AccountId: 011433970860
ContactId: f059275c-bfc1-4b65-bd1a-f9037c42ea01
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 811130 ms
Total Talk Time (AGENT): 258944 ms
Total Talk Time (CUSTOMER): 322321 ms
Interruptions: 6
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/f059275c-bfc1-4b65-bd1a-f9037c42ea01_20250219T18:08_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is um [PII]. How are you?
[AGENT][POSITIVE] I'm good. How about you, Miss [PII]?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Good, um, I'm calling you because I have a claim that, um, I, I kind of been trying to understand why it hasn't been processed because it kept saying that I need to, uh, send the explanation of benefits, but I just go with my primary insurance and they told me that they do not call it EOB anymore. They call it health statement which I did submit it. If you can help me with that, I would appreciate it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the policy number and let me have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Just take a look.
[CUSTOMER][NEUTRAL] OK. Callback number is [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] I have the claim number if you want to, I mean, I don't know I just log in. Let me see if I can log in and then give you the policy number. Hold on. Because to be honest, it's the first time doing a claim through APL, so I have no idea because it has, I probably like open multiple claims, but they're all for the same, you know what I mean? So because I have no idea how this works. Um, let me see where I can find my policy number. Welcome, [PII], policy contact info.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Policy number is in blue. It's in blue.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, it says.
[CUSTOMER][NEUTRAL] ABL.
[CUSTOMER][NEUTRAL] Policy contacts, let me see.
[CUSTOMER][NEUTRAL] What is the contact info?
[CUSTOMER][NEUTRAL] OK, let me go back to
[CUSTOMER][NEUTRAL] So it to home? Oh my [PII].
[CUSTOMER][NEUTRAL] Sorry, I, it took me out of my.
[CUSTOMER][NEUTRAL] OK, let me go back to home.
[CUSTOMER][NEUTRAL] OK, policy number is 2587677777.
[AGENT][NEUTRAL] But you can
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, can you repeat that one more time?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 258-767-777
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] May I have your date of birth for security?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And I need uh the mailing address on file for verification.
[CUSTOMER][NEUTRAL] I, I don't know if I have the [PII]. That will be [PII].
[CUSTOMER][POSITIVE] Or a yogurt, OK, good.
[AGENT][NEUTRAL] Yeah, um, yeah.
[AGENT][NEUTRAL] Yeah, that one is fine. I need the mailing address on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me check and see who's the primary one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] um
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] I said you have [PII] as your primary?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah, [PII] has an EOB an explanation of benefits, um.
[AGENT][NEUTRAL] See
[CUSTOMER][NEGATIVE] I just, I just literally, I just literally hang off the phone with um, with [PII] Blue and call you guys. The person that assisted me, so, you know what I mean, it's like, it gets frustrated because I've been told something different. I called twice already. Twice, and then she says to me the representative, she even told me how to go online and look for it. She goes, go to [PII], log in.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Or register on the top right top right hand side, and then you go to claims, you go to your daughter's name, and then you go to health statement. It's no longer called EOB.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So my point is that I have sent you an APL, of course, the payment that I received through the mail because at the beginning, you know, I didn't want to do it online. I thought I could just requested it. I waited for the mail to come. I sent it, and then I see my claim is just so, you know, have sending process because they're asking me for it.
[AGENT][NEUTRAL] OK, I have a question.
[AGENT][NEUTRAL] All right. Uh, is this for [PII]?
[CUSTOMER][NEUTRAL] What happened?
[AGENT][NEUTRAL] Is this, is this for Quest Diagnostic?
[CUSTOMER][NEUTRAL] No, I'm, I'm, I'm, like I told you, I mean, I don't, I don't know, like, I never put in a claim, but it's for the $6000 from the hospital.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Oh, OK. So this EOB, uh, OK, the EOB we have is for request. Bear with me just a second. Let me see if I have another EOB because this one is just for request, OK? One moment.
[CUSTOMER][NEUTRAL] That's what my main concern is.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, this one is um.
[AGENT][NEUTRAL] No, I don't see anything. No, there's nothing else. Yeah, this one is just for Quest. That's the reason um the one for Quest doesn't have anything apply, uh, where we can pay because there's nothing applied towards the deductible co-payment and co-insurance and um in order to, um, let's see.
[AGENT][NEUTRAL] The only co-payment amount was for the office visit, which we don't cover office visits, so that one was denied. um, but, um, yeah, it looks like you need to send us this benefits for the hospital.
[CUSTOMER][NEUTRAL] But you guys will cover.
[CUSTOMER][NEUTRAL] Yeah, let me ask you, so just that I know, so once I send you that, you guys will cover, you know, the, the claim is OK for the emergency one, right?
[CUSTOMER][NEUTRAL] Meaning like, I'm OK making a claim for the emergency for the ER for the bill.
[AGENT][NEUTRAL] Yeah, you can always submit any claims, any types of claims. We'll have to go under there and review the benefits and the information of the claim to determine benefits. Um, we cannot guarantee payments over the phone or benefits over the phone, um, but you can.
[CUSTOMER][NEUTRAL] Oh, I got you. OK, OK, OK, OK, understood. Let me.
[AGENT][NEUTRAL] Mhm. Yeah. So, yeah, it's basically because the one we got was for requests. It's not for the ER it's not for the hospital. So when you send it again, um, yeah, I do see that it says health statement and it says this is not a bill, so that is the correct document and
[AGENT][NEUTRAL] It does have all the information, but yeah, it's just when the provider of service, it needs to say the hospital name not Quest, um, and it has to have the full amount on their amount billed. It has to have that total amount that you're stating that $6000 so it will be the correct one, and then, um, we're gonna.
[CUSTOMER][NEUTRAL] OK, let me search.
[AGENT][NEUTRAL] Hm. OK.
[CUSTOMER][NEUTRAL] OK, let me search that information um right now and see if I can pull it up, OK?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and we also we're gonna need one more document which is the claim form. The claim form you can find it on our website at [PII]. We did not receive the claim form. We're gonna need that information as well, OK? So, uh.
[CUSTOMER][NEUTRAL] But I did submit it the first time, didn't I? Can you check if I was submit it, because I looked it up and I, yes, I submitted first ever first time that I ever got an email from you guys saying that you guys needed a diagnostic uh code or processed code, whatever. I submitted in my time. I just thought I didn't have to do it every time I go I had and do it.
[AGENT][NEUTRAL] The first time.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, is all right. Bear with me. Is this for your claim or for Grace?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's always for Grace, it's not me.
[AGENT][NEUTRAL] Nothing for you. OK, so it's always for Grace. OK, let me go to Grace. All right, um, bear with me. Let me pull the details on this 11 moment.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Do you mind holding for me? I'm just gonna pull all the documents here and see um.
[AGENT][NEUTRAL] Because yeah, I was looking into your claim.
[AGENT][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] 5.
[CUSTOMER][NEUTRAL] I take you more or no.
[CUSTOMER][NEUTRAL] yeah it's it's so uh so it's all ok and.
[CUSTOMER][NEUTRAL] But I can have
[CUSTOMER][NEUTRAL] Percu cue.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that's not it.
[CUSTOMER][NEUTRAL] It's possible.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, I'm just saying 33 pages.
[AGENT][NEUTRAL] OK, so this is details of the stay.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so yes, um.
[CUSTOMER][NEUTRAL] Yeah, I remember that.
[AGENT][NEUTRAL] OK, so yeah, we do have the claim form, so we just need the EOB so it has to be detailed.
[CUSTOMER][NEUTRAL] Yeah, can you, yeah, can you make sure, yeah, can you make sure that that's on the note on the system that way. So let me, I'm gonna go online right now and see if I can get that online. And um, and then submit it. I can always submit it online and then like uh
[AGENT][NEUTRAL] Uh, go ahead.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like a new claim, but it's not a new, it's basically her. It's just that I don't know how to click on the same claim and upload more documents, you know, so every time I upload documents, I open. Oh, OK, so then I'll send me a new one and then put it in. And then, and then you guys have to go back to all the paperwork because this claim has only been about her, I mean has only been about her, it's not about me, OK?
[AGENT][NEUTRAL] You you cannot.
[AGENT][NEUTRAL] You cannot.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. All right, so yes, um, just go ahead and um submit the explanation of benefits that's a new claim, we'll go ahead and put it together and process the claim, OK?
[CUSTOMER][NEUTRAL] go ahead.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, you've been very helpful. I appreciate it.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][POSITIVE] Thank you. Bye bye.