AccountId: 011433970860
ContactId: 29d101ee-05e3-4a5b-ba3c-7c48b72de1fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1055380 ms
Total Talk Time (AGENT): 356043 ms
Total Talk Time (CUSTOMER): 401919 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/29d101ee-05e3-4a5b-ba3c-7c48b72de1fa_20250411T16:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh yes, hi, um, I need to, uh, file a claim, but this is the first time that I'm going to be doing that. And um, can you tell me what the procedure should be? is there a form?
[CUSTOMER][NEUTRAL] Or um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What are the requirements?
[AGENT][NEUTRAL] OK, are you the insured or provider?
[CUSTOMER][NEUTRAL] I um they both.
[CUSTOMER][NEUTRAL] Both
[AGENT][NEUTRAL] Uh, the provider is the doctor. Are you the insured?
[CUSTOMER][NEGATIVE] Dangerous, dangerous.
[AGENT][NEUTRAL] May I have your name, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] [PII]
[AGENT][NEUTRAL] And may I have your policy number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. I'm needing your policy number.
[CUSTOMER][NEUTRAL] Oh, I have a group number is and what you need or.
[AGENT][NEUTRAL] It should be your outpatient or inpatient certification number.
[CUSTOMER][NEUTRAL] Oh wait, hold on.
[CUSTOMER][NEUTRAL] Let me get it for my card, hold on.
[CUSTOMER][NEUTRAL] Um, payer ID is that it?
[AGENT][NEUTRAL] It would be outpatient or inpatient certification number.
[AGENT][NEUTRAL] May I have your social? I can pull it up that way.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], I do need to verify your date of birth and the mailing address, please.
[CUSTOMER][NEUTRAL] [PII] and my email is [PII].
[AGENT][NEUTRAL] OK. May I have your residential mailing address that's listed on file?
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][POSITIVE] And thank you so much Miss [PII] for verifying your policy. You were trying to see what do you need to submit in a claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so for submission of claims there is a claims form that will have to be filled out.
[AGENT][NEUTRAL] Do you have access to that claim form?
[CUSTOMER][NEUTRAL] No, I don't have that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for that claim form you can actually go on to [PII] and I will give that information again and you will be able to download that the claim form. If you don't have access to it, then you do have the option to just submit in the documentation that you're needing for us to review.
[CUSTOMER][NEUTRAL] OK, what's the name, is it the website again, the
[AGENT][NEUTRAL] The website is I'm sorry, it is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII] and
[CUSTOMER][NEUTRAL] Wait, uh,
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] OK, and then sign some forms.
[AGENT][NEUTRAL] Yes, claims inform.
[CUSTOMER][NEUTRAL] And some forms, got it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Signing
[AGENT][NEUTRAL] Let me get you to the correct area.
[CUSTOMER][NEUTRAL] Um, but how do I?
[CUSTOMER][NEUTRAL] Um, uh, right now it's like on the the company.
[CUSTOMER][NEUTRAL] How do we switch?
[AGENT][NEUTRAL] OK, so you, you don't sign in, you will continue to scroll down past it.
[AGENT][NEUTRAL] You will, you will password say file claims online, sign in or register. You will keep scrolling.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then you will come down to claims form and policy change documents.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, download and complete the appropriate claim.
[AGENT][NEUTRAL] OK, so the correct claim.
[CUSTOMER][NEUTRAL] Actually
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The correct claim that you would need to download would be the midli claim form and let me find which that is on section 2.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Or page 2.
[CUSTOMER][NEUTRAL] Me in claim form OK.
[CUSTOMER][NEUTRAL] Download form.
[CUSTOMER][NEUTRAL] It just printed and completed or do it uh in the computer?
[AGENT][NEUTRAL] OK, repeat that question again please.
[CUSTOMER][NEUTRAL] Uh do I do it in the computer or just print it and fill it out by hand?
[AGENT][NEUTRAL] You can do it either on the system, but we will have to have your signature. So it will just be best to download it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To sign it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Downloaded OK.
[CUSTOMER][NEUTRAL] And then just do that.
[CUSTOMER][NEUTRAL] OK, and then.
[CUSTOMER][NEUTRAL] And do I email it or what do I do?
[AGENT][NEUTRAL] We only have the option to either mail, fax, or the secured portal.
[AGENT][NEUTRAL] Where you can file it online.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Do you have access
[CUSTOMER][NEUTRAL] And how do I sign it online?
[AGENT][NEUTRAL] Go ahead, do you have access? Have you set up the username and password for the online service?
[CUSTOMER][NEUTRAL] And I did it, yes, I should be able to.
[AGENT][NEUTRAL] OK. So the way that you will go into it, you will sit, you will go into the secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And once you go into there you you would have to go into the username and password and then you would be able to pull your account up and you will be able to upload those claims.
[CUSTOMER][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] Going through it now, you said secure?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it is spelled SEC.
[CUSTOMER][NEUTRAL] Like Yarn.
[AGENT][NEUTRAL] You are
[AGENT][NEUTRAL] ED
[CUSTOMER][POSITIVE] Yes, I got it um.
[CUSTOMER][NEUTRAL] Yes, I, I, I'm in there, but the thing is that I also uh manage the um.
[CUSTOMER][NEUTRAL] Company, so my logged in, I'm already logged in but I'm logged in as our com[PII], not myself, not my user personal.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know if you understand what I'm saying.
[AGENT][NEUTRAL] So if it comes from, which will be the group, if you're submitting it in from the group, we can accept it that way.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] But you may want to set, we can accept it from being submitted in from the group, but you may wanna go ahead and set up you a an account for individual.
[CUSTOMER][NEUTRAL] You cannot
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So if we were to submit anything back to you, you would be able to receive that information.
[AGENT][NEUTRAL] And submit it via your secured portal.
[CUSTOMER][NEUTRAL] OK and um.
[CUSTOMER][NEUTRAL] I'm trying to.
[CUSTOMER][NEUTRAL] Contact uh I I how do I switch? How do I create my own personal?
[AGENT][NEUTRAL] You would have to go back to the beginning and say new user.
[CUSTOMER][NEUTRAL] OK. Oh, I got it um.
[CUSTOMER][NEUTRAL] Manage manage user create new user.
[AGENT][NEUTRAL] Yes, you will go into it'll say log in and new user you would choose new user.
[CUSTOMER][NEUTRAL] Oh, but I think I did that already.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] How do I know if I already created it?
[AGENT][NEUTRAL] You will go to log in.
[CUSTOMER][NEUTRAL] We don't know.
[AGENT][NEUTRAL] And if you know your username, you will be able to enter that information in in a password.
[AGENT][NEUTRAL] But let me see if we have one set up for you already.
[CUSTOMER][NEUTRAL] No, I don't think I have it, um.
[AGENT][NEUTRAL] OK, so it does look like you do have one set up already.
[CUSTOMER][NEUTRAL] My husband, probably, Ernesto.
[AGENT][NEUTRAL] No, this is for you.
[AGENT][NEUTRAL] So you do have, you do have the portal already set up.
[CUSTOMER][NEUTRAL] Ah, OK. OK.
[CUSTOMER][NEUTRAL] Oh, OK. How do I get into that?
[AGENT][NEUTRAL] OK, do you, you, you don't remember the user name?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah I I think.
[AGENT][NEUTRAL] So what it has for your username, it does show that you have your first, no, you have your last name and first name in lower case.
[CUSTOMER][NEUTRAL] My last name and then my first name is [PII] is a user.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then, uh, for lockdown, should I lock out of um
[CUSTOMER][NEUTRAL] They took on the company user log out and then log in again with this user.
[AGENT][NEUTRAL] Yes, you will have to be out of that account in order for you to be able to log in to your personal account.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] I see, I, I got the other one. The Savanoil is already safe. It's already, OK, OK.
[CUSTOMER][NEUTRAL] OK, so I would say to change.
[CUSTOMER][NEUTRAL] I was able to change it. So right now, I, I am under [PII].
[CUSTOMER][NEUTRAL] Not the company but myself. OK. So, I see where it says um my claims and then upload files.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, but then, um, the claim, uh, I need to complete it here by hand and then upload it. Is that so that they have the signature is that it?
[AGENT][NEUTRAL] Yes. Now, if you wanted to complete it while it was in the system, you could have entered in the entry part, but we would have had to have your signature.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] On there.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, I got it.
[AGENT][NEUTRAL] And the documentation that we would need for submission would be your primary EOB.
[AGENT][NEUTRAL] Which is showing that you do have a patient's responsibility applied to the deductible coinsurance or co-pay.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then you have to have that diagnosis code from the provider.
[AGENT][NEUTRAL] For their services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um it's, this is from um University of Miami, the hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they have
[CUSTOMER][NEUTRAL] Um, it says like clinic visit, and it's got like, um, it says our clinic level 2, and then GO 463 and then CPT. Is that, is that what the code would be? I don't, I don't, I'm not sure.
[AGENT][NEUTRAL] You said
[CUSTOMER][NEUTRAL] This is what it shows what I have here, it's what's showing up in the
[CUSTOMER][NEUTRAL] Billing information from UM.
[AGENT][NEUTRAL] OK, so the
[CUSTOMER][NEUTRAL] From the hospital.
[AGENT][NEUTRAL] The G0462, that is the procedure code or hick pick code that was used. So that's the services that was rendered. You would have to get the reason for that visit. So that is the reason that you went to the doctor or to the hospital. So you would have to contact that provider.
[AGENT][NEUTRAL] That rendered the services which would be in the facility, and they will be able to send you either an itemized bill that will show the reason that you were at the hospital, or they can give you something on one of their letterheads with that data service to show that diagnosis code.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's called the diagnosis code.
[AGENT][NEUTRAL] Yes, now if you're calling to ask them, you would ask them for the ICD.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 10.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] D I C as in Charlie. D as in David.
[AGENT][NEUTRAL] Yes, and the number 10.
[CUSTOMER][NEUTRAL] And then number 10.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK dokey.
[CUSTOMER][NEUTRAL] And, OK, and they need to give, give me that and um.
[CUSTOMER][NEUTRAL] And let it head from, from them.
[AGENT][NEUTRAL] Yes, and just make sure that they do indicate that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK dokey. Let me see if I can get that information from them. Anything else that I need to send?
[AGENT][NEUTRAL] That will be it. And did you get your policy number? Do you see it on the, your portal?
[CUSTOMER][NEUTRAL] Oh, let me see, policy number, yes, I see it, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And yeah, let me write it down. If I go I need to complete that in the
[CUSTOMER][NEUTRAL] Form, right? Correct?
[AGENT][NEUTRAL] Yes, you would be, you would have to use that on the form.
[CUSTOMER][NEUTRAL] At
[CUSTOMER][NEUTRAL] OK. 255, right? Is that the number 255.
[AGENT][NEUTRAL] 4567.
[CUSTOMER][NEUTRAL] 4567.
[CUSTOMER][POSITIVE] OK, very good. OK, thank you very much for your help, and then I just turned it in online.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Do you know how long it takes for the process?
[CUSTOMER][NEUTRAL] To be done, reviewed.
[AGENT][NEUTRAL] Once, once we receive the claim, it can take up to 10 to 15 business days or possibly 7 to 10.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Very good. OK. Thank you so much. I'll try to get this information.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can assist you with today, Miss [PII]?
[CUSTOMER][POSITIVE] No, no, no, you were very helpful. Thank you.
[AGENT][POSITIVE] Thank you. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] OK