AccountId: 011433970860
ContactId: 2ab4c8c1-616c-4b0a-bc08-52c81c74488e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 534289 ms
Total Talk Time (AGENT): 298089 ms
Total Talk Time (CUSTOMER): 149254 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/2ab4c8c1-616c-4b0a-bc08-52c81c74488e_20250512T16:59_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes, I was calling with questions about the claim I submitted on Friday.
[AGENT][NEUTRAL] I'll be happy to verify claim status. May I have your name and a policy number?
[CUSTOMER][NEUTRAL] Uh, my name is [PII], and I'm sorry, I don't have the policy number.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] Uh, um, I can get it. Hold on.
[CUSTOMER][NEUTRAL] OK, um, so.
[CUSTOMER][NEUTRAL] Is the claim number the confirmation number?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] I can do it.
[CUSTOMER][NEUTRAL] OK, I think I got a policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, hold on, um,
[CUSTOMER][NEUTRAL] It's 256.
[CUSTOMER][NEUTRAL] 9252.
[AGENT][NEUTRAL] And may I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you one moment, I'll get this pulled up.
[AGENT][NEUTRAL] And can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] Yeah [PII].
[AGENT][NEUTRAL] Do you have an email address?
[CUSTOMER][NEUTRAL] Yes, [PII]. Oh no, it's probably my work it's [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised the verification of coverage does not guarantee the payment of a claim. Let me get this pulled up and it looks like we received on [PII].
[AGENT][NEUTRAL] And it is in line for processing let me open it up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, [PII], and how can I help you today?
[CUSTOMER][NEUTRAL] Um, yeah, so the last one I submitted, the lady told me they didn't cover, um, um.
[CUSTOMER][NEUTRAL] Uh, visits, I guess, like office visits.
[AGENT][NEUTRAL] Office visit, yes ma'am.
[CUSTOMER][NEUTRAL] With this one, it wasn't, this one wasn't an office is, so are they gonna cover it?
[AGENT][NEUTRAL] So as long as it's not an office visit, let's see if it's office treatment, it'll be covered. Let me see.
[AGENT][NEUTRAL] I'm just waiting on it to open. It's 18 pages.
[CUSTOMER][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Where was the place of service?
[AGENT][NEUTRAL] So it looks like outpatient radiology.
[CUSTOMER][POSITIVE] I think that's the one for the grand.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So you do have that benefit. And did you submit the diagnosis code?
[CUSTOMER][NEUTRAL] Yeah, I submitted everything.
[AGENT][NEUTRAL] OK. Yes, so this plan does not cover the office visit. It does cover the office treatment, but it looks like everything else.
[AGENT][NEUTRAL] Looks like it should be coverable up to your benefit amount.
[CUSTOMER][NEUTRAL] OK, OK, alright, um, so let me ask you something, so when I went to the doctor last week, I got like a bunch of um labs and stuff, are they covered?
[AGENT][NEUTRAL] If where they performed in the doctor's office?
[CUSTOMER][NEUTRAL] Um, so they drew the blood and they sent it off to the lab.
[AGENT][NEUTRAL] So you do have that lab benefit rider, so that if you go to an independent lab, that would be covered. If they took your blood in the office, that would be covered, it's just the actual office visit itself.
[CUSTOMER][NEUTRAL] Oh, OK. OK. So let me get my stuff together for that too. They're trying to figure out if I have type 1 or type 2, diabetes, I mean that, you know, extra information, but they did some extra tests. That's why I have another bill.
[AGENT][NEUTRAL] Yes, ma'am, and that's why I'm looking through your bills that you submitted and you know the provider can submit the claims for you as well.
[AGENT][NEUTRAL] But I don't see.
[CUSTOMER][NEGATIVE] Well, they act like they didn't know what this was. They act like when I tried to show them uh AP like the little card that I have, I have a picture of it on my phone. They was like, we don't know what that is.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, just tell them to file it with your secondary insurance cause I know they submitted it to your primary.
[CUSTOMER][NEUTRAL] That's what I told him.
[AGENT][POSITIVE] Yes, ma'am, and they can file for you.
[CUSTOMER][NEUTRAL] That's what I told him.
[AGENT][NEUTRAL] But I'm looking on that one. Let me go back.
[CUSTOMER][NEGATIVE] Cause this is annoying. I ain't gonna lie.
[AGENT][NEUTRAL] Yes, it is, and that's why we try to make it as simple as possible, and we always tell our insurers to let them file, but it looks like as long as we have your primary insurance EOB.
[AGENT][NEUTRAL] Your um itemized bill from your provider and it has to have the diagnosis codes on it and that's what I'm looking for while I have you on the phone.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To see, I see a diagnosis code.
[AGENT][NEUTRAL] And the diagnosis is the reason for the test and you just indicated that.
[AGENT][NEUTRAL] So that's what I'm looking for. I don't see that.
[CUSTOMER][NEUTRAL] On the, on the latest one I submitted?
[AGENT][NEUTRAL] Yes, ma'am. It's 18 pages. I see the CPT code cause it looks like in hospital. Looks like you went maybe to the emergency room on [PII] for your ankle or foot.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right, right, right.
[AGENT][NEUTRAL] But I don't see whether it was a sprain or fracture. I don't, that's what I'm looking for, the diagnosis code.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And I don't see that.
[AGENT][NEUTRAL] So that's what I'm looking for on that.
[CUSTOMER][NEUTRAL] It's not on there? Oh.
[AGENT][NEUTRAL] I do see the emergency records.
[AGENT][NEUTRAL] But I don't see that one.
[AGENT][NEUTRAL] Look at 4.
[CUSTOMER][NEUTRAL] So I need to call them back.
[AGENT][NEUTRAL] Yeah, cause it looks like we don't show the diagnosis code, which is the reason for your visit.
[AGENT][NEUTRAL] And I do see the EOB. So on this one, once they process this one, they're gonna ask for the diagnosis code on that one.
[CUSTOMER][NEUTRAL] Yeah, that's
[CUSTOMER][NEUTRAL] Is it not on the EOB?
[AGENT][NEUTRAL] No, some, most of the insurance companies don't put the diagnosis codes on that one.
[AGENT][NEUTRAL] And this one is from Blue Cross Blue Shield of South Carolina.
[AGENT][NEUTRAL] And I see you do have a deductible.
[AGENT][NEUTRAL] So they will process this one and ask for a diagnosis code, which is the reason for your visit.
[AGENT][NEUTRAL] It looks like on the other one, what did they ask for?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the other one looks like they asked for.
[AGENT][NEUTRAL] An itemized bill for 425.
[AGENT][NEUTRAL] Looks like this was DME, so for that DME they need to know what equipment.
[AGENT][NEUTRAL] was um
[AGENT][NEUTRAL] Purchased on that one.
[CUSTOMER][NEUTRAL] Yeah, I've been trying to get that too.
[AGENT][NEUTRAL] Even if you can get the CPT code.
[CUSTOMER][NEUTRAL] OK, well, I guess I got some more phone calls.
[AGENT][NEUTRAL] Even if they'll give you a CPT code on that DME, that will work too.
[CUSTOMER][NEUTRAL] So what I will call back and give it to you?
[AGENT][NEUTRAL] Yes, well, no, they want them in writing. We can't take them over the phone anymore. We have to have them in writing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So I'm looking at this one.
[CUSTOMER][POSITIVE] All right, well, I'll get on that. Well, thanks.
[AGENT][NEUTRAL] I'm sorry. Is this the same diagnosis code 4, looks like this one was 425. Looks like there's an accident code. Is that the same?
[AGENT][NEUTRAL] Diagnosis for when you went to the ER?
[CUSTOMER][NEUTRAL] It should be.
[CUSTOMER][NEUTRAL] Yeah, it should be.
[AGENT][NEUTRAL] Because if that's the same, they, I can make a note of that so that they can get that one processed.
[CUSTOMER][NEUTRAL] Yeah, it is. So I had to go back for a follow-up.
[AGENT][NEUTRAL] OK, so let me make a note of that so that they can get this one processed.
[AGENT][NEUTRAL] And then it looks like they would just need that uh DME code on the uh on the first one.
[AGENT][NEUTRAL] Cause it just says purchased equipment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. So I'll go ahead and write this one up and get that sent over so that I can get that one processed. Is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, I appreciate you looking into this and telling me what's going on, but thank you so much.
[AGENT][POSITIVE] [PII], you're so welcome and thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.