AccountId: 011433970860
ContactId: 098b0eaf-28b6-4852-aee8-a90da5d6882b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1165300 ms
Total Talk Time (AGENT): 464751 ms
Total Talk Time (CUSTOMER): 493379 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/098b0eaf-28b6-4852-aee8-a90da5d6882b_20250107T17:11_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], yeah, um, this is [PII], um, and [PII]. Um, we have American Public Life Insurance, um.
[CUSTOMER][NEUTRAL] Uh, we're a plan with you guys, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would you like the the ID?
[AGENT][NEUTRAL] Uh yes ma'am you can give me policy number.
[CUSTOMER][NEUTRAL] Number
[CUSTOMER][NEUTRAL] OK, it's 682.
[CUSTOMER][NEUTRAL] 945192
[AGENT][NEUTRAL] OK, and Ms. [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Um, go ahead, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, I appreciate that. And let me pull in this policy for you real quick.
[AGENT][NEUTRAL] OK, that policy number is a little long to be one of ours. Do you see an inpatient or an outpatient certificate number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, there's a different policy number. Sorry, we received two different things in the mail, so I can give you the, uh, another one and see if that works. Is that OK?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Um, it's 025.
[CUSTOMER][NEUTRAL] 47209.
[AGENT][POSITIVE] OK. That sounds like a good number. Let me look that up.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I've got the policy pulled up. Um, [PII], can you verify your date of birth for me please sir?
[CUSTOMER][NEUTRAL] Yep, [PII].
[AGENT][NEUTRAL] Thank you, sir. And then also, can you verify your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Yep, my uh phone number is [PII]. I live at [PII].
[CUSTOMER][NEUTRAL] And the email should be [PII].
[AGENT][POSITIVE] Yes, sir. Thank you. I appreciate you verifying the information. And Ms. [PII] is on the phone. Is it OK for me to discuss your policy with Ms. [PII] and yourself? OK, thank you so much.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Absolutely.
[AGENT][NEUTRAL] All right, so I've got you pulled up. Do you have any questions that I can answer for you?
[CUSTOMER][NEUTRAL] Sure, yeah. So, um, I'm covered with my husband here and I was, I've been visiting Dartmouth Hitchcock Medical Center, um, since September of this, of last year, I guess, yeah, not this year, last year, [PII], um, soon after we got the, the policy with you, with you guys.
[CUSTOMER][NEUTRAL] Um, and then about a month or so ago I received an email from Dartmouth that they hadn't received any payments or anything from you guys over there so I've been kind of going back and forth with Dartmouth and and trying to figure out um.
[CUSTOMER][NEUTRAL] How we could get covered for some of some of my appointments that I've had um in the beginning of December, my husband and I we sent over an itemized bill um itemized bills for each of the visits and also something that someone over there told us that we had to kind of fill out I don't remember do you remember what it was called? Uh, no, they sent the it was like a claims form that they sent over that we had to fill out with.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] With each bill so we sent uh we sent about.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Different claims forms and then also send over an itemized bill of each one.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, so I just called Dartmouth and they hadn't, they haven't received anything from you guys yet and I just wanted to see um.
[CUSTOMER][NEUTRAL] If if you guys had sent anything over and if you hadn't um.
[CUSTOMER][NEUTRAL] If um if there's anything that we could kind of do do um.
[CUSTOMER][NEUTRAL] Kind of get that moving I guess um I I don't know if you guys were sending we did get one thing through the mail um regarding one appointment uh explanation of allowable charges.
[CUSTOMER][NEUTRAL] Um, for one of the 7 appointments, and I, I know that Dartmouth didn't receive it, so I wondered if you guys send anything over to [PII] or if you send everything through us and we're responsible for sending things over to [PII] after that.
[AGENT][NEUTRAL] OK. Um, so looking at your policy, I see that one claim has been um submitted, but it wasn't for Dartmouth. It was for Mary Hitchcock Memorial Hospital.
[CUSTOMER][NEUTRAL] Yes, that's sorry yeah sorry it's a big branch.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Oh OK alright so we did receive that claim, let me tell you some of the remarks that is on the claim so that can help you further as as far as what else you need to send in um.
[AGENT][NEGATIVE] So some of the claim information received was uh they were unable to process it because the copies could not be read.
[CUSTOMER][NEUTRAL] OK, do you know what?
[AGENT][NEUTRAL] Uh, we
[CUSTOMER][NEUTRAL] What that means.
[CUSTOMER][NEUTRAL] Like the handwriting?
[AGENT][NEUTRAL] The copies were
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] To not be read. Um, that's the only remark that I have. And then, um.
[AGENT][NEUTRAL] They need the itemized statements of services provided listing the diagnosis code and the procedure code needs to be on the itemized statement.
[CUSTOMER][NEUTRAL] OK, do you think that maybe they just hadn't received that yet because I did get letters from um Dartmouth.
[CUSTOMER][NEUTRAL] With all with the itemized bills and I did send those over, is it possible that they hadn't, they haven't received those yet? That was like a [PII] I would say.
[AGENT][NEUTRAL] It could be possible if they were mailing to them that we have not received them yet um if they sent them electronically I don't know if they have our payer ID number but I can give you that if you need to give it to them so they can send the claim information electronically.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I, I have all of, I have all of them because I have a portal. Would I be able to send them to you?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, how could I do that?
[AGENT][POSITIVE] Absolutely. Yes, ma'am.
[AGENT][NEUTRAL] Um, you can send them through the portal, you download them onto your computer and then you upload them through the portal through um claims.
[CUSTOMER][NEUTRAL] OK, so, um.
[AGENT][NEUTRAL] Then I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] On the first claim that you sent in, I also have another remark, uh, this policy does not provide any benefits for diagnostic testing.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, there was a claim sent in for diagnostic testing.
[AGENT][NEUTRAL] And it does not provide benefits for that. Uh, I'm looking to see there's several remarks on here.
[AGENT][NEUTRAL] It looks like it's just the diagnostic testing that has been denied so far and the rest of it is just um needing the my statement with diagnosis and procedure codes and
[AGENT][NEGATIVE] Maybe the copies that were sent in were unreadable.
[AGENT][NEUTRAL] The way they were sent, you might want to try to resend the claim again with an itemized statement with diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so, um, where can I access the portal that you're talking about? I think, I think it's member.
[AGENT][POSITIVE] Yes, yes ma'am you go, you go to [PII].
[CUSTOMER][NEUTRAL] Oh, go ahead.
[AGENT][NEUTRAL] You go to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you've never signed up before you're gonna sign up as a new user and then the second option you choose is I'm an individual with a policy.
[CUSTOMER][NEUTRAL] Where is it right that? Where's the data?
[CUSTOMER][NEUTRAL] Would that be under log in or new user?
[AGENT][NEUTRAL] New user.
[CUSTOMER][NEUTRAL] Because I only see 2
[CUSTOMER][NEUTRAL] New user and then an individual with an APL insurance policy, OK.
[CUSTOMER][NEUTRAL] OK, I can I can um we can set up that and um.
[CUSTOMER][NEUTRAL] And then we can file all of those itemized bills that we received.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, right on there through, OK, so a bit quicker.
[AGENT][NEUTRAL] Yes ma'am, and then you're also going to need to get a claim form to upload. Let me tell you where to get the claim form.
[AGENT][NEUTRAL] You're gonna go to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And [PII] OK.
[AGENT][NEUTRAL] At the top of the web page you will see claims and forms.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And when you go into the claims and forms, you're gonna need the hospital indemnity claim form.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Uh, hospital and de, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, this is the one that was sent to my husband, but maybe that's the one that couldn't be read because everything, everything else was like, you know, like printed from like, you know, it was, it was like a printed font. So that maybe it was this that we had to fill out that was hard to read.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, do we need
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Upload this
[CUSTOMER][NEUTRAL] Um, one per visit, one per itemized bill, or just one?
[AGENT][NEUTRAL] Just one and then the backup documentation could go with the one claim form.
[CUSTOMER][NEUTRAL] OK, so I'll just I make uh make a username for APL um download all of the itemized bills and down download uh a copy of the hospital indemnity claim form.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and then you will is that something that you guys will get right away then because it's in the portal?
[AGENT][NEUTRAL] Right, once you send it, you'll, you'll.
[CUSTOMER][NEUTRAL] Or is that gonna be
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Once you send it you'll get a confirmation back that we have received it.
[CUSTOMER][NEUTRAL] Go ahead sorry.
[CUSTOMER][NEUTRAL] OK, and then.
[CUSTOMER][NEUTRAL] Once you guys start.
[CUSTOMER][NEUTRAL] I think that's what I'm curious about. I guess once you guys start looking at those things, will you send over the information to myself as well as Dartmouth because again Dartmouth hasn't gotten anything from you guys, um, or [PII] like any of the things that you, I mean you, I got two things, we got two things through the mail, but Dartmouth didn't get those. Will you send those over to Dartmouth or are we responsible for sending those over to Dartmouth?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, once we get the claim, it takes 7 to 10 business days to process, and you would get information through the online service center and Dartmouth will get an explanation of benefits from us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] They will get an explanation of benefits.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And how do you, do you fax those or do you email those?
[AGENT][NEUTRAL] They mailed them out.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And do you know where they're sending them? Have they sent anything to Dartmouth yet? Because I just wanna make sure that they have the right information because if they have sent anything then they don't have the right information and if they haven't then.
[CUSTOMER][NEUTRAL] I guess I wanna make sure that they're sending it to the.
[AGENT][NEUTRAL] So the information that we receive is from Dartmouth and they send us their tax identification number and address for us to send those to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, so they haven't sent anything yet though, is that something that you can check?
[AGENT][NEUTRAL] I can't check that, um.
[AGENT][NEUTRAL] To see if any, well, yes I can. Let me look.
[AGENT][NEUTRAL] Let me look real quick. Let me look at this EOB here and see if it's been sent to them.
[AGENT][NEUTRAL] It's gonna be just a second while my computer pulls it in.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, we have sent an EOB to them.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On the denied claim.
[AGENT][NEUTRAL] Stating that we need the itemized statements.
[AGENT][NEGATIVE] And that it does not provide benefits for diagnostic testing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And that um we could not read the copies that were supplied were unable to read.
[CUSTOMER][NEUTRAL] OK, OK, well we'll, we'll do what we can over here with the online user and uploading them all to the portal and uploading.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Hospital stuff and then we'll just give a call back if we don't hear anything or we'll give uh the Dartmouth a call in a week or so and see if they've gotten anything.
[AGENT][POSITIVE] OK. All right, sounds perfect.
[CUSTOMER][NEUTRAL] Alright, oh go ahead.
[AGENT][POSITIVE] It's all right. Yes.
[CUSTOMER][NEUTRAL] I just one more question, so you said that um uh there's no benefits provided for diagnostic testing so what uh what are we covered? Where do we get benefits?
[CUSTOMER][NEUTRAL] What sort of hospital visits.
[AGENT][NEUTRAL] OK, let me look and see for.
[CUSTOMER][NEUTRAL] Do receive
[AGENT][NEUTRAL] Uh, let me pull in your policy so I can read it to you.
[AGENT][NEUTRAL] It's gonna be just a second while the computer downloads it for us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] And of course this is just to verify your coverage. It's not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your policy is not uploaded for me to read, isn't that great? OK, um.
[AGENT][NEUTRAL] Let me see if I can find one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so you have this policy covers multiple things. You have an accident sick and sickness injury.
[AGENT][NEUTRAL] For surgery.
[AGENT][NEUTRAL] Which pays $500.
[AGENT][NEUTRAL] Um, you also have.
[AGENT][NEUTRAL] General anesthesia, if you ever have to have surgery is also covered under the plan, um, in the amount of $125.
[AGENT][NEUTRAL] Uh, you have a hospital admission benefit of $750 upon the first admission.
[AGENT][NEUTRAL] Uh, you have a hospital admission.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Per benefit period per calendar year.
[AGENT][NEUTRAL] You also have um hospital confinement benefit if you have to go in the hospital for more than 18 hours, you have uh uh uh
[AGENT][NEUTRAL] Confinement benefit of $200 per day.
[AGENT][POSITIVE] Let's see, you have intensive care benefits if you should ever have to go into intensive care.
[AGENT][NEUTRAL] You have outpatient sickness and treatment um for physical therapy. Uh, looks like you also have it for, um,
[AGENT][NEUTRAL] For a physician or urgent care center or emergency center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's basically what.
[AGENT][NEUTRAL] What's covered on the plan.
[AGENT][NEUTRAL] Now the things that you guys are doing that's considered outpatient can be covered if it's in an ER urgent care center or physician's office for covered procedures.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, OK, cool.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah and then so just uh and.
[AGENT][NEUTRAL] All right. Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, um, thank you, you've been very helpful, um, so if we cancel this insurance now.
[CUSTOMER][NEUTRAL] We can still go through and receive the benefits for the period that we were covered, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, excellent because I think we would like to go ahead and cancel the uh insurance please.
[AGENT][NEUTRAL] OK, that would have to be done through your employer because your, your benefits are payroll deducted through your employer.
[CUSTOMER][NEUTRAL] OK, um, and if we're paying privately because that's how I got it, not through the employer.
[AGENT][NEUTRAL] No, sir, you're, you're set up on a group plan with Business Workers of America.
[CUSTOMER][NEGATIVE] Oh, OK, so I have to call them again and cancel through them OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Business Workers of America. Yeah, that's the people that we were just on the phone with they transferred. OK. OK. All right, well thank you very much. Oh.
[AGENT][NEUTRAL] OK. All right.
[AGENT][POSITIVE] You're very welcome. You guys have a great day and thanks for calling APL.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome sir bye bye.