AccountId: 011433970860
ContactId: fae586bf-2895-4428-af4f-eea436ba47e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 584900 ms
Total Talk Time (AGENT): 147291 ms
Total Talk Time (CUSTOMER): 324127 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/fae586bf-2895-4428-af4f-eea436ba47e4_20250225T20:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, um, my name is [PII]. I've got, uh, a question regarding.
[CUSTOMER][NEUTRAL] A claim on a laboratory uh uh claim that was sent into you.
[AGENT][NEUTRAL] I'm sure [PII]
[CUSTOMER][NEUTRAL] Um, and it
[CUSTOMER][NEUTRAL] Yeah, um, I give you some numbers here that might be important, um, claim number, would you like that?
[AGENT][NEUTRAL] Well, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] OK, um [PII].
[AGENT][NEUTRAL] OK. Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Uh, policy number.
[CUSTOMER][NEUTRAL] I got a group number. I got an account number provider number.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Shoot. Hang on a second.
[AGENT][NEUTRAL] If
[AGENT][NEUTRAL] OK. If you don't have that, I can look it up by your social.
[CUSTOMER][NEUTRAL] OK, it's uh [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And is this for a medical or dental client?
[CUSTOMER][NEUTRAL] Uh, medical.
[AGENT][NEUTRAL] OK. And please verify your first and last name again and your date of birth.
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And please verify your mailing address and your email address.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] What was the second question?
[AGENT][NEUTRAL] Your email address, please verify that.
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Actually, I'm showing a different email address.
[CUSTOMER][NEUTRAL] Uh [PII], OK, another one will be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir. That's the one we have on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what's the claim number, please?
[CUSTOMER][NEUTRAL] Uh, the claim number is kind of lengthy, so, and I can't see that great. I'm gonna do the best I can. Well, it starts off with 2024.
[CUSTOMER][NEUTRAL] And then it goes 10:22.
[CUSTOMER][NEUTRAL] And then 0474.
[AGENT][NEUTRAL] And what's the date of service on the claim?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh shoot, well, the date of this correspondence was [PII], the date of service.
[CUSTOMER][NEUTRAL] Let's see, um, I got the bill in my hand from the lab.
[CUSTOMER][NEUTRAL] Oh shoot, having a hard time find his service date was [PII].
[AGENT][NEUTRAL] OK. Yes, sir. I do show those claims on file for Quest Diagnostics. I'm showing that they denied because under this policy, services um incurred in an independent lab like Quest is not um covered under the policy.
[CUSTOMER][NEUTRAL] Uh, it, OK, um, it was.
[CUSTOMER][NEUTRAL] It was ordered by my primary care physician and, and for my physical exam.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See I didn't have uh.
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Well, I was just letting you know, according to the documentation we received, um, it looks like it took place um at Quest and that's why I denied.
[CUSTOMER][NEUTRAL] I was just saying that
[CUSTOMER][NEUTRAL] It it looks like it. I'm sorry, I didn't understand it looks like it was placed what?
[AGENT][NEGATIVE] The place of service was at Quest Diagnostic. Therefore, that's why I denied because services again, um, provided that independent labs are not covered.
[CUSTOMER][NEUTRAL] I see what you're saying. Well, no, ma'am, this was through my, um, this is the pay. I think we got the answer. This is ordered by my primary care physician.
[CUSTOMER][NEUTRAL] And it, and I, I got it the referring physician is on there with his name and his number and his address.
[CUSTOMER][NEGATIVE] Um, is on the bill and it that they I took blood and they took blood in his office. I didn't where it wasn't.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You know, uh, I didn't just go to the lab for no reason. I mean, it was a word about my doctor.
[AGENT][NEUTRAL] OK. Yes, sir. Well, we can only go by the documentation that we received and according to the documentation, um, that's who's billing it. Quest Diagnostics, and again, it's not covered. So if they would need to resubmit the claim, they can always do that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] How how should they do that?
[AGENT][NEUTRAL] Well, they would um they would resubmit the claim showing that it took place in the doctor's office.
[CUSTOMER][NEUTRAL] Um, oh, OK, because, and, well, and to, how can I appeal to your higher powers, um, what's my best, um, course of action here with y'all?
[CUSTOMER][NEUTRAL] Because I'm like everything I'm telling you is legitimate. I had the insurance with you and you should pay the bill and so I just got to figure out how to make it happen because you can tell by the date of service quest is coming after guess who me and I don't want them to get on my um.
[CUSTOMER][NEUTRAL] That credit list, but at the same time I don't feel like I, it builds mine. I mean, I have with you guys for this very reason and like I said it was a, a physical exam. It wasn't like.
[CUSTOMER][NEUTRAL] Yeah it was a preventive thing which is covered correct so let me ask you if, if this had come through my doctor's office, I reckon.
[CUSTOMER][NEUTRAL] Would um.
[CUSTOMER][NEUTRAL] Would uh this would have been taken care of this would have been a non issue, right?
[AGENT][POSITIVE] That's correct because I'm showing the services provided in the doctor's office is covered.
[CUSTOMER][NEUTRAL] OK, so I've got to figure, so I don't know quite how to to do this because you I mean.
[CUSTOMER][NEUTRAL] Shoot.
[AGENT][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh, I'm kind of at a loss here. I mean, because I don't know what to do other than get in trouble for not paying a debt that I don't know, um, I don't know what my next steps are.
[AGENT][NEUTRAL] Well, you would reach out. Well, normally, um, when I've seen members have a similar issue, they will reach out to the provider's office and have them to resubmit the claim.
[CUSTOMER][NEUTRAL] OK, so, and in this case that would be the lab?
[AGENT][NEUTRAL] No, it wouldn't be the lab. It will be the doctor's office because if the lab submits the claim, it wouldn't be covered because of the place of service.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK, so what I can do then is have.
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][NEGATIVE] What a mess because it says quite plainly right here.
[CUSTOMER][NEUTRAL] That referring physician Doctor [PII] and you know his address and that's requested by him and I was done in his office. I didn't go to a lab.
[AGENT][NEUTRAL] Uh yes, sir, according to the documentation that we have, that's, we can only go by what we have on file and we received the um the claims from Quest.
[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEGATIVE] I need to somehow convince them and by the way I've had I've been calling them for 3 weeks and you know they just finally called me back just a second ago while I was on the phone with you but I figured it more important that I would need to talk them to take that call because I wouldn't know what to say to them but uh.
[CUSTOMER][NEUTRAL] So I need to get them to resubmit.
[CUSTOMER][NEUTRAL] Somehow stating that it was well it says it right here on the bill. It says that it was I mean I don't know what else y'all need. I mean it says it right there. I understand that they might have submitted it because.
[AGENT][NEUTRAL] Yeah, but we didn't receive, we didn't receive that bill we just received the claim. We received the claim directly from Quest, so.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] What if I what if I send you that bill? I mean, it's documented debits, right?
[AGENT][NEUTRAL] No, sir. We would need to receive a claim from the provider's office.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Well, now I know why so many Americans are leaving the country. All right, ma'am, thank you for your time, um.
[CUSTOMER][MIXED] You sure didn't help me out other than some information but I appreciate it.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Well, no, ma'am, obviously not. I think I've asked all the I know to ask. I appreciate it. Thank you for your time.
[AGENT][POSITIVE] OK. Thank you again, [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] Grandma.