AccountId: 011433970860
ContactId: fdef3825-b424-4c2c-915e-c7b7022b9664
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1040310 ms
Total Talk Time (AGENT): 345046 ms
Total Talk Time (CUSTOMER): 569726 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/fdef3825-b424-4c2c-915e-c7b7022b9664_20250219T18:15_UTC.wav
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[AGENT][NEUTRAL] Good Afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, uh, good afternoon. How are you?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I was wondering um I don't know if you can check uh for me if you were able to receive one of the claims from uh Quest Diagnostics.
[AGENT][NEUTRAL] OK, I can verify the claim has been received, and your name is?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] OK. And what is the policy number, please?
[CUSTOMER][NEUTRAL] We have uh
[CUSTOMER][NEUTRAL] That would be, I have a I have a group number.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Would that help or
[AGENT][NEUTRAL] Are you looking at a copy of the card?
[CUSTOMER][NEUTRAL] I have a card with me.
[AGENT][NEUTRAL] OK, do you see a policy certificate number or in-hospital outpatient benefit cert number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh yes, uh, I have 2. There's an in-ho, a certain number, and then an outpatient, uh, number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Either one is fine.
[CUSTOMER][NEUTRAL] Either one is fine? OK, uh, 020.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] 21
[CUSTOMER][NEUTRAL] 776
[CUSTOMER][NEUTRAL] And then ML 7, which is in hospital.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, uh, I have the, the office number just in case it's [PII] or do you need my cell number or?
[AGENT][NEUTRAL] Uh, either one, cell number if you like.
[CUSTOMER][NEUTRAL] OK, uh, it's uh [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. I think that's the one on file but I.
[AGENT][NEUTRAL] OK, give me one moment. [PII].
[AGENT][NEUTRAL] Oh, you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I don't know why I was thinking you said [PII]. I'm sorry.
[AGENT][NEUTRAL] OK, and verify your date of birth, mailing address and email address for me.
[CUSTOMER][NEUTRAL] It's [PII] then my address is [PII].
[CUSTOMER][NEUTRAL] And my email, right?
[AGENT][NEUTRAL] Uh, yes, sir.
[CUSTOMER][NEUTRAL] Uh, yeah, it's [PII].
[AGENT][NEUTRAL] OK, and you say you wanted to verify we received a claim from Quest Diagnostics?
[CUSTOMER][NEGATIVE] Yeah, because they keep sending me uh the uh some bill that supposedly.
[CUSTOMER][NEUTRAL] Uh, they sent it.
[CUSTOMER][NEGATIVE] And I was supposed to check on Monday but I got hung up here at uh at work and I wasn't able to call in to to uh make sure.
[AGENT][NEUTRAL] OK, um, and what was the data service, or do you have that data service?
[CUSTOMER][NEUTRAL] Ah, I don't have it with me, but
[CUSTOMER][NEUTRAL] Uh, I think it was for.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I know it was from last year, uh, [PII], but, uh, I think it was like for $28 something or $30.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Just don't have, I don't have the the bill here with me.
[AGENT][NEUTRAL] OK. Do you, do you know around what month or so?
[CUSTOMER][NEUTRAL] I mean that could be wrong. It could be.
[CUSTOMER][NEUTRAL] Maybe September.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Maybe maybe maybe a little bit further down the line, but I think it's either $28 or $30.
[AGENT][NEUTRAL] OK, give me one.
[CUSTOMER][NEUTRAL] I don't remember what was the current one.
[AGENT][NEUTRAL] I see yeah.
[CUSTOMER][NEGATIVE] I should have taken a picture and I kept it, keep it with it, but I totally forgot about it.
[AGENT][NEUTRAL] No, you're fine. Um, I don't show we received any claims from Quest.
[CUSTOMER][NEGATIVE] No, nothing. Supposedly to send, uh, they said supposedly they'll send it to you, uh, by mail. I don't know.
[AGENT][NEUTRAL] Uh, no, sir.
[CUSTOMER][NEUTRAL] Or or a fax, I, I have no idea either.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I mean they said that, you know, that they were going to do it, but you know it's, it's quite.
[CUSTOMER][NEUTRAL] I have no idea.
[AGENT][NEUTRAL] Yeah, yes, sir. I, like I said, don't show we received it, but um you can ask them to fax the claim to us and attention and claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see if I can find that.
[CUSTOMER][NEUTRAL] Oh yeah, here it is uh.
[CUSTOMER][NEUTRAL] I only took the
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I only, I guess the, the camera moved, uh, my phone, but it's only for $28.65.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, they can still submit it to us.
[CUSTOMER][NEUTRAL] I thought I had
[AGENT][NEUTRAL] I can give you the fax number if you like.
[CUSTOMER][NEUTRAL] Oh wait a minute, I think I saw the, uh, oh, I think I saw the date, uh, cause you need a date, right?
[AGENT][NEUTRAL] Uh, yeah, it would be easier to try to look up that way. I just didn't see any from Quest.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] I think it said March.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] The service date [PII]. I found it.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] It's what happens sometimes it's like, yeah, then you finally find it the last moment.
[CUSTOMER][NEUTRAL] Yeah, I, I, yeah, I, I thought I took a picture, but I, when I, I guess I moved and I took where of the amount instead of like the whole thing.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And let me see because I do show we received two claims for that data service, but it doesn't look like Quest Diagnostic. Let me double check.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, it looks like one was for facility UMHC.
[AGENT][NEGATIVE] And the other one was from Miami Medicine Hematology, but we have not received anything from Quest.
[CUSTOMER][NEUTRAL] Nothing, nothing from us or anything, but you did get one from from UM correct?
[AGENT][NEUTRAL] Uh no, sir.
[AGENT][NEUTRAL] Well, we received one for the facility and looks like one for the physician's office for that date.
[CUSTOMER][NEUTRAL] Oh, OK. Alright, the right, that, that would be the, uh, like from the main, uh, also, uh, I also, I also have the, uh, with you guys with the which is the gap, OK, so you have not received anything from from Quest, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You ask them to do one thing and they can't even do that, jeez.
[AGENT][NEUTRAL] Uh, well, and
[CUSTOMER][NEUTRAL] Yeah, because the
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEGATIVE] Like I kept getting, uh, they keep sending me the bill saying oh like it's delinquent, you know, like I'm not paying anything. I know you're supposed to send that, uh, the APL, you know, like it's your responsibility, not mine.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know, I, I only provide the insurance. That's it. And then you guys pick up the, uh, the tab like um that's why I pay you guys as well.
[AGENT][NEUTRAL] OK date of birth.
[AGENT][NEUTRAL] Right
[AGENT][POSITIVE] It's like I already did my part. Y'all do your part. Well, yeah.
[CUSTOMER][NEUTRAL] You know, I mean,
[CUSTOMER][NEUTRAL] Yeah, yeah, like do your thing, you know.
[CUSTOMER][NEGATIVE] Uh, I guess they can't do that right except send, send you a bill saying, oh, you're not paying me. Oh, I don't know.
[AGENT][NEUTRAL] Yeah, and the only other way, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Oh, you don't talk
[CUSTOMER][NEUTRAL] Yeah, like if you don't tell me like, oh we're not receiving or like the house was not sending it to us, you know, like so we can do it, and that's, that's, you know, then I gotta call you in for it.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] But, but all the bills are coming from quest, you know, not enough of them to win.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You know they keep charging me and I'm like I already paid this and then they say no we didn't, uh, you know, you guys aren't paying me.
[CUSTOMER][NEUTRAL] I go.
[AGENT][NEGATIVE] Well we can't pay if we hadn't received.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's like, uh, how, what am I supposed to do, you know, like you're, it's your responsibility to call, you know, the insurance provider as well.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, not just me. I'm calling you because
[CUSTOMER][NEUTRAL] Obviously you know I need to check to make sure because they keep putting it as I'm not like if I wasn't going to.
[CUSTOMER][NEUTRAL] Ah, like pay them or anything, you know.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, the only other way is like I said, you can contact that provider, just let them know your secondary has not received the claim, and they can fax it to us, or if you happen to have a copy of the EOB or explanation of benefits for that date, you can submit it to us, so we can um start the processing of it and then if any payable benefit will go to you since we haven't received it from the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but I would need the, um, I would need the uh the bill correct?
[AGENT][NEUTRAL] Not really because hold on one second.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][POSITIVE] Bless you.
[AGENT][NEUTRAL] Oh, thank you, sorry. Um, since we received a claim, uh, let me see.
[AGENT][NEUTRAL] From the facility and from a physician and then we have the diagnosis codes for that date, um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] We would just, you can just submit the EOB showing for request diagnostic for that date and we can process it that way.
[CUSTOMER][NEUTRAL] OK, um, let's see, I know I have a.
[CUSTOMER][POSITIVE] I got to do some labs with them in house.
[CUSTOMER][NEUTRAL] From UM, I know that, uh, I, I do, I usually do everything, uh, in the house with them, so I guess they are partner with Quest I think.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I don't know if they have a separate bill for that. I mean, I mean, it's usually tied together. I mean, I'm, I'm not even sure what they do.
[AGENT][NEUTRAL] Well, sometimes, but for the most part, like you can go for one day of service.
[AGENT][NEUTRAL] And say it's for outpatient, you're gonna have several bills depending on the type of service received like for this one, we received the physician, we receive the facility, and then there could be one for a lab.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Like from Quest. Mhm.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEGATIVE] Right, I think the one that keeps the, the one that they keep they keep sending it, I think it's for labs, but I don't think they're sending anything to you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know, I think they're holding it. I, I don't know what the heck they're doing.
[AGENT][NEUTRAL] I hold it just send it.
[CUSTOMER][NEGATIVE] I mean it it's no good for them, you know.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I mean, all it does is, you know, put me on a list and say, oh, you know, like he, he's not willing to pay anything, you know.
[AGENT][NEUTRAL] Yeah, and it, I mean, and it could go towards your credit, you know, and most don't want to mess up the credit, right?
[CUSTOMER][NEUTRAL] That's why, that's why I'm calling it, yeah.
[CUSTOMER][NEUTRAL] Because I don't know if uh if they're sending or they're sending it to the wrong place or to the wrong office.
[AGENT][NEUTRAL] Yeah, I would say to double check with them just to verify the address they submitted it to and let them know you do have secondary. Here's the fax number and ask them to fax that claim and primary EOB to us.
[CUSTOMER][NEUTRAL] They have all.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or like I said, you can submit that EOB and we can process it that way.
[CUSTOMER][NEUTRAL] I mean, can I do that with you now, or I mean, I, I
[AGENT][NEUTRAL] No, we don't process claims over the phone. You just have to, you can either fax, mail, or um if you set up on our online service center, you can upload the claim to the site.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 00, through, uh, through APL, oh, OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Yeah, I mean like if I don't hear from them, I, I guess I'll just
[CUSTOMER][NEUTRAL] I guess do it on my own. I don't know.
[AGENT][NEUTRAL] You can, yes, sir. Unfortunately, unfortunately, sometimes happen to insurers where we might not receive the claim and you're being billed and sometimes they would submit their claim to be so we can at least have it processed.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right, yeah, cause I called them last week, uh, I think, I think I, I think I called them on a Friday.
[CUSTOMER][NEUTRAL] Or something like that maybe on a Thursday and the other lady that I spoke to, she was just, you know, wait a couple of days maybe, you know, maybe we'll get it and then call us back so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, uh, supposedly the, the lady from, you know, Quest Diagnostics said that we'll send, uh, like a paper claim, uh, to the FDL.
[CUSTOMER][NEUTRAL] I'm, I'm not even sure you, you guys are receiving any mail, so I don't know.
[AGENT][NEUTRAL] Yeah, I would definitely just they fax it. That way we can get it a lot quicker, obviously, but, you know, and then you can receive a confirmation that it's been received.
[CUSTOMER][NEGATIVE] Right, yeah, I'm just scared that they'll just send it, you know, through the mail, and then, well, it's not there anymore, you know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know. OK, so.
[CUSTOMER][NEUTRAL] So do you want me to go ahead and call Quest?
[CUSTOMER][NEUTRAL] Tell them to fax you everything.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Correct, the fax the billing primary EOB. Just uh let them know that your secondary insurance has not received the claim and if they will fax that to us instead of mailing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Alright, I'll, I'll get that on right now so that way, you know, that way you guys get the claim so I, you know, they're taking me off, uh, off that list, you know, saying, oh, I'm not being paid, you know.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] How are you going to get paid if you don't send the bill?
[AGENT][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] So what does that make me, you know, I've, I've no idea what goes over there. I don't know who gets paid.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I just know, you know, I just get an alert, you know, saying like in the emails, you know, saying, oh, you know, you're everything has been processed, and that's pretty much it.
[CUSTOMER][NEUTRAL] You know, and I don't see a bill until I go back.
[CUSTOMER][NEUTRAL] That's it, you know.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] This time they sent me a whole bunch of uh.
[CUSTOMER][NEUTRAL] letters saying, you know, oh, you know, we're gonna put you in the we're gonna write you up, you know, and stuff like that, no idea.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You're supposed to do, you're supposed to process it, you know, your stuff.
[CUSTOMER][NEUTRAL] You know, I mean.
[AGENT][NEUTRAL] Yeah, you just always wish that someone just do what they're supposed to do, so it wouldn't put a burden on you, but I understand.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Um, because, you know, it kind of bothers her, you know, they have someone over there that's not doing the work.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You know, like, you know, unlike you guys, you know, follow a deal with thousands of people every day.
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] Yeah, just send it to us and we can process it.
[CUSTOMER][NEUTRAL] But you get stuff done.
[CUSTOMER][NEGATIVE] You know, like you guys, I know you guys, you know, do this stuff all the time and you know, and you guys get it done, you know, I don't know, I don't know what they do.
[CUSTOMER][NEUTRAL] You know
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, all right.
[CUSTOMER][NEUTRAL] I'll see, uh,
[CUSTOMER][POSITIVE] I'll see what I can do, uh, with them and hopefully they'll, uh,
[CUSTOMER][NEUTRAL] They'll fax it to you.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] Uh, yeah, that would be awesome.
[CUSTOMER][NEUTRAL] OK, do I need to, uh, send it to a specific person or just?
[CUSTOMER][NEUTRAL] Tell them to or or well they should know, right?
[AGENT][NEUTRAL] Yeah, it's just attention claims department. It comes straight to our claims department.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, and, and then they'll and then you guys will process, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, uh, will I get a like a, like an email confirmation that you guys processed everything, or, or will I, or I want to.
[AGENT][NEUTRAL] Have you set up on our online service center?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, you should if you set up where you can receive a text message of when a claim has been received and um once the claim is processed, you also receive a text message that way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] All right, I'll, um,
[CUSTOMER][NEUTRAL] I'll call him and
[CUSTOMER][NEUTRAL] And see what uh
[CUSTOMER][NEUTRAL] What are they doing?
[AGENT][POSITIVE] All right. Well, I thank you for calling APL. You have a great day, Mr. [PII].
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][POSITIVE] All right, thank you so much, all right.
[AGENT][POSITIVE] You're welcome. Bye.
[CUSTOMER][NEUTRAL] But