AccountId: 011433970860
ContactId: e6f45e63-74c6-458e-8c46-38ed36caab9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419440 ms
Total Talk Time (AGENT): 181778 ms
Total Talk Time (CUSTOMER): 205958 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/e6f45e63-74c6-458e-8c46-38ed36caab9d_20250123T15:30_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Hi [PII], good morning. How are you?
[AGENT][POSITIVE] I'm great, thanks for asking. How are you?
[CUSTOMER][NEUTRAL] Good good thank you um, [PII], I have a question. I need to submit a claim and this is gonna be my first time doing that so I'm not sure how to do it.
[AGENT][NEUTRAL] Sure, I can assist you with that. Can I have a policy number?
[CUSTOMER][NEUTRAL] Sure it is.
[CUSTOMER][NEUTRAL] 60
[CUSTOMER][NEUTRAL] 801.
[AGENT][NEUTRAL] It should say policy or certain number on your card because that's not long enough.
[CUSTOMER][NEUTRAL] Oh, that, that's, that's the payer ID. It could be the group number one.
[AGENT][NEUTRAL] It's just a policy of certain number it should say inpatient or outpatient.
[AGENT][NEUTRAL] On your card?
[CUSTOMER][NEUTRAL] In inpatient, OK, which one you want? In hospital outpatient?
[AGENT][NEUTRAL] Either one.
[AGENT][NEUTRAL] Either one will be fine.
[CUSTOMER][NEUTRAL] OK, is 01797912 ML8.
[AGENT][POSITIVE] Thank you and what's your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And [PII], a good, good call back number is [PII] just in case the call is disconnected.
[CUSTOMER][NEUTRAL] Um, that's my office number [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Or you can take my cell phone if you want.
[AGENT][NEUTRAL] OK, what's your cell phone number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Thank you. Could you verify your mailing address and your date of birth for me, [PII]?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and my date of birth is [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is the email address that we have on file for you?
[CUSTOMER][NEUTRAL] Is [PII]? Oh I'm not sure if you have my employer.
[AGENT][NEUTRAL] What's your employee email address?
[CUSTOMER][NEUTRAL] Is [PII] and it used to be right OK because we changed it.
[AGENT][NEUTRAL] Yes, that's what we have.
[AGENT][NEUTRAL] And you're calling to submit a claim, so we would need your explanation of benefits from your primary insurance company.
[CUSTOMER][NEUTRAL] I do have it, uh, where should I send it?
[AGENT][NEUTRAL] And do you have your diagnosis codes?
[CUSTOMER][NEUTRAL] Diagnosis go let me see, hold on.
[AGENT][NEUTRAL] The reason for the services mhm.
[CUSTOMER][NEUTRAL] Explanation of benefits for a claim received [PII]. [PII] claim claim ID provided network account name.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] On bill cost amount.
[CUSTOMER][NEUTRAL] What I oh you see I don't see.
[AGENT][NEUTRAL] So you will have to get that from the the facility where you receive the services from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can write that on your EOB and if when you get that diagnosis code and you write it on your ELB ELB you can send it to us by fax or you can upload it in your online account or you can send it to us by mail. Would you like the fax number?
[CUSTOMER][POSITIVE] Um, give me, how can I do it online? It's gonna be easier for me.
[AGENT][NEUTRAL] So go to [PII].
[CUSTOMER][NEUTRAL] OK, A.
[CUSTOMER][NEUTRAL] Uh, what's the website? I'm sorry, [PII].
[AGENT][POSITIVE] [PII].
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] I'm not sure if you set up an account or not yet.
[CUSTOMER][NEUTRAL] No, not yet.
[AGENT][NEUTRAL] So you will have to set up an account.
[CUSTOMER][POSITIVE] OK perfect I will do that.
[AGENT][NEUTRAL] Click on sign in.
[CUSTOMER][NEUTRAL] Fine.
[AGENT][NEUTRAL] And you're gonna sign in.
[AGENT][NEUTRAL] The sign in tab.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once you go to the sign in tab you're gonna hit new user.
[CUSTOMER][NEUTRAL] OK, yeah, OK.
[AGENT][NEUTRAL] And when you hit new user you're gonna choose I am an individual.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And once you do that you're gonna put in all your information and it's gonna say not a policy number but put your policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And exactly what do you need from the facility?
[AGENT][NEUTRAL] So you would just call them to ask them for the diagnosis code. And once you get the diagnosis code, you can write it on your ELB.
[AGENT][NEUTRAL] For the date of service.
[CUSTOMER][NEUTRAL] Date of service.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be your ICD 10 code.
[CUSTOMER][NEUTRAL] OK, so I put it there and what else do you need uh from me? Do you need a receipt showing that I paid because I, I pay I paid it out of pocket.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, no, it's just the payment.
[AGENT][NEUTRAL] It's just gonna go to you. Whatever went towards your deductible, co-pay or co-insurance on your ELB, do they have an amount under there like your diagnosis it's gonna say um.
[CUSTOMER][NEUTRAL] Yes, it says it says um.
[CUSTOMER][NEUTRAL] Surgery surgery, radiology, and then, and then cost reduction and then amount not covered 38678.
[AGENT][NEUTRAL] And is that under your deductible co-pay or your co-insurance column?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] It uh.
[CUSTOMER][NEUTRAL] It says called pay 0 deductible 0, and then what I owe it says 38678.
[AGENT][NEUTRAL] So do we have a PR beside that 3?
[AGENT][NEUTRAL] Patient responsibility. Do we have a PR like do we have PR 3 patient responsibility?
[CUSTOMER][NEUTRAL] If I have what?
[CUSTOMER][NEGATIVE] I'm sorry, you're breaking up.
[CUSTOMER][NEGATIVE] It says what I owe 36, no cover, and then, no, I don't see.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Patient.
[AGENT][NEUTRAL] Send in that EOB with the diagnosis codes and your receipt showing what you paid.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Correct, OK, perfect, um, I will do that and upload the explanation of benefits as well, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect thank you so much I will do that.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No, how long does it take for you to process the claim?
[AGENT][NEUTRAL] Um, once we receive it, probably about 10, between 7 to 10 business days.
[CUSTOMER][NEUTRAL] And how you send the money back in a check?
[AGENT][NEUTRAL] If it, if you have direct deposit then it'll be direct deposit but if you don't have that then we will send it in to you with a form of a check to your mailing address.
[CUSTOMER][NEUTRAL] I do have I mean but how you guys gonna know direct deposit?
[AGENT][NEUTRAL] So if you do want direct deposit, there should be a direct deposit form on the website that you could fill out and submit it with your claim as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, I will do it then. OK, thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today?
[CUSTOMER][NEGATIVE] No thank you bye bye.
[AGENT][POSITIVE] You're welcome thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] I see