AccountId: 011433970860
ContactId: 392b007b-ac9a-49de-be54-f732ce886b28
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 807940 ms
Total Talk Time (AGENT): 220092 ms
Total Talk Time (CUSTOMER): 377481 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/392b007b-ac9a-49de-be54-f732ce886b28_20250619T20:07_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] Is this [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I have a three way call going on with SSM physician Group. I believe her name is [PII]
[CUSTOMER][NEGATIVE] And they called to verify my benefits. It looks like on [PII] and spoke with you and you had stated that my coverage was terminated, but it's not.
[CUSTOMER][NEUTRAL] So I need you to research because I just talked to [PII] a few minutes ago and I spoke to somebody else last week. If you can look at my policy, please.
[AGENT][NEUTRAL] Yes, may I have your policy number?
[CUSTOMER][NEUTRAL] It's 01897873.
[CUSTOMER][NEUTRAL] The last name is spelled the [PII], and I am covered underneath my husband [PII].
[AGENT][NEUTRAL] And may I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] [PII] address is [PII], and I don't know if you have my email address or my husband's. My husband's is [PII], and mine's just [PII], but I am horrible about looking at my emails.
[AGENT][NEUTRAL] I think
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. So I'm looking at this account, it looks like
[AGENT][NEUTRAL] The husband showing active.
[AGENT][NEUTRAL] Yourself and [PII] or [PII] is showing not active and [PII] and [PII] are showing active.
[AGENT][NEUTRAL] One moment, let me.
[CUSTOMER][NEUTRAL] I'm [PII].
[AGENT][NEUTRAL] OK, so there's 2 [PII] on here. Hold on, let me get this.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] There
[AGENT][NEUTRAL] To on.
[CUSTOMER][POSITIVE] I'm a whirlwind. They might, they might count me as two people. I'm a big girl.
[AGENT][NEUTRAL] So it looks like what they did was they have you in the system twice, and the first one, which is in the correct position for female spouse, they're showing as laps, but when you go down to the bottom one, they're showing that one as active.
[AGENT][NEUTRAL] Let me see if anybody has noted that in the system. I do apologize for that.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] That's OK. They're just not sending you the claims, and I'm gonna have a lot of claims coming through because I've been diagnosed with a melanoma, so I wanna make sure that everything's done correct.
[AGENT][POSITIVE] OK. I do apologize for that. It looks like.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] [PII] 5 [PII]. OK, so it looks like someone sent this over to get this fixed in our system. So as of right now, [PII], you are active on this plan.
[CUSTOMER][NEUTRAL] So how when was my effective date because they keep asking me that and I have a card in front of me.
[CUSTOMER][NEUTRAL] That he brought home from work and it's [PII].
[AGENT][POSITIVE] That is correct.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So I didn't have a lapse or anything.
[AGENT][POSITIVE] This plan is effective. Let me make sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, ma'am, there is not.
[CUSTOMER][NEUTRAL] OK, so you're, are you still on the line, hon? Yes, ma'am, and um I wanted to ask a question, um, do we need to resubmit the claims to um.
[AGENT][NEUTRAL] Let me double check.
[CUSTOMER][NEUTRAL] To get them um processed.
[AGENT][NEUTRAL] Do you have a data service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yes, ma'am. I have, um,
[CUSTOMER][NEUTRAL] It's, uh, it's gonna be 3, claims for the same date of service, um, of [PII].
[AGENT][NEUTRAL] Thank you. Let me see if we have those in our system. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm not showing
[CUSTOMER][NEUTRAL] [PII], while you're lucky though.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] You guys cover deductibles too because they said normally you guys don't and I know this is an odd policy that through my husband's employer group that they do cover deductibles and.
[CUSTOMER][NEUTRAL] Co-pays and stuff like that, cause it's the
[CUSTOMER][NEUTRAL] Meddling plan, but
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I just would rather you so yours can put the notes in the system that she verified with you.
[AGENT][NEUTRAL] Yes, this plan will pick up the copays, the co-insurance and our deductibles up to the benefit amount, and I'm not showing any data service for 5-19-2025 being received.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so let me have those resubmitted. Bear with me one second.
[AGENT][NEUTRAL] Would you like to fax them over?
[CUSTOMER][NEUTRAL] Um, no, I can only put in requests to have, um, to central billing to have them submitted, um, and that's as far as I can go, um, so give me one second, let me put in this request.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, so I mean I'm letting them know that the patient is active and it is being worked on the insurance side, um, as well to get, um, that, um, corrected, um, and that the claims need to be submitted and I am escalating this, um, for Central billing to have that, um, those claims submitted. And again, um, it can typically take 30 to 45 days for that to process.
[CUSTOMER][NEUTRAL] OK, as long as it's at the insurance level and it's not at my level, that'd be great.
[CUSTOMER][POSITIVE] Yes ma'am, and is there anything else I can assist with um today? If I can stay on the line with [PII] for one more couple questions with her I'm good with you thank you for your time. Uh, you're welcome and thank you again for calling SSM. You guys have a great evening. Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He, I had a couple claims from 23 that I was working on that I spoke to someone a few weeks ago.
[CUSTOMER][NEUTRAL] And she gave me a uh uh fax number to fax it in to you guys once I got all the paperwork together and I somehow have misplaced all that information with everything I've got going on. I apologize, so I had foot surgery.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I think she said that.
[CUSTOMER][NEUTRAL] It, that it would probably pick up it that she'd have to see, um, on the claim, but she said normally outpatient surgeries or ambulatory surgeries would be covered. Can you see any of those notes or anything? I apologize on my account.
[AGENT][NEUTRAL] No, you're fine. Under this plan, you do have the outpatient calendar year benefit amount of 3500.
[AGENT][NEUTRAL] Let's see if we have any claims in here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The only claims that I'm showing under yourself would be those two office visits in [PII]. Office treatment is covered, but not the actual office visit.
[CUSTOMER][NEUTRAL] But like the doctors see, so like when she had to do the surgery in the operating room and all of that, like any of my preoperative testing and stuff.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] If it was performed in the doctor's office, the actual office visit, that wouldn't be covered, but the outpatient.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Any of the outpatient parts where you
[CUSTOMER][NEUTRAL] So like
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes. So the doctor that performed the surgery.
[CUSTOMER][NEUTRAL] So like if I went in that house.
[CUSTOMER][NEUTRAL] Right, and then any of the preoperative testing, the blood works or EKGs or any of that they had to do for the surgery to make sure.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so the only thing they do do is the diagnostic like your regular office co-pay for why you see them, but any treatments. OK, so I need to work on getting that done too, so I apologize. Um, how, how do I get the claims to you, the
[CUSTOMER][NEUTRAL] The Bill C I apologize.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] No, you're fine. You can mail them, fax them, or upload them. Did you register your account online?
[CUSTOMER][NEUTRAL] My husband, well, I don't, I don't know. My husband does all of that, the uploads and stuff, but we can either mail, fax.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] Or upload if he, yes, ma'am, if you registered the account, you can upload them there.
[CUSTOMER][NEUTRAL] Or upload
[CUSTOMER][NEUTRAL] And is that just through the APL website or is that through his um Paula where he works?
[AGENT][NEGATIVE] No, he should have went to [PII] and created an account.
[AGENT][NEUTRAL] And you can see every claim that was actually submitted for you and your family on that account.
[CUSTOMER][NEUTRAL] OK, so secured [PII]?
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Yes, put a [PII] in between secured.
[CUSTOMER][NEUTRAL] OK, that.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Yes, ma'am. We register as a new user.
[CUSTOMER][NEUTRAL] OK, I will
[CUSTOMER][NEUTRAL] Register new user OK.
[CUSTOMER][NEUTRAL] OK, I'll have to do that. That would probably be easier.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] All right, thanks [PII]. I appreciate you. But, but they keep, I talked to them twice and they keep saying they sent them and I go, you guys didn't send it. I've just talked to [PII]. And so I talked to her and she goes, Well, we checked and we talked to someone named [PII] I was so glad I got a hold of you. I was like, Oh, thank you, God, are.
[AGENT][POSITIVE] [PII], you're so welcome. You're welcome.
[AGENT][POSITIVE] Yes, I'm glad you did too, and I sent another request so that they can get this corrected.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Thank you, hon.
[AGENT][POSITIVE] You are so welcome. Thank you for calling American Public Life, [PII]. You have a great day. Bye-bye.
[CUSTOMER][POSITIVE] All right have a good day.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.