AccountId: 011433970860
ContactId: 4013730e-5f6b-43d2-b3d9-6d73d16955f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380540 ms
Total Talk Time (AGENT): 121058 ms
Total Talk Time (CUSTOMER): 219805 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/4013730e-5f6b-43d2-b3d9-6d73d16955f3_20250205T14:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Good morning [PII] [PII], how are you today?
[AGENT][POSITIVE] I'm great how are you?
[CUSTOMER][NEUTRAL] I'm confused. Um, I sent in a claim and then you guys looks like you either denied it or closed it or I'm not really sure is asking for a medical code, so do we just go back on this claim or do I have to start a whole new one?
[AGENT][POSITIVE] I'll be happy to assist you with the claim status. May I have your policy number?
[CUSTOMER][NEUTRAL] Yeah, I can give you a claim number also if you'd like um the what do you want? Which one?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Either one's fine.
[CUSTOMER][NEUTRAL] Alright, so the policy number is 025867552.
[AGENT][NEUTRAL] May I have your name and a good callback number please?
[CUSTOMER][NEUTRAL] [PII] phone number is [PII].
[AGENT][NEUTRAL] Thank you. [PII], can you verify your date of birth, your mailing address, and your email?
[CUSTOMER][NEUTRAL] Yeah, that's funny. [PII] [PII] [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. So, it looks like on claim 3559517, we are asking for a diagnosis code. So, unfortunately, you can't add to the existing claim, you have to submit it as it's a new claim, but it will process the claim.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] So I'm looking at the billing section on the my chart, OK? And I assume it's the 93458, the 92928, the 93005 that sound about right for y'all?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, the diagnosis code would be the reason for your visit.
[AGENT][NEGATIVE] Headache, backache, stomach ache?
[CUSTOMER][NEUTRAL] A stent, um.
[AGENT][NEUTRAL] So, so that would be the diagnosis. So I would just write that on your claim form or whatever paper that you would use.
[CUSTOMER][NEUTRAL] Your your claim system it doesn't explain that very well. It's just, you know, it's, it's very vague as far as the the claim deal goes. I can enter in a file, but that's all it allows me to do on your site.
[CUSTOMER][NEGATIVE] It lets me upload a file on a new link, but it doesn't let me talk to it.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] So how am I supposed to give y'all an explanation of why I went to a hospital if it doesn't even allow me to do it?
[AGENT][NEUTRAL] So do you have a claim form?
[CUSTOMER][NEUTRAL] I'm on your site as we speak.
[AGENT][NEUTRAL] OK, so if you go to forms, you would have to upload or download that form.
[AGENT][NEUTRAL] So that you can enter that information in there.
[CUSTOMER][NEGATIVE] So with all due respect, I pay you guys monthly to have a policy. You can't make a phone call and fix this. I have to do extra work. I mean, I sent you the bill which has all the details about it with the billing number and the the dates and all that stuff it's you guys don't do any extra you just say yep, yay or nay.
[AGENT][NEGATIVE] Unfortunately,
[CUSTOMER][NEUTRAL] I just wanna make sure I'm on the same page.
[AGENT][NEUTRAL] Yes, unfortunately, we cannot accept the diagnosis calls over the phones. They have to be in writing.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] I don't even know where to find it. You're asking for a code, and I'm just telling you I had to have a stent replaced and you're saying that's good enough. It's not a code. I'm just telling you what I had to go in for.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So I'm not sure how what and that's gonna work as a code. I just tell you I had to have a stent put in and we're good.
[AGENT][NEUTRAL] OK. Was the stent like for heart, for whatever it was, and then once we get that information, we'll put it in the system, the code will pop up for that procedure.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So I go to your website which I'm on right now and I go to claim forms, correct? Great, so when I do this.
[AGENT][NEUTRAL] Yes. Yes.
[CUSTOMER][NEUTRAL] It wants me to sign in.
[CUSTOMER][NEUTRAL] Every single time.
[CUSTOMER][NEUTRAL] Claims and forms.
[CUSTOMER][NEGATIVE] I may be wrong with this, please don't hold me to that yet.
[CUSTOMER][NEUTRAL] File a claims online.
[CUSTOMER][NEUTRAL] Sign in the register.
[CUSTOMER][NEUTRAL] Mail paper form
[CUSTOMER][NEUTRAL] Download included complete the appropriate claim form, is that what you want me to do?
[AGENT][NEUTRAL] Yes, for Metlink.
[CUSTOMER][NEUTRAL] From Medin
[CUSTOMER][NEUTRAL] Hospital indemnity.
[CUSTOMER][NEGATIVE] Um, it doesn't give me that option. I have accident authorization to closed information, cancer, change in request form, continuation forms, critical illness.
[CUSTOMER][NEUTRAL] Medical or dental direct deposit direct deposit hospital indemnity.
[AGENT][NEUTRAL] Under the medical and dental, is there more forms?
[CUSTOMER][NEUTRAL] Is there more?
[CUSTOMER][NEUTRAL] Ah, meddling claim form.
[AGENT][NEUTRAL] There it is.
[CUSTOMER][NEGATIVE] They make this very difficult y'all.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is this fillable?
[CUSTOMER][NEGATIVE] It is not fillable.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, I guess I'll send this out and see what y'all say um.
[CUSTOMER][NEGATIVE] So it's interesting you asked me to give you a code which it doesn't even offer on this meddling claim form.
[AGENT][NEUTRAL] And that's what we've been told a lot, so I would just write it anywhere that you can write it on there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They revised those forms.
[CUSTOMER][NEUTRAL] I know it's not on you, but y'all need to fix this. If they made this link like this claim form a link online with a fillable, man, it would save a whole lot of problems.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And we've noted that as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We're trying, we're trying.
[CUSTOMER][NEUTRAL] I understand, I understand, uh, it's not even fillable, so you guys are gonna get chicken scratch out of me, but I'll do my best.
[AGENT][NEUTRAL] And that's fine. That's fine. At least we can legally say [PII], put it in here.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][POSITIVE] Alright cool I'll get this done and I'll send it out to y'all here in just a little bit.
[AGENT][POSITIVE] Thank you, [PII], I appreciate it.
[CUSTOMER][NEUTRAL] Now do you want me to send over the bill also that I sent you again?
[AGENT][NEUTRAL] No, no, we already have that one. We just need the diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, but you're not gonna use the old claim you're starting a new one that's why I'm curious and if you're gonna need it again just to cover myself.
[AGENT][NEUTRAL] No, because we have it in our system, so we'll create it again.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Fabulous. I'll get this handled for you now thank you.
[AGENT][POSITIVE] Thank you, [PII]. Thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Alright bye thanks.
[CUSTOMER][POSITIVE] Good bye.