AccountId: 011433970860
ContactId: fe6d90e0-ec32-4462-b515-abbdd12c3641
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 696039 ms
Total Talk Time (AGENT): 360797 ms
Total Talk Time (CUSTOMER): 292594 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/fe6d90e0-ec32-4462-b515-abbdd12c3641_20250211T18:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I received some bills, medical bills, and I would like to know if you can cover this, please.
[AGENT][NEUTRAL] OK, we can go over your benefits. Uh, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Outpatient benefit 01.
[CUSTOMER][NEUTRAL] 867-080 M as in mom L as in Louis 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. I'm just gonna verify some information really quick, can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. Uh, last thing I need is the uh email address that we've got on file for you. Uh, looks like it is through an organization.
[CUSTOMER][NEUTRAL] Well, I'm with food for the call, but you can send me emails, personal emails.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, did you want me to change that?
[CUSTOMER][NEUTRAL] Uh, which is
[CUSTOMER][NEUTRAL] Uh, I'd rather have everything in my personal email, yes.
[AGENT][POSITIVE] OK, sure I can get that changed.
[CUSTOMER][NEUTRAL] OK. So it's gonna be [PII], that's my last name.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], uh my first name.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. So your last name. your [PII]?
[CUSTOMER][NEUTRAL] Yeah, let me spell for you my last name because it's I'm unusual. It is [PII]
[CUSTOMER][NEUTRAL] And then [PII] which
[AGENT][POSITIVE] Got it OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Got it. Alright, thank you for verifying that. I'll go ahead and get changed for you. Let's see.
[CUSTOMER][NEUTRAL] Yeah, and the period, don't forget that you're in the mirror because many times people.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] I got it. Thank you.
[AGENT][NEUTRAL] And that has been updated. OK, so you've got some um medical bills. Are you wanting to see uh how to file those claims?
[CUSTOMER][NEUTRAL] Yeah, I mean, I see.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hey bro.
[CUSTOMER][NEUTRAL] And uh [PII].
[CUSTOMER][NEUTRAL] I have one for $90. I have another one for 203.
[CUSTOMER][NEUTRAL] And there is a note that says 1,747.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, all right, so let's see.
[CUSTOMER][NEUTRAL] Which includes
[AGENT][NEUTRAL] Whenever you are ready, [PII], I will first let you know all of the information that we need for you to file the claim and then um how you can get those filed so if you wanna grab something to write with just say that you've got it let me know when you're ready.
[CUSTOMER][NEUTRAL] Give me a little second. Where is my pen right here, and the fresh face.
[CUSTOMER][NEUTRAL] And I'm talking to [PII].
[CUSTOMER][NEUTRAL] Um, today is [PII].
[CUSTOMER][NEUTRAL] OK. Tell me.
[AGENT][NEUTRAL] OK, so for as this is a secondary medical policy, we would need itemized statements.
[AGENT][NEUTRAL] That show diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] What do you mean the bill?
[AGENT][NEUTRAL] So on the automized statements it really does depend on each provider [PII], they sometimes they're a bit different um but on the autoized statement we would need them to show diagnosis and procedure codes so you can get that information from the provider that may be what they have given you. I'm not quite sure sometimes they just give you the bill which just shows what it was and the dollar amounts that they were charging.
[AGENT][NEUTRAL] Um, but the itemized statement showing those codes is what we need.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, yeah, this one for $90. It has a lot of it has like uh the date, then a number, and then like a description, and it's like a
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 10 or I don't know how many
[AGENT][NEUTRAL] It's possible is what they gave you um just so that you're aware though you can absolutely send us what you've got and then you know if we need additional information we'll let you know.
[CUSTOMER][POSITIVE] All righty.
[AGENT][NEUTRAL] OK, and then the other thing that we need is going to be the explanation of benefits from your primary insurance. And again you can get that from the provider wherever you went for treatment. Essentially that's just going to be showing us that your major medical did help uh pay.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, hold on, explanation of benefits and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I need to ask for to be from whom?
[CUSTOMER][NEUTRAL] From my daughter.
[AGENT][NEUTRAL] Um, wherever you went for treatment, yeah, uh, so whoever sent you the bill, wherever you went for treatment, um, they'll have that information. So whoever your primary medical is, it's just going to show what they contributed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, um,
[CUSTOMER][NEUTRAL] This is a surgery that I had recently, actually was for uh [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's like I'm receiving all this.
[CUSTOMER][NEUTRAL] Um, bills from that surgery.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, I have like a
[CUSTOMER][NEUTRAL] Tomography, gray.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And other demography.
[CUSTOMER][NEUTRAL] And this is one bill.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And there is another one.
[CUSTOMER][NEUTRAL] That is like uh
[CUSTOMER][NEUTRAL] I don't know, like a 20 different things, like a test maybe that they give me just.
[AGENT][POSITIVE] Oh goodness.
[AGENT][NEGATIVE] Yeah, they sure don't make it easy. They make it so confusing.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] Well, let me ask you this, [PII], before we go any further, um, I don't know if you remember or not, but did you give them this policy information um prior to your procedure?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, no, I gave my.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess my regular insurance, which is United Health.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK well it's worth a shot um if you've not paid those bills yet to reach out to them with this information to see if they'll file the claims for you that would just be a you know less of a headache for you to have to worry about they've got all the information there um so I would first of course see if they're willing to do that for you um if not you know you can still file them yourself um you know just saves you a little bit of hassle.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Actually
[CUSTOMER][NEUTRAL] Um, actually, um, because I've been dealing with, um, I have cancer, so I've been dealing with this for almost 3 years. So it's not the first time that I'm calling you and telling me what you are telling me right now. And usually they do everything. I just tell them, get in contact with uh with you guys and then between you arrange whatever it needs to be arranged.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, yes.
[CUSTOMER][NEUTRAL] So, I just called them.
[AGENT][NEUTRAL] OK, so maybe they just need to reach out to us um because I'm not showing that we've received anything prior to [PII] of last year was the last time we received something.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Exactly, because I had the surgery on November, actually.
[AGENT][NEUTRAL] Right, yeah.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] And before that, I, I, what can I say? surprises, OK, I know so out of the blue.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I know they're sorry.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And uh that's what I'm receiving now.
[AGENT][NEUTRAL] OK, so, OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][POSITIVE] Call them and let them know to call you so they can arrange everything through you.
[AGENT][NEUTRAL] I would
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] I absolutely would again that's just that much less you don't have to worry about but just so that you are aware, [PII], if there is any push back or you know they're not wanting to work with you for whatever reason you still can file the claims yourself so let's just see what they have to say first um hopefully they're willing to just do it for you so you don't have to worry about it.
[AGENT][POSITIVE] Um, if not, you know, definitely come back to us and we'll walk you through, um, how to get the claims filed and sent to us. We'll still get you taken care of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, great, because for what I see in, in some of this, um, my insurance cover.
[CUSTOMER][NEUTRAL] A lot.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And it's like that the remaining that my insurance didn't cover.
[AGENT][POSITIVE] Right and that's what this, yes, that's what this policy is uh for so that's that's exactly what this policy is supposed to help with so they, you know, and most, most providers are really good um and they will help, you know, obviously they want to get paid so they'll um.
[CUSTOMER][NEUTRAL] You know what I mean?
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][POSITIVE] There shouldn't be any problems with them filing the claims for you, but they're all different so just if they give you any kind of pushback or trouble um strongly encourage them to call us if they don't give us a call right back and we'll walk you through what you have to do so we'll help.
[CUSTOMER][NEUTRAL] OK, OK. So I'm gonna call.
[AGENT][NEUTRAL] And now um
[AGENT][NEUTRAL] Yes, now, um, I don't know if you have it or not. I know you've had your policy with us for quite a while, [PII]. Did you have a copy of your policy?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Is that something that you would like to have?
[CUSTOMER][NEUTRAL] I just have
[CUSTOMER][POSITIVE] If you can send it by email, it would be great.
[AGENT][POSITIVE] Absolutely, absolutely, um, I'm a very visual person so I like having a reference to go back to, you know, um, so I like, you never know, you know, if you've got it or not, and it's very easy to read. It's not just a bunch of jargon, I promise, um, but it does go clearly what is and is not covered dollar amounts, frequencies, things like that so I can absolutely email that to you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great, great. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I will go ahead and send that now um did you have any other questions for me at the moment Lela?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No, I'm gonna call all these providers and all these people and then they, they're gonna be contacting you one by one. It's like 3 bills that I have.
[AGENT][POSITIVE] Got yeah, that is perfectly fine. We will do what we can get those knocked out for you.
[CUSTOMER][POSITIVE] OK, great. Well, thank you so much.
[AGENT][POSITIVE] All right. Well, thanks for giving us a call, [PII]. Yeah, I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] OK, bye-bye. You too. Bye. God bless.
[AGENT][POSITIVE] Thank you. Bye-bye.