AccountId: 011433970860
ContactId: 408ba436-c3e3-40da-856b-4e6db59e6fed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 692750 ms
Total Talk Time (AGENT): 374706 ms
Total Talk Time (CUSTOMER): 243198 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/408ba436-c3e3-40da-856b-4e6db59e6fed_20250311T13:08_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK, good morning. Uh, I'm calling about my, uh, a claim. Uh uh uh uh do you think you can help me with it?
[AGENT][NEUTRAL] OK, are you you're wanting to check claim status for yourself, is that correct?
[CUSTOMER][NEGATIVE] No, no, this is the answer. The company give me to my claim. That means it is like I, I find the answer very stupid because I find it, I, I file a claim, I submit the document that I have, the document I can have, uh, the document from the, the provider, the receipt where I did the thing, and they ask asking me the thing that I do not access to. They they are asking me to, to send a, a code of postage or something like that. Oh.
[CUSTOMER][NEUTRAL] Listen, this is the reason why I tell you, can you, can, can you connect me with a supervisor or someone who can
[CUSTOMER][NEUTRAL] who can handle this case?
[AGENT][NEUTRAL] OK, so you have already submitted a claim to APL, is that correct?
[CUSTOMER][POSITIVE] Yes, yes, yes. Yes.
[AGENT][NEUTRAL] And we're needing additional information, is that what I'm understanding?
[CUSTOMER][NEUTRAL] OK. OK. Do, can I provide you the, the claim number?
[AGENT][NEUTRAL] OK, first off, uh, who am I speaking with please?
[CUSTOMER][NEUTRAL] OK, my name is [PII].
[AGENT][NEUTRAL] Can you please spell your name for me?
[CUSTOMER][NEUTRAL] [PII] is my first name, [PII] is my last name.
[AGENT][NEUTRAL] [PII], say your last name for me one more time, please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you, Mr. [PII]. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] It is 01867130.
[AGENT][NEUTRAL] OK, thank you. So give me a moment, please, Mr. [PII] to get your information pulled up.
[AGENT][NEUTRAL] OK, and Mr. [PII], I will need to verify several things with you first for security, and then also any information that I do provide for you will be a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, also your home mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the phone number that we show on file for you is is um it's actually different than what you gave me. What is another phone number that we could have on file for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Is that still a good phone number for you?
[CUSTOMER][POSITIVE] It is a good phone number.
[AGENT][NEUTRAL] OK, thank you. And lastly your email address Mr. [PII] and this does appear to be your work.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] One moment. You said the, the, the, the, the what email address you need, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII] that, uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you very much for verifying all of your information. And you said that you do have your claim number, Mr. [PII]?
[CUSTOMER][NEUTRAL] It is 337-3252.
[CUSTOMER][NEUTRAL] No, no, it is 35733573252.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, thank you, so give me just one moment please to get that claims information pulled up.
[AGENT][NEUTRAL] OK, so this was for Boca Raton outpatient surgery. Is that correct?
[CUSTOMER][POSITIVE] It is correct.
[AGENT][NEUTRAL] OK, so give me one moment to look at the remarks on your claim.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. So, yes, sir. I can see it states.
[AGENT][NEUTRAL] Receipt of your claim is acknowledged, however, in order to further give consideration of this loss, this policy, we on this policy, we will need supporting documentation to evidence the accidents on our sickness. Supporting documentation may include, but is not limited to, itemized bills with the diagnosis codes, super bills, office notes, hospital admission and discharge summaries, and or diagnostic testing results.
[AGENT][NEUTRAL] There are certain pieces of documentation, Mr. [PII], that's required in reviewing this type of claim on the policy you have with us.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEGATIVE] How I'm gonna have these things because I, I, the insurance, they cannot contact my primary insurance company.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] What do I know about uh uh uh uh about code? What do I know about this thing?
[AGENT][NEUTRAL] And then you would contact the provider, the facility that you went to, this, the Boca Raton outpatient surgery and let them know that what you are needing. An itemized bill that includes your diagnosis and proceed exactly what it states on that explanation of benefits.
[CUSTOMER][NEUTRAL] And what is separate bills? What is that?
[AGENT][NEUTRAL] I'm sorry, that is just a form of a bill depending on how the hospital, it's their term.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] So I, I will, I will, I will have to fight to, to, to find all these things.
[AGENT][NEUTRAL] You just wait, OK, so we received your explanation of benefits.
[AGENT][NEUTRAL] From your primary insurance carrier. That is what we received. But we have to have the other information also.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I, I, I submitted, I, I submitted the bill to the Bocaraton outpatient bill. I submitted this.
[AGENT][MIXED] Correct, but it doesn't have your diagnosis code on it.
[AGENT][NEUTRAL] That is only a bill.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And we have to have if, do you have a copy of our claim form for this type of policy because I just, I can see that we did receive that, but the claim form.
[AGENT][NEUTRAL] Um, have all of the instructions, Mr. [PII], of exactly what is in it.
[CUSTOMER][NEUTRAL] I have a copy with me. No, no, no, when you, when you say the claim form, it is the, the thing when they, they put the, the, the remark receipt of your claims is acknowledged, however, in order to provide further, is it, is it that you're talking about, no?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Yes, no, sir, I'm, no, sir, I'm, I'm referring to this is the bill. I'm referring to the not the explanation of benefits that shows it wasn't paid but our actual claim form.
[CUSTOMER][NEUTRAL] I have it with me.
[CUSTOMER][NEUTRAL] Well, I don't know what you call actual cream from, I don't know.
[CUSTOMER][NEUTRAL] I don't know what it is it.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] If, are you able to?
[CUSTOMER][NEUTRAL] Because I, I, I have a document, I, I, I printed the document from your website with two pages. The first page say American Public Life Insurance Company PO Box, and so on. And it's a check, a check date.
[AGENT][NEUTRAL] Does it say Medlink claim form at the top?
[CUSTOMER][NEGATIVE] No, nothing like that. No, no.
[AGENT][NEUTRAL] Yes, sir. I'm ref, yes, so this is not, now I'm not.
[CUSTOMER][NEGATIVE] I said, I, I, it says this is, this is not a bill. This is what I read. This is not a bill, and they have a, a, a check date XXT policy number reference inert.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir. Does it say explanation of benefits at the top?
[CUSTOMER][NEUTRAL] Total bill charge.
[CUSTOMER][NEUTRAL] Yeah, it says explanation of benefits, yeah.
[AGENT][NEUTRAL] OK, so that is not what, that is not the claim form, that is the explanation of benefits. Now, I will be happy to email you the actual claim form for this type of policy that you have with APL.
[AGENT][NEUTRAL] And it does give you the instructions of exactly if you're gonna be filing the claims with us instead of your provider.
[AGENT][NEUTRAL] It gives you the specific instructions of the documents that we have to have when reviewing this type of claim.
[AGENT][NEUTRAL] Would you like for me to email that to you?
[CUSTOMER][NEUTRAL] Of course you, you can email it to me, but OK, besides the, the itemized bill, you see, if, if, if I contact [PII] and they provide me that what you call the itemized bill, I, I'm OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Well, we would have to, I can't say that. We will have to review that. You just need to make sure that and
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, when I say I'm OK, do I, it's OK. I don't have to provide anything else.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I can't answer that question until we receive the documentation from them, Mr. [PII], for us to review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I can just tell you that based on the information that we did receive what is stated on that explanation of benefits is the additional information that we need in order to complete the review of your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I'm going to email you this document in just a moment, this claim form that I was referring to Mr. [PII], and it's called a Medlink claim form and if you you'll notice on your ID card, it shows that you have a Medlink policy.
[AGENT][NEUTRAL] Do you see where it says Medlink on your?
[AGENT][NEUTRAL] ID card.
[CUSTOMER][NEUTRAL] I don't have it with me, but this, the word you say, I, I, I, I'm familiar with it. When I, when I, I do everything online, and I don't really use that thing. You see, when, when I go online, I see the word you say.
[AGENT][NEUTRAL] Yes. OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, and once you have this additional information that we're that we are in need of to complete the review of your claim, you can upload that information, Mr. [PII] directly into your portal just like you did these other documents.
[CUSTOMER][POSITIVE] Yeah, thank you very much.
[AGENT][NEUTRAL] Well, you're very welcome. So you should have that um email for me in just a moment, and it will come from [PII] and I did put APL and Medli claim form in your subject line.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. Well, can I help you with anything else at the moment?
[CUSTOMER][POSITIVE] No, it's OK, it's OK for today. Thank you very much.
[AGENT][POSITIVE] OK, well, you're very welcome and thank you again for calling APL. I hope you have a very nice day, Mr. [PII].
[CUSTOMER][POSITIVE] You too you too bye bye.
[AGENT][POSITIVE] Yes, sir. Thank you. Bye bye.