AccountId: 011433970860
ContactId: 0110b872-2abe-495e-ae77-a0a3fe0ee08a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1096010 ms
Total Talk Time (AGENT): 292220 ms
Total Talk Time (CUSTOMER): 319304 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/0110b872-2abe-495e-ae77-a0a3fe0ee08a_20250508T15:42_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I'm sorry, did you say your name is [PII]?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, how do you spell that? I'm sorry, I'm taking notes.
[AGENT][NEUTRAL] It's OK. [PII].
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] I'm calling regarding a statement that I just got from a provider, a medical provider that says I have a balance due, and I just got off the phone with them, and it is the balance due is from my deductible and so I have supplemental insurance through my employer with American Public Life and the lady that I just spoke with said that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] The deductible was sent to American Public Life, but they rejected it and I don't.
[CUSTOMER][NEUTRAL] Understand why that happened. It shouldn't have been rejected, so could you look at that for me please?
[AGENT][NEUTRAL] Sure, I can check the claim status on that. And may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Of course, so my name is [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The callback number just in case we get disconnected Miss [PII].
[CUSTOMER][NEGATIVE] Oh, I'm sorry, I totally lost track of what I was doing [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Thank you. And may I have the policy number, Miss?
[CUSTOMER][NEUTRAL] The policy number is.
[CUSTOMER][NEUTRAL] 02352944
[AGENT][NEUTRAL] OK. For security, may I have your date of birth, mailing address, and email address on file?
[CUSTOMER][NEUTRAL] So my date of birth is [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] My mailing address is [PII], and then my email is [PII].
[AGENT][NEUTRAL] All right, perfect, thank you. OK, and what is the date of service on that claim, Miss?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So the date of service looks like um [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm, um, yeah, I mean on a different pair of glasses, but visit on, yeah, [PII].
[AGENT][NEUTRAL] OK, I don't see a claim for [PII]. Um, the only one I see here around that.
[CUSTOMER][NEUTRAL] OK, well, they probably go ahead, sorry.
[AGENT][NEUTRAL] OK, that's OK. Yeah, the only one I see here is [PII], but uh this was just an office visit, which office visit we do not cover and it was denied.
[CUSTOMER][POSITIVE] Go ahead, sorry. No, you're good.
[CUSTOMER][NEUTRAL] Phone an office is it what copay or something?
[AGENT][NEUTRAL] Yeah, it was a co-payment. Mhm.
[CUSTOMER][NEUTRAL] For what doc for what office? what doctor office?
[AGENT][NEUTRAL] Uh, let me pull the image on that let me pull the documents. OK, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] I see you're waiting on the documents.
[CUSTOMER][POSITIVE] You're OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, so I got a claim from doctor.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, that's
[CUSTOMER][NEUTRAL] That's the doctor, so somebody put an extra 2 in there cause that's the.
[CUSTOMER][NEUTRAL] That's the uh claim that I'm looking at here, but it says visit on [PII] and I only maybe I did go there twice maybe I went there twice maybe I went there to see him and I went back for the test or something. OK, so what was the co-pay on that? What is that? Can you see that?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, um, it looks like, um, it was the, they applied it towards the coinsurance at that time. I guess you already probably use or pay all the benefits, um, but they apply $70.
[CUSTOMER][NEUTRAL] They applied it towards.
[AGENT][NEUTRAL] Co-insurance.
[CUSTOMER][NEUTRAL] So I don't know anything. Oh, OK. To quote insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, so but you're saying it didn't get paid?
[AGENT][NEUTRAL] But it was an office there.
[AGENT][NEGATIVE] No, because it was an office visit and we do not pay for office visits. We only pay for procedures done in the office. So it was denied just saying that office visits are not covered. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you're saying you don't see the one from [PII] when I had, yeah, because I had the test first and then I saw him afterwards. So you're saying you don't see the office visit on the [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] No, we do not have the claim for [PII]. This is the claim for [PII], OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so how do I, I understand, so how do I.
[CUSTOMER][NEUTRAL] Um, do I need to call that office and have them resubmitted, or how do I, how do I take care of that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that would be the best um solution or the best way to handle it will be to call him, let him know that we have not received the claim to see if they can send it directly to us. um, if they say they cannot send it for any reason, then you can send your own claim. Um, if you're gonna send your own claim, we do need a couple of documents. So we're gonna need um a claim form and we're gonna need the itemized bill and the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Those 3 documents.
[CUSTOMER][NEUTRAL] OK, can you email those to me?
[AGENT][NEUTRAL] I can send you the claim form and the claim form has instructions on what you're gonna need. Is that OK?
[CUSTOMER][NEUTRAL] OK, OK, yeah, that's fine.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this email to you with the claim form?
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] Yeah, sure, yeah, yeah, for sure, go ahead. I mean, yes, of course I can't talk.
[AGENT][NEUTRAL] OK. All right. No problem. It's OK. Let me go ahead and put you on a brief hold so I can send this email. OK, one moment.
[CUSTOMER][NEUTRAL] Trying to do two things at once.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for Miss [PII] Would you like to check and see if you received that email?
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] I know her.
[CUSTOMER][NEUTRAL] Let me double 4.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh la la la.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Downloading and downloading attachments and the text message.
[CUSTOMER][NEUTRAL] Oh my God, to keep the information check this message and want to download anyway, want this email that works good.
[CUSTOMER][NEUTRAL] OK, I have it, but.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My emails being silly, so.
[CUSTOMER][NEUTRAL] Anyway, so.
[AGENT][NEUTRAL] Mm
[CUSTOMER][MIXED] Telling me the market looks safe, but I don't know where I go to do that.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I get on my numbers here we go. It's downloading now, I think.
[CUSTOMER][NEUTRAL] OK, alright, so can you hear me OK?
[AGENT][POSITIVE] Yes, I can. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So yeah, so I just need to fill this out and send it to APL is that what I need to do?
[AGENT][NEUTRAL] Um, the claim form, if you're gonna submit your own claim again, it does if they cannot send the claim for you, then you need to uh fill that out and send it back together with the documents that is on the instructions, which is an itemized bill with diagnosis code and a copy of the explanation of benefits from the primary insurance, and you can either fax it, mail it, or if you have created an account online, you can upload it to your account.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so either they can resubmit it or I can resubmit it by doing what you just explained.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, OK, alright, and I would get the EOB from them.
[AGENT][NEUTRAL] The explanation of benefits, you get it from the primary insurance.
[CUSTOMER][NEUTRAL] Got it. Oh, from the primary insurance. OK, got it.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] OK, not the provider.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. OK.
[AGENT][NEUTRAL] No
[CUSTOMER][NEUTRAL] I think I understand everything so do you show anything else out there that's been rejected because I have another one for 13966.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They got turned over collections because they rejected that.
[AGENT][NEUTRAL] OK, I have one.
[AGENT][NEUTRAL] For date of service, [PII] from AmeriPath that we need uh the primary explanation of benefits. We did not receive that part, so it's still pending for that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me see if there's anything else.
[AGENT][NEUTRAL] April and this is an office visit, so that's.
[CUSTOMER][NEUTRAL] And you said that was [PII], sorry.
[AGENT][NEUTRAL] Um, let me go back.
[CUSTOMER][NEUTRAL] I'm sorry I got interrupted course.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] It's OK. [PII].
[CUSTOMER][NEUTRAL] And who is that with?
[AGENT][NEUTRAL] A merry path.
[CUSTOMER][NEUTRAL] And they
[CUSTOMER][NEUTRAL] I have no idea what that is.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's a lab, I guess it was lab work, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK. Oh, OK, really? That's weird. OK, alright, so what do I need to do with that one?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, this one, if you have a copy of the explanation of benefits from the primary insurance, you can submit a copy or just call them to have them send us the copy they have.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] So that has been turned over to collection, so will that matter? Will you guys go ahead and just pay it or do I have to deal with the collections agency on that?
[AGENT][NEUTRAL] Yeah, if they can still send in that document from you, then we can go ahead and pay them directly. Um, but if you want to send your own claim, like if they say it's past the time, we cannot send it, you have to just send it, then you'll go ahead and send that that explanation of benefits and we'll go ahead and send you the payment so you can pay them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, perfect.
[AGENT][NEUTRAL] Mhm. Yeah.
[CUSTOMER][POSITIVE] All right, OK, thank you so much.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today? Any other questions and concerns, Ms. [PII]?
[CUSTOMER][POSITIVE] No, I think that takes care of it. I would just use the same form you just sent me to do both, right?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, yes, that'll be perfect. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright. OK, thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too mhm bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.