AccountId: 011433970860
ContactId: f7c9af79-9a87-4535-b157-2ec2431d73fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 648059 ms
Total Talk Time (AGENT): 365872 ms
Total Talk Time (CUSTOMER): 270998 ms
Interruptions: 8
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/f7c9af79-9a87-4535-b157-2ec2431d73fa_20250129T15:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hi, hi. My name is [PII]. Uh, I, I currently, we currently have a plan with you. I can give you the payer ID it helps.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I wouldn't be able to find with a payer ID that's simply a way that, uh, providers can send claims to us. Um, that's OK though. Um, are you looking at your card right now?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yes, I am.
[AGENT][NEUTRAL] Do you see anything that says member ID or in hospital outpatient cer certification number?
[CUSTOMER][POSITIVE] I do, oh yes, policy certification, that helps.
[AGENT][NEUTRAL] Uh-huh. Yes, sir.
[CUSTOMER][NEUTRAL] OK. It's uh 02.
[CUSTOMER][NEUTRAL] 51
[CUSTOMER][NEUTRAL] 3169.
[AGENT][NEUTRAL] OK, thank you and then um can I get the call back number from you in case we're discussed please?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure. Uh [PII].
[AGENT][NEUTRAL] Alright, I probably, I'm just gonna verify some information really quick. Can I get your date of birth, please?
[AGENT][NEUTRAL] Thank you and can I get your mailing address?
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] My mailing address, it should be [PII]. Uh, the zip code is [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Perfect, thank you for verifying that. All right, what can we help you with today?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, first of all, uh, how, how can I, uh, I need to update the address because, uh, I recently moved.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So is that something that we can do, uh, OK, so, OK, OK, it's uh [PII].
[AGENT][POSITIVE] Yeah, I can get that changed for you. Yeah, I can get that changed for you. What's the new address?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, sorry, uh, yeah, [PII].
[AGENT][NEUTRAL] know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] What was the city? I'm so sorry.
[CUSTOMER][NEUTRAL] Ohme [PII].
[AGENT][NEUTRAL] Could you spell that for me?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] N E
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And then what was the zip code?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, so that was I'm just gonna read it back, make sure I heard it correctly um that was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I will go ahead and get that changed for you. Um, did you want to add an email account, uh, to your account with us as well, [PII]? If you ever wanted to create an online account, um, that would be the email that you used to create an account on our portal.
[CUSTOMER][POSITIVE] Sure, sure. That would be perfect.
[CUSTOMER][NEUTRAL] OK, OK, that's uh.
[AGENT][NEUTRAL] OK, what would you like that email to be?
[CUSTOMER][NEUTRAL] I guess I'll, I'll, I'll do that. Uh, it's my [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the last name that was [PII] [PII]
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, got it. Alright, I will get that added as well. Uh, was there anything else I could help you with [PII]?
[CUSTOMER][NEUTRAL] Yes, uh, my, my wife is doing, uh, a few procedures, uh, and, and every time that we, we go to, uh, a, a doctor or when they request, uh, an exam, we show both cards, right?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Perfect, yes.
[CUSTOMER][NEUTRAL] Uh, but I'm, I'm not quite sure if they're, uh, considering the, uh, the APL card.
[CUSTOMER][NEUTRAL] So, uh, is there, is there a way that I can, uh, I can do, I can, uh, do I have to submitted like a, a, um, a claim to you guys? How that works?
[AGENT][NEUTRAL] OK, so is it that they're not accepting the APL card when you give it to them or they're saying that they don't take it?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I don't know, uh, we, we're presenting them. I'm just, I'm just not quite sure if they are considering when they, uh, when they do the credit because I have to pay, uh, a substantial amount out of pocket, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] And is this for was this for uh [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, um, well, before we go any further um yes you can absolutely file those claims yourself, but let me check to see if we've received any claims uh for her.
[AGENT][POSITIVE] Just so we can kind of cross that off, OK, I've got one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That we've received um and then cancer associates.
[AGENT][NEUTRAL] Looks like that was the date of service was [PII] of last year.
[AGENT][NEUTRAL] And office visits are not covered under this policy, so we were unable to pay that benefit um but that is the.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Only claim that we've received from her so yes so this is what I would recommend yes so here's what I would recommend um get a hold of those providers wherever she went uh to receive treatment.
[CUSTOMER][NEUTRAL] That is the only one?
[CUSTOMER][POSITIVE] Oh wow. Yeah.
[AGENT][POSITIVE] Um, and ask them, you know, of course if they have tried submitting claims to us if they give you any sort of push back or run around or, you know, again they don't know if they accept it, they are more than welcome to give us a call 9 times out of 10 with providers they've they're not familiar with this policy or our company um or how it works so we're more than happy to explain it to them. We do talk to providers all the time, so hopefully that could alleviate some confusion.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, if they're still not willing to file for you, you can't.
[AGENT][NEUTRAL] Absolutely file those claims.
[CUSTOMER][NEUTRAL] I, uh,
[CUSTOMER][NEUTRAL] I can file myself.
[AGENT][POSITIVE] Absolutely, yes, you can absolutely file the claims for yourself, your spouse and your dependents absolutely.
[CUSTOMER][NEUTRAL] Hello. OK.
[CUSTOMER][NEUTRAL] Oh, OK. So, and, uh, how, how do I, uh, how do we get it like, cause I already, we already paid so.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh I see OK all right so I would say the quickest and easiest way to get claim information to us is going to be through our online portal um I can give you that web address to create the account you'll simply use all of this information that we just verified so the email that you gave me I did update your address so it would be that new zip code um and there's a spot there where you can upload claim information.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I can give you that web address whenever you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it's the [PII].
[AGENT][POSITIVE] Yes, [PII], that is correct.
[CUSTOMER][NEUTRAL] OK, uh, hashtag, uh, logging I guess I I have it here.
[AGENT][POSITIVE] OK perfect all right yeah um so that.
[AGENT][NEGATIVE] Is the web address I will say to upload claim information it does have to be accessed through a desktop or a laptop computer it does not have much support for mobile devices like phones or tablets.
[CUSTOMER][NEUTRAL] That's fine. And the only thing that you needed is a, is a uh EOB?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, that is not the only thing that we need. That is one absolutely. So when you're doing it online, of course we would need the correct claim form filled out. So this policy is your medin you'd be able to find that really easily when you go to file a claim online, um, so you would fill out that claim form. We do need the primary EOB essentially showing what they paid for each procedure, but then we would also need the itemized statement that shows diagnosis and procedure code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Codes and you can get that from the.
[CUSTOMER][NEUTRAL] Uh, well, so, so that's.
[CUSTOMER][NEUTRAL] Uh, OK, so, uh, I'm gonna try to have them, uh, push that back then because that will that will be easy.
[CUSTOMER][NEUTRAL] Because, because that that that.
[AGENT][NEUTRAL] Yeah, so and they would be able to give you that information.
[CUSTOMER][NEUTRAL] OK, yeah, cause then, like, I, I, I, I don't want it to be in the middle because you're probably gonna be asking some information and I'm gonna have to ask them. So that is gonna be a little, a little.
[AGENT][NEUTRAL] Oh yes, that's true um but I mean it really does depend on the provider uh but they would should have all of that information, that itemized statement with those codes and the primary EOB so hopefully they could just send it to you all at once. You simply upload that to us and we'll be able to process the claims.
[CUSTOMER][NEUTRAL] OK. And um the, the, how should I, how should I introduce the topic to them because they take only the health, uh, the United Health uh card. The, the APL, it's, uh how, how should I describe the service for them? It's, it's like an additional.
[AGENT][NEUTRAL] It's OK. Yeah.
[AGENT][NEUTRAL] You can explain, sure you can explain that you do have a secondary medical policy and you need to file a claim, um, and then just ask for that information, the itemized statement with the diagnosis and procedure codes and the EOB from your primary insurance. There they should know exactly what you need and what you're trying to do, so they should not give you any push back.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK. OK, perfect. OK. Thank you very much. I, I will, I will provide that to them. All right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Yes, if you have any other questions I know it's very confusing uh don't hesitate to give us a call back uh did you have any other questions for me at the moment?
[CUSTOMER][NEUTRAL] No, no, that, that's all. I, I will, uh, yes, because that's like she has.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, she has claims from, wow, back in November, she has a lot of claims, uh, quest, like she has a bunch of, she has, she has a bunch of claims, yeah.
[AGENT][NEUTRAL] OK. Yes, so since.
[AGENT][NEUTRAL] Sure, so since this policy was active, uh, [PII] of last year, anything from that point up until now, there's no timely filing limit, so you can file any and all claims uh from that time that this was active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK. I will, OK, I'll, I'll do that. I'll ask her to, uh, to, to do this.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] OK, yeah, sounds good. Well, thanks for giving us a call, [PII]. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Sure. You too. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.