AccountId: 011433970860
ContactId: 1ee12031-1fe1-4973-a4a6-5ccedf914f44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214690 ms
Total Talk Time (AGENT): 85072 ms
Total Talk Time (CUSTOMER): 109997 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/1ee12031-1fe1-4973-a4a6-5ccedf914f44_20250507T13:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, do you want my policy number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02608321
[AGENT][NEUTRAL] May I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Your mailing address and your email?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. And how may I help you today, [PII]?
[CUSTOMER][NEUTRAL] I guess I didn't under I guess I don't understand um if I have to go to a doctor and they charge me because I haven't met my deductible yet, isn't that what the gap is for?
[AGENT][NEUTRAL] Yes, the gap will pick up your copays, the co-insurance and or deductibles up to the benefit amount.
[CUSTOMER][NEUTRAL] OK, because they just denied my first claim, um, saying that.
[CUSTOMER][NEUTRAL] I needed support further consideration of this loss under the policy we'll need supporting documentation to evidence the accident or sickness, so they just need my EOB. I, I don't understand. I had, I had to have an X-ray done on my knee.
[AGENT][NEUTRAL] And it looks
[CUSTOMER][NEUTRAL] And so, and then I just had to have an MRI yesterday.
[AGENT][NEUTRAL] And it looks like this one was for data service 42.
[AGENT][NEUTRAL] For $174 and we would need the primary insurance explanation of benefits to see what was applied to your co-pay, co-insurance, and our deductibles.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Oh, OK, so I that's what I submitted I submitted showing what my patient responsibility was.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So I got the bill from Reyes showing hey it was 117 or 174, they paid 113 so I had to pay 60 and that's what I submitted.
[AGENT][NEUTRAL] Yes, but it's not from the
[CUSTOMER][NEUTRAL] So I was like then they could see what I had to pick.
[AGENT][NEUTRAL] Yes, ma'am, but it's not from your primary. It has to come from the primary because this does not indicate co-pays, coinsurance, and or deductibles. They will not process them.
[CUSTOMER][NEUTRAL] Got it. So just the next, so the EOB from Cigna.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, that's fine now I know like I said, if I was like, let me just call and find out, so I will do that.
[AGENT][NEUTRAL] And also, I'm looking at this, [PII], they are going to ask for the diagnosis code as well, which is the reason for that X-ray.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and, and I do have the prescription that was sent over from the referring doctor, would that help them?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK all right I have that.
[AGENT][NEUTRAL] Yes, ma'am. And then they'll get your claim processed.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're so welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Mhm bye.
[CUSTOMER][POSITIVE] No, that helps me now I know and I'll, I'll be able to, I just, yeah, like I said, I was like, well, we'll just try maybe it's this and then when that didn't work I'm like, alright, let me call and find out. Thank you so much.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] [PII], you're so welcome. Thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] You too.