AccountId: 011433970860
ContactId: ecacd60c-50a3-4df1-ac77-87574f4cbe09
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444600 ms
Total Talk Time (AGENT): 258591 ms
Total Talk Time (CUSTOMER): 153966 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/ecacd60c-50a3-4df1-ac77-87574f4cbe09_20250314T19:53_UTC.wav
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[AGENT][NEUTRAL] Contacting APO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, good afternoon and uh let me give you my ID number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Or the policy number, what what is better for you?
[AGENT][NEUTRAL] Uh, the policy number usually begins with a 01 or 02.
[CUSTOMER][NEUTRAL] 025727772
[AGENT][NEUTRAL] Thank you. And if I could verify your name, uh date of birth, and a phone number, please, sir.
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] And your phone number, sir?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, um, I do have your policy pulled up. How may I help you?
[CUSTOMER][NEUTRAL] Uh, recently, uh, I went to surgery.
[CUSTOMER][NEUTRAL] And I'm trying to file a claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I don't know how what kind of paperwork, who I have to contact to get the paperwork if you can guide me through would be highly appreciated.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Certainly, um, so the very first thing that you will need is the documentation or the itemized bill from, um, your doctor, uh, or from the surgery center, whatever it is that you're trying to.
[CUSTOMER][NEUTRAL] Itemized
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Itemized bill from the doctor hospital.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, the doctor, the hospital, the anesthesiologist, whoever it is you're trying to send and uh and get reimbursed for, we will need the itemized bill and the itemized bill has to include, um, what was done, the, the, the procedure that was done, as well as your diagnosis code and your diagnosis code is, is, uh, what, um, the, the reason that you had the surgery, and that should be on your itemized bill.
[AGENT][NEUTRAL] And then the other thing that we.
[CUSTOMER][NEUTRAL] OK, so I have to call, so the first thing I do, I call, I call the hospital, the provider and ask for itemized.
[AGENT][NEUTRAL] Yeah, you would call your doctor.
[AGENT][NEUTRAL] An itemized bill. That's correct. That's correct, yes, and the diagnosis code. And then the next thing that you're, that uh we will need is that you have, you have a major medical and we need the explanation of benefits, you know, what, how did they process that claim? Um, so you would have an explanation of benefits from your major medical for
[CUSTOMER][NEUTRAL] Automized bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So explanation.
[AGENT][POSITIVE] That service, uh-huh, of benefits. Sure, absolutely.
[CUSTOMER][NEUTRAL] Give me just a second, let me write down explanation.
[CUSTOMER][NEUTRAL] Of benefits from my insurance provider.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] So you'll need those things and then you can do uh one you can submit it to us one of three ways, um, you can mail it to us.
[AGENT][NEUTRAL] You, you'll mail us those documents or you can fax it to us or we also have a online service center which is probably the fastest, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On your card, it should state uh that um uh it should have our uh website on there and that website is [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's it, yes sir. If you, if you were to send that in and that's really the fastest way to do that and if you want to go ahead and send it in that way you can also track your claim, so you'll know when we get it, when we process it, and when is it paid out.
[CUSTOMER][NEUTRAL] And usually how long it takes to the claim to be paid.
[AGENT][NEUTRAL] It's usually 3 to 6 business days after we receive it.
[CUSTOMER][NEUTRAL] OK, so if I can get the itemized bill from the hospital.
[CUSTOMER][NEUTRAL] And the explanation of benefits from my insurance, I have to do that on the site.
[CUSTOMER][NEUTRAL] And 3 to 6 days I should receive a check or the check who the check goes to goes through the the balance that I have with the hostel or goes to.
[CUSTOMER][NEUTRAL] Uh, me.
[AGENT][NEUTRAL] It, well, you're the one who's submitting the claim.
[AGENT][NEUTRAL] And so it's going to go to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] And I have no clue under my name there correct?
[AGENT][NEUTRAL] Uh, no, not, not as of right now.
[CUSTOMER][NEGATIVE] OK, so they didn't do anything because I gave the the cards to them they said they're gonna do it so they didn't do anything.
[CUSTOMER][NEUTRAL] OK, and this is the main phone number that I.
[CUSTOMER][NEUTRAL] Should always go correct?
[AGENT][POSITIVE] That is correct, yes.
[AGENT][NEUTRAL] And uh if you, if you wanted to, um you can also uh you can also have your provider, but you can make sure with your provider if you don't want to file the claim yourself, and you can also um just remind you can contact them and let them know you have the secondary insurance and that we will take care of of the bill. So you can either have them file it, um, and if they haven't filed anything yet, sometimes it takes them a while to do that, um, but if it's uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] If they haven't filed it yet, you can always just contact them and let them know uh that you have the secondary insurance that they want to file through through us to get the payment.
[CUSTOMER][NEUTRAL] OK, so I'm gonna try to get that, uh, itemized bill sent to me and also gonna call my provider to try to get uh the explanation of benefits.
[CUSTOMER][NEUTRAL] And I'll try to upload that tomorrow on the site. I have to create the account on the site.
[AGENT][NEUTRAL] Uh yes, sir. This takes a few moments and, and all you're doing is creating a username and a password. And then once you do that, uh, yeah, and then if you can also print out uh new uh insurance cards, you can see how the claim is processed, anything like that. And, and just make sure that they have your diagnosis code on that, on those itemized bills. Is there anything else at all that I may help with?
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] That's it that they own the itemized bill should show the, the, the, uh, my diagonals, right, or I have to ask them to.
[AGENT][NEUTRAL] That, well, they, they should show on there. If not, you can just go ahead and ask them and they'll, they'll give you something that because, you know, it is your, it is your medical information, so they'll give you that information.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good.
[AGENT][NEUTRAL] OK, well, if there's
[CUSTOMER][NEUTRAL] Let me take just one look here. I'm gonna take a look because I have, I have my health chart.
[AGENT][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Let me see if they have billing summary should be that no.
[AGENT][NEUTRAL] Well, it, it might be, uh, what is it, does it list, uh, what they did and how much they
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, there's nothing there.
[AGENT][NEUTRAL] Because sometimes the bills that they send you, sometimes the bills that they send you, that's not what you're looking for. It's, it's the, it's the actual, um, they have what is called a walkout sheet or um an itemized bill and, and what the itemized bill is is it, it lists everything that uh that they did and they, and they give that to you because you know that's, that's part of your record.
[CUSTOMER][NEUTRAL] When I see billing summer.
[CUSTOMER][NEUTRAL] That's that's part of your record. Right, so I'm gonna call them and they can get that that's the first thing and then call my provider. Alright, sounds good thank you.
[AGENT][NEUTRAL] So that they'll give that to you.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] OK, well, thank you for contacting API. Have a good day.