AccountId: 011433970860
ContactId: 40b1bab1-b97b-455d-982a-f0c5eec96525
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323290 ms
Total Talk Time (AGENT): 78916 ms
Total Talk Time (CUSTOMER): 188773 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/40b1bab1-b97b-455d-982a-f0c5eec96525_20250414T17:10_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] How was that
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, I was calling about a claim that I submitted that was just recently completed.
[CUSTOMER][NEGATIVE] And I'm wondering why they didn't pay out the one portion of it, which was the largest part that I had to pay.
[AGENT][NEUTRAL] May I have your policy number and I'll pull up your claims.
[CUSTOMER][NEUTRAL] Yes ma'am, um, my policy number is 259-7363.
[AGENT][NEUTRAL] One moment. May I have your first name and a good callback number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] What else did you need?
[AGENT][NEUTRAL] Your email and your mailing address.
[CUSTOMER][NEUTRAL] Uh, my mailing address is [PII]. My email address that you guys have, I believe is my work email, which is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. And what is the claim number or date of service?
[CUSTOMER][NEUTRAL] OK, so the date of service is [PII].
[CUSTOMER][NEUTRAL] Um, the claim number they paid it out on was 3587747, but the EOB that I sent them was on a different claim number, but they needed um the doctor's notes with like diagnosis on it which I had to send separate after they denied my claim.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, so on this claim data service 318.
[AGENT][NEUTRAL] Looks like they paid the provider [PII]. Looks like that was inpatient.
[CUSTOMER][NEUTRAL] Yeah, so, on, on the EOB like I do see the number, like I, the number that they came up with, but there's also because I had to pay like 5600 and.
[CUSTOMER][NEUTRAL] $60 or something.
[CUSTOMER][NEUTRAL] And there's one on here for $4,651.98 for like my recovery room, um, medication, all like inpatient, um, anesthesia, physical therapy. It's like a whole bundle thing and they didn't.
[CUSTOMER][NEUTRAL] They didn't um I don't know if they didn't receive that part. I mean it's in the file I can see it on my file viewer in my APL dashboard.
[AGENT][NEUTRAL] What is the name of the provider on that one?
[CUSTOMER][NEUTRAL] On that particular like that amount.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It says Westmoreland Regional Hospital CCU Intermediate.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm showing
[CUSTOMER][NEUTRAL] Which they paid like just the one co-insurance for that of the 65651 98, but I'm wondering if it's because like they charged me $4,651.98. They paid $651.98 but if I look through all of the rest of them, it doesn't show like the breakdown of the $4000 as co-insurance.
[CUSTOMER][NEUTRAL] Is that why? Like, do I need to get that from them?
[AGENT][NEUTRAL] Yes, because it looks like the 665198 was paid to Westmoreland, but if it doesn't show it was applied to the copay coinsurance and or deductible, they would not have processed that additional 4000.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, yeah, cause it just shows that as owed from like the total, but it doesn't show it anywhere on them from co-insurance. So I will see uh they uh they said I was getting a corrected EOB so I'll see if that's available yet.
[AGENT][NEUTRAL] OK, cause I'm looking at this one.
[CUSTOMER][NEUTRAL] And I, so I'll just, I just.
[CUSTOMER][NEUTRAL] So I just resubmit that?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Once it's OK.
[AGENT][NEUTRAL] You don't have to submit everything, just that corrected EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's all I wanted to make sure that way I got exactly what you needed.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK. Thank you so very much.
[AGENT][POSITIVE] [PII], you're so welcome and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.