AccountId: 011433970860
ContactId: e5d1b0ef-ffb0-47d0-a607-2c22bb03a24d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 783960 ms
Total Talk Time (AGENT): 377767 ms
Total Talk Time (CUSTOMER): 328370 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/e5d1b0ef-ffb0-47d0-a607-2c22bb03a24d_20250428T21:18_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I'm sorry, who is this?
[AGENT][NEUTRAL] This is [PII] with APL.
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'll give you my member number.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] 0133
[CUSTOMER][NEUTRAL] 669-2 ML 7
[AGENT][POSITIVE] Thank you. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, the [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I just called in like 5 minutes ago and talked to [PII], yeah.
[AGENT][NEUTRAL] Yeah, I have to write it down.
[AGENT][NEUTRAL] Oh OK, yeah. Let me just make sure that it doesn't disappear and I don't have the number no more. OK, and um Mr. [PII], I just need to verify your date of birth for security and your address.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And how may I assist you today, Mr. [PII]?
[CUSTOMER][NEGATIVE] OK. I don't know why, but you're breaking up really, really bad. When I talked to [PII] a couple of minutes ago, she wasn't. I don't know. Are you working from home?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We all working from home.
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] Everybody in this company is working from home.
[CUSTOMER][NEUTRAL] Oh, OK, well.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, you've got a bad connection. um, so here's the deal. Quest neglected to send a bill into you guys and I had asked them twice to send it in and I forgot about it and now they're sending me nasty notices, so.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] If I, I can't get them on the phone because they're already closed for the evening. If I paid Quest this money, how would I submit, how can I put this? I would need to, what do I need to submit to you then to get paid for this?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So, uh, to submit a claim, and this is for all types of of claims, um, for everybody, um, you need 3 documents. The first document is the claim form. Yes, 3 documents. Mhm.
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] For reimbursement.
[CUSTOMER][NEUTRAL] Where, where do you get the claims forms from?
[AGENT][NEUTRAL] OK, the claim form you can find it in our website at [PII].
[CUSTOMER][NEUTRAL] Alright, let me write this down.
[CUSTOMER][NEGATIVE] At this point, I am like beyond annoyed at this stuff. It's not you, it's just I'm beyond annoyed. I hate Quest. I hate them. It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, Am like in the morning [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, I need the claim form, OK.
[AGENT][NEUTRAL] Mhm. Yes, you will get the claim form through there and it's gonna be the meddling claim form.
[CUSTOMER][NEUTRAL] Net link claim form. OK, let me write this net.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Linked claim form. OK. Yes, ma'am.
[AGENT][NEUTRAL] OK. Together with that, we're gonna need an itemized bill.
[AGENT][NEUTRAL] With diagnosis codes.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] The CPT codes or the diagnosis codes?
[AGENT][NEUTRAL] It's gonna need to have both of them, the CPT codes and the diagnosis codes.
[CUSTOMER][NEUTRAL] Quest bills just give you a CPT code on their bill.
[AGENT][NEUTRAL] On their, yes, on their regular bills, they only have the CVC codes. In order to get one with diagnosis code, you will have to request one from them.
[CUSTOMER][NEUTRAL] The, the codes from the insurance company you want to?
[AGENT][NEUTRAL] Unless you have um Blue Cross Blue Shield, that they do have that code, then that's the only company that works with that code. Uh the other ones they don't.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so what I have is United Healthcare, and they have claims processing codes on them on their copy of what they sent me.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes, but they don't have.
[AGENT][NEUTRAL] They don't have diagnosis codes.
[CUSTOMER][NEUTRAL] Say what?
[AGENT][NEUTRAL] They don't have the diagnosis codes on their explanation, the benefits.
[CUSTOMER][NEUTRAL] The GEV 003 is not a code.
[AGENT][NEUTRAL] That more than likely that's a procedure code or a code that they work with.
[AGENT][NEUTRAL] The only one that we know that.
[CUSTOMER][NEUTRAL] The PP0.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEGATIVE] OK, so what is this like a new scam that APL is doing because this has never happened in all the years that I've had it.
[CUSTOMER][NEUTRAL] They've always taken the quest bill.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And the thing from the healthcare.
[AGENT][NEUTRAL] If Quest send in the claim directly they're gonna have the diagnosis code, but we need the diagnosis code for any claims that just been forever. It's, it's a must to have the diagnosis code for all claims.
[CUSTOMER][NEUTRAL] And the CPT code is not a diagnosis code.
[AGENT][NEUTRAL] That's a procedure code. The CPT code is a procedure code.
[CUSTOMER][NEUTRAL] I've never had a problem in all the years I've been doing this. This has never happened like this before.
[CUSTOMER][NEGATIVE] So you're saying the CPT code is not good enough.
[AGENT][NEUTRAL] No. OK, let me tell you the difference in between the two codes so you, so you will have a better understanding. OK, the CPT code is a procedure code will let us know that they did, and this is just an example, a CT scan. Now, the diagnosis code is the, the code that tells us why you have to have that CT.
[AGENT][NEUTRAL] So, in order to pay for that CT we need to know if that was an accident or you had pain in the back, um, you had pain in one of your organs, if something is wrong, if
[AGENT][NEUTRAL] We need to know the reason why you had to have that CT. So the diagnosis code is the one that tells us why you had to have that CT, which is the CPT code.
[CUSTOMER][NEGATIVE] And nobody puts that on their, on their stuff is what you're telling me?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] So you're telling me that nobody puts these codes on their paperwork.
[AGENT][NEUTRAL] The insurance companies, the primary insurance companies, they don't put the diagnosis code. Now when you ask the provider of service or just an example, whenever we receive a claim from a provider, they send it to us with the diagnosis code. Like if we sending the claim directly to us, it needs to have that diagnosis code and usually they do send us a diagnosis code, but when they send the bill to you, to your home.
[AGENT][NEUTRAL] They don't include that diagnosis code for some reason.
[AGENT][NEUTRAL] I'm not sure why, but it's just not included on the regular bill. They send it if it has to be sent to us like a 1500 form which is medical form that they use or the UVO4 which is a medical form they use those two need to have that information which is usually there and that's why we have paid all your claims that we receive from the providers because the provider does give us that information all the time.
[CUSTOMER][NEGATIVE] You know what, seriously, this is like this is [PII] that I've gotta go through this trying to get this paid. This is just ridiculous.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And this is, this is like, this is like your company trying to avoid paying claims is what this comes down to. I mean, this is ridiculous.
[AGENT][NEUTRAL] I do apologize if you feel like that, but we need a claim and, and we have not received the claim. So really we need the quest to send the claim in to know that you did have a service rendered.
[CUSTOMER][NEUTRAL] This, this is I.
[CUSTOMER][NEUTRAL] Well, I've got a copy of their bill here. Yeah, I, I get you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And then I've got a thing from the insurance company that I was there as well. So I, I still don't, I think it's a scam that your company is going to deny payment. I, I, at this point, I, I think I need to file a complaint with the state of [PII] because this is ridiculous. I shouldn't have to go through all of this when I have a bill from them and then they from the insurance company. This, this is not right. This is totally not right.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Just regular requirements for everybody. Mhm.
[CUSTOMER][NEGATIVE] At all.
[CUSTOMER][NEUTRAL] Well, so if this is a regular requirement for everybody, then this should be a law for all of the insurance companies to supply this.
[CUSTOMER][NEUTRAL] On their ELBs, it should be on there. If this is a bonus requirement.
[AGENT][NEUTRAL] The primary insurance is not the one that
[AGENT][NEUTRAL] Miss [PII], the, the primary insurance is not the one that needs to send the claim. The claims are sent from the providers, so the insurance is not really obligated to have that information because they're not the one that's gonna send the claim to us. The claims is gonna come from the provider.
[AGENT][NEUTRAL] So the one that needs to have
[CUSTOMER][NEUTRAL] You, when you say the provider you mean quest?
[AGENT][NEUTRAL] Yes, so the one that needs to have that information on the paperwork is is the provider's request.
[AGENT][NEUTRAL] It's not the insurance company. It's not the primary insurance.
[CUSTOMER][NEUTRAL] So then if this is required to pay, why doesn't Quest have it on their bills?
[AGENT][NEUTRAL] I'm not sure. That's something you probably need to ask them, but.
[CUSTOMER][NEUTRAL] Wouldn't that be the law if it's requested?
[AGENT][NEUTRAL] Like I said before, when they send it in, they have a medical form. There is a medical form that they need to use, which they do have to send that information over to us to order in order to get payment, but when they send it to the member, they just go ahead and send the regular bill, which it doesn't have that information.
[CUSTOMER][NEGATIVE] Well, I'm gonna start calling them again first thing in the morning then because I'm not paying this and you guys are required to pay this, so I will figure this out but like I say, I'll file a complaint with the state of [PII] with the health department. Yes, I, I don't need to go through all of this to try to get it all paid all the time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I'm sorry for your frustration, but yeah, if you can get requests and just let them know that you need an itemized, you need an itemized bill with the diagnosis code or if they can just go ahead and send that claim for you, we can go ahead and process the claim, but yeah, we're gonna need that information to process.
[CUSTOMER][NEUTRAL] Itemized bill with what code?
[AGENT][NEUTRAL] Diagnosis code.
[CUSTOMER][NEUTRAL] Diagnosis.
[AGENT][NEUTRAL] Yes, diagnosis.
[CUSTOMER][POSITIVE] Oh, I'm gonna start calling them in the morning. You don't know, this has been going on with Quest for years and thank [PII] we're no longer gonna use them. Thank God, because this, this has been the story with them for 10 years.
[AGENT][NEUTRAL] Hm.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEGATIVE] Whenever you get anything done there, they're not submitting the stuff that needs to be submitted. And then we, as people that have paid $200 a month for APL are doing all of this additional stuff that we shouldn't have to do to get our bills paid. It's like bogus, man. It's like, it's like a joint effort to rip you off.
[CUSTOMER][NEGATIVE] I will get on this first thing in the morning and then if they will not send that to you, then what do I do? I'm out the money and I've got to pay them?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Again,
[AGENT][NEUTRAL] If they say they're not going to send the claim to us for 1 reason, you're going to ask them.
[CUSTOMER][NEUTRAL] But they tell me all the time that they're sending them to you and they say that they've sent them.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] I do understand that they're not getting here, so I'm not sure where they're sending it to. So if for any reason if they say we already send it, we're not gonna send it again or we, we have sent it, um, and you know that you called us, you check and also you can go ahead and register online and you're gonna see that we have not received it, so it is, we have everything recorded.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So you can let them know, well, they are, they are not receiving the claim, so can you please send it if they say for X reason that they're not gonna send it, then you need to ask them, well, go ahead and send me a copy or you send me an itemized bill with the diagnosis code. I need to be a detailed itemized bill with the diagnosis code. I don't want the same bill you sent me before because that one doesn't have the diagnosis code. I need the one with the diagnosis code.
[CUSTOMER][NEUTRAL] OK, and detail the itemized bill?
[CUSTOMER][NEUTRAL] With diagnosis code.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I wonder what time they open in the morning.
[CUSTOMER][POSITIVE] Sounds like it's gonna be another lovely day tomorrow trying to figure this out. All right, I'm gonna do my best because I'm not paying for something I shouldn't have to pay for. I thank you for your time.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, no, no, thank you.
[AGENT][POSITIVE] Mm OK. And you're welcome and thank you for calling APL. Have a good afternoon. Bye-bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You too.