AccountId: 011433970860
ContactId: ef20d359-3147-4498-934c-95481caa5e9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 565820 ms
Total Talk Time (AGENT): 292883 ms
Total Talk Time (CUSTOMER): 225379 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/ef20d359-3147-4498-934c-95481caa5e9a_20250218T13:35_UTC.wav
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[AGENT][POSITIVE] Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello. Hi, my name is [PII]. I'm calling because I had filed a claim and I received a text message. I'm not sure if it was actually from you guys or not. That's why I'm calling, saying that the claim has been completed or processed or something, but I don't see any information on the website. Will you be able to help with that?
[AGENT][POSITIVE] It would be my pleasure to assist you, Ms. [PII]. Do you have your policy number available?
[CUSTOMER][NEUTRAL] Um, let me see if I can get that for you.
[CUSTOMER][NEUTRAL] I don't think I see a policy number here. Where would I find that?
[AGENT][NEUTRAL] This is it.
[AGENT][NEUTRAL] Does it have a claim number attached to the text?
[CUSTOMER][NEUTRAL] I do have a claim number it's 356.
[CUSTOMER][NEUTRAL] 322.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 35
[CUSTOMER][NEUTRAL] I'm sorry, 356-432-2.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right. Miss [PII], can you verify your date of birth and current mailing address?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] And mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and what is a good callback number just in case we get disconnected please ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you. We have a different phone number in the system, uh phone number ending in [PII]. Do we need to update that phone number is that still a valid phone number?
[CUSTOMER][NEUTRAL] No, that's not a valid number. I'm not sure what number that is, but yes please update it because as you can see I received a text to this number, so I don't know where that number came from.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And that area code [PII]?
[CUSTOMER][NEUTRAL] E [PII]
[AGENT][NEUTRAL] All right, I've updated that for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] It looks like they did process a claim yesterday that was submitted on [PII].
[AGENT][NEUTRAL] Uh, for data service 11725.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, it sometimes takes.
[AGENT][NEUTRAL] up to 24 hours to be able to view.
[AGENT][NEUTRAL] It on the portal.
[CUSTOMER][NEUTRAL] Oh, OK, I understand. OK, that's why it's not showing anything on the website, got you.
[AGENT][NEUTRAL] That, that's right. And so what they are needing additional information.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like that you submitted a receipt for your services. However, they're gonna need a fully itemized bill.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] With diagnosis codes and procedure codes, along with a copy of your primary insurance explanation of benefits, because we're secondary, we have to have that primary EOB and show that AOB stands for explanation of benefits, and that will show us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The EOB would be for, I'm sorry to interrupt, but you mean an EOB for the month of January?
[AGENT][NEUTRAL] Just from your primary insurance for that data service of [PII].
[CUSTOMER][NEUTRAL] Well that's um OK, so here's the issue. I had a surgery and the date of service was actually [PII]. I had this was my deductible that I had to pay prior to the procedure, so that's why I made the payment on the [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, got you, and see that um from the receipt that's the only information that we have.
[AGENT][NEUTRAL] So I I see what, I see what you're saying. So, anytime that you submit a claim, we're gonna need the itemized bill from the surgeon or the facility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right, so I can get that from them.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] That's right. That'll be from where you had your surgery. Was it, it was it an outpatient surgery?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I went home the same day as it was done at um Memorial Hospital or something like that, Memorial Miramar.
[AGENT][NEUTRAL] OK, so you can request from them a certain form. It's called a U as in umbrella, B as in Bravo, 04, that's a UB04.
[AGENT][NEUTRAL] And that will come from the hospital.
[CUSTOMER][NEUTRAL] I'm requesting that from the.
[CUSTOMER][NEUTRAL] OK, so I'm, I, I'm gonna need the itemized bill and a UBO4 from the hospital.
[AGENT][NEUTRAL] From the house.
[AGENT][NEUTRAL] If you can get that UBO4 that will, that is in the itemized bill from the hospital. That's actually the same type of form that they use to submit claims to insurance companies. It'll have all your procedure codes, your diagnosis codes, and your charges listed, and the type of facility. And then
[CUSTOMER][NEUTRAL] But I can get that from the surgeon too, right?
[AGENT][NEUTRAL] Yes, ma'am. Now, the surgeon is going to have just his, probably just have his surgical charges. It won't have the facility charges.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] But the house
[CUSTOMER][NEGATIVE] The charges went to the surgeon because I, when I presented, when I presented both my insurance, um, the hospital, everything went through because I, I didn't, I didn't think I would have to pay anything because I assumed the APL would pick up everything.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So the day of the surgery or before the surgery, the doctor's office called me to tell me they're not taking the APL that's gonna cover his deductible. Yeah. So when I called APL to ask how do I proceed, they explained to me that once I pay the doctor, I can just file a claim because they say they pay everyone because they're my secondary insurance. They don't.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They don't, they're not the ones not saying they're not paying because I thought they were the ones denying the claim. So when the doctor informed me it's them that I want to take the insurance, so I went and I paid his portion of his deductible, but the hospital was paid, everything else was paid by APL on their end, but the doctor himself is the one that I had to pay that $1100 to to.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] That's so frustrating. I'm so sorry. Yes, ma'am. Um, you, you would contact the doctor for an itemized, just tell him you need an itemized bill with diagnosis codes. You should have no problem getting that. Now, because your policy is a secondary policy, we will also need a copy of the explanation of benefits from your primary insurance showing what was applied to your deductible.
[CUSTOMER][NEUTRAL] Contact them for their receipt?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it'll just be for the surgeon charges that we'll need.
[CUSTOMER][NEUTRAL] Now, do you think that um you, with your experience, you think that you'll be, will be ready by now?
[AGENT][NEUTRAL] It's, and who's your primary insurance with?
[CUSTOMER][NEUTRAL] As Med
[AGENT][NEUTRAL] As it could be. I would call them and ask them if they have processed the claim for um Doctor [PII] for that data services 117.
[AGENT][NEUTRAL] And if they have, you should be able to get that on their website.
[AGENT][NEUTRAL] And then you can just upload it on your policy, along with the itemized bill from the doctor.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And that's what what and I'm sorry they didn't discuss that with you prior.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEGATIVE] On your prior phone call what I was needed because I know that's frustrating to send something in and then say what?
[CUSTOMER][NEGATIVE] Right, no.
[CUSTOMER][NEUTRAL] No, all, all, all she said was just call us back and we'll walk you through how to process the claim when you're done. That's what she said, but when I went on your website, I kinda, you know, followed the steps on submitting the claim. It was pretty self-explanatory except for the fact that I guess I admitted the wrong, I uploaded the wrong file. But um, I'm going to call the surgeon's office now and ask for an itemized bill because I don't know how long that's gonna take for them to get me. And in the meantime, I guess I should try to get that EOB from AMed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, and your claim is not denied, it's just pending for the additional information.
[CUSTOMER][POSITIVE] Got you thank you so much and what's your name?
[AGENT][NEUTRAL] My name is [PII] and the first initial of my last name is [PII]
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] And if you ever want to view your policy benefits online, all you have to do is click on your policy number, and it'll download your policy certificate so you can view all the benefits covered. We never want you to miss your benefits, and it's a lot easier to use when you know what's covered.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Exactly thank you so much [PII] I appreciate your help.
[AGENT][POSITIVE] It's been such a pleasure to assist you, Ms. [PII]. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that'll be all. I'll just get on the information to submit to you guys. Thank you.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day. Call us if you need anything, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Will do thank you bye bye.
[AGENT][POSITIVE] Thank you, bye bye.