENT][NEUTRAL] Oh, the one after it was Quest. OK. So the last claim from Quest was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can you tell was that received through the mail or was it through fax?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I'm gonna say fax because of how it just says CMS, so it's just a claim form, it doesn't.
[AGENT][NEUTRAL] Like show me if it was mailed or faxed or how it came in, it just shows like what was sent in.
[CUSTOMER][NEUTRAL] OK, are you able to see because I've actually got two different answers from somebody today over one bill. One person told me that you guys received it, you didn't pay anything, um, and then this other person just told me that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] They got no response back from you guys.
[AGENT][NEUTRAL] Well, do you have a data service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 13 of 2024.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] OK, hold on one second, let's see.
[CUSTOMER][NEUTRAL] The bill that I got is for $59.08.
[AGENT][NEUTRAL] 13 of 2024.
[CUSTOMER][NEUTRAL] 13 of 2024.
[AGENT][NEUTRAL] So we received 3 claims on this day. Do you mind if I place you on just a brief phone? I'm just gonna go through the claims.
[CUSTOMER][POSITIVE] Yeah, you're good.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, thank you so much for holding. I apologize for that wait. So of the three claims that were received um with the date of service [PII], only one was from Quest. That bill totaled $66.83. Um they well, that was the total bill charged before they sent it to primary, um, and then after we received it, we paid $9.66 to the claim.
[AGENT][NEUTRAL] Which is what was left over after primary.
[CUSTOMER][NEUTRAL] OK, yeah, so that doesn't sound like the bill that I currently have.
[AGENT][NEUTRAL] Yeah, so that's the only claim that they sent in for that day. So I mean, there's no like deadline or anything, they still can send it, we just haven't received it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, and they, so I, after speaking with them today there were 3 claims that have been re-faxed today.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEGATIVE] Um, but I just, I don't know how why it's like some of them go through, but some of them don't like.
[CUSTOMER][NEUTRAL] I don't know exactly like where they're going, but like.
[CUSTOMER][NEGATIVE] It's just, it's odd to me that some of them like they you guys receive some of them but don't receive some of them.
[AGENT][NEUTRAL] It depends.
[AGENT][NEUTRAL] Yeah, it depends on how they, I mean, there's several variables that can go into that. If they have us in your, if they have us in their system, do they have the old information and they were sending it to [PII] and then they sent it here like there's a lot of things that can go into that. I unfortunately can't uh.
[AGENT][NEUTRAL] Can't really help on it, but yeah, I mean, because we did have the old claims mailing address. I don't know if it was faxed, and they had to refax it.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah, I've, I've given them all the, all the new information off the back of my card which is [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But do you know roughly how long it takes from the time they fax until you guys receive it?
[AGENT][NEUTRAL] Well, usually with fax, we say to give it at least an hour. Um, if it's not received in 24 to 48, then they need to definitely resend it.
[CUSTOMER][NEUTRAL] OK, so you, you should be able to see if you guys receive a fax.
[AGENT][NEUTRAL] Uh-huh, um, even if we, because when the fax is sent in, it goes to um document management.
[AGENT][NEUTRAL] And then they'll like upload it. So even if like it's in between that process, we'll still be able to see it's here, we might not be able to access it, but we can see something came in, you know.
[CUSTOMER][NEUTRAL] OK, are you able to see because they faxed two of them earlier today. This 3rd 1 they didn't just fax until 10 minutes ago.
[AGENT][NEUTRAL] Sure, hold on one moment. And it was faxed today?
[CUSTOMER][NEUTRAL] Today.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Oh yeah, there's a, I mean, so there's a total of 20 that came in today. Let me see if they've put a policy number on anything yet.
[AGENT][NEUTRAL] So I can at least see if it's yours. Hold on one moment.
[AGENT][NEUTRAL] So far, I don't see it, but there are a few here that haven't been tagged with the policy number yet, so it could be those. I, I would just have to wait and see if a policy number populates, so then I can, you know, say this is for you for sure, but there's 20 that um are in this queue right now.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Are just curious, are you able to see like a balance?
[AGENT][NEUTRAL] A balance?
[CUSTOMER][NEUTRAL] Of what what what.
[CUSTOMER][NEUTRAL] Like the an amount that was sent.
[AGENT][NEUTRAL] Oh, like how much is, oh, OK. Um, no, I just see the day, the time, and then like if there's a policy, if they have worked it, there's a policy number here, so we know whose policy it belongs to, but
[AGENT][NEUTRAL] Um, then there's a few here that are blank.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You can
[CUSTOMER][NEUTRAL] Can you not see the data service on them either?
[AGENT][NEUTRAL] No, it just shows me the um the day and time it came in.
[AGENT][NEUTRAL] Yeah, it's not specific other than the policy numbers once they're added and then we can go in there and see what.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Yeah, I called uh.
[CUSTOMER][NEUTRAL] How do I call?
[AGENT][NEUTRAL] But if they sent it today, then definite. I'm sorry.
[CUSTOMER][NEUTRAL] it it was like [PII] is when I, sorry about that. It was like [PII] when I called them and they around [PII] is when they faxed them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But um,
[CUSTOMER][NEUTRAL] I mean I'll give it a full day and then I guess I'll call back tomorrow and see.
[AGENT][POSITIVE] Oh, definitely. We can check for you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] So OK, I appreciate it.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, no, um, just curious if, if for some reason the faxes don't seem to be going through, is there another way that I can.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Submit these basically.
[AGENT][NEUTRAL] Yes, um, you can mail them or you can submit them online through our online portal, um, electronically.
[CUSTOMER][NEUTRAL] OK, what's what is needed to submit them?
[CUSTOMER][NEUTRAL] Like, I have the paper from Quest. Is that good enough?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So anytime you submit the claim or file a claim, you're going to need the claim form, the Medlink claim form, which can be found on our website. Um, you're going to need the itemized bill from Quest. Um, they have your patient copy, but Quest may have a, um,
[AGENT][NEUTRAL] Well, I don't know because course is the provider. So as long as your bill has like the diagnosis codes and the um procedure codes, it should be OK to go ahead and submit. We just need those coding. One shows the medical necessity, the other shows the treatment, why that treatment is needed for that medical necessity.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sounds good to me.
[AGENT][NEUTRAL] All right, well, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that is it thank you so much.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APL and I do hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you, bye bye.