AccountId: 011433970860
ContactId: 467f8a46-0439-4802-98d4-738328336e41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 586010 ms
Total Talk Time (AGENT): 201577 ms
Total Talk Time (CUSTOMER): 270509 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/467f8a46-0439-4802-98d4-738328336e41_20250602T18:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, uh, I'm calling because, um, I recently submitted a claim, um, on your new um service center online, and, um, I was just calling to make sure that it went through because I logged in. I don't see it, um, that is, it says submit it but I don't see it on there as you know.
[CUSTOMER][NEUTRAL] Let's log in log in.
[AGENT][NEUTRAL] OK, may I have your name please?
[CUSTOMER][NEUTRAL] Um, [PII]
[AGENT][NEUTRAL] And may I please have a callback number and then your policy number?
[CUSTOMER][NEUTRAL] Callback number will be [PII].
[CUSTOMER][NEUTRAL] Um, policy number would be 2552435.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], I do need to verify your date of birth and then the mailing address listed on file.
[CUSTOMER][NEUTRAL] Sorry, can you repeat that?
[AGENT][NEUTRAL] I do need to verify your date of birth and the mailing address listed on file.
[CUSTOMER][NEUTRAL] I get that.
[CUSTOMER][NEUTRAL] OK, and date of birth is [PII]. Email address is [PII].
[AGENT][NEUTRAL] OK. And may I have the residential mailing address?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And thank you so much for verifying your policy. You were calling in to see if we have received a claim. Is this for you or another member listed on the policy?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, yes, sorry.
[AGENT][NEUTRAL] It's for your son
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, a claim for data service so.
[CUSTOMER][NEUTRAL] Of, um, what is it?
[CUSTOMER][NEUTRAL] Um, 326 2025.
[AGENT][NEUTRAL] OK, and the phone had went out was this claim for you or someone else listed on the policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, someone else on my policy, it would be for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have her date of birth, please?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And that is for 326 of 25, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Now this look like we did receive 3 claims today from the secured portal. I'm gonna pull those up for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] You see I've been asking.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I do see for this claim.
[AGENT][NEUTRAL] It is for date of service of 326 and 327.
[AGENT][NEUTRAL] It's the primary EOB?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, um, actually it's, it's for a child later when she gave birth to in the hospital, so it may be, it's from the first day is 3:26 to about the 29th, I believe so, but um.
[CUSTOMER][NEUTRAL] Um, the, um, on the EOB it says 326. The itemized has all the, um, 326 through about the 29, so. And also I, I submitted it twice because it was 3 claim files, but online it's a maximum of 20 MB so I I submitted it, um, I submitted the EOB and itemized together and I submitted the other page of the itemized separately.
[CUSTOMER][NEUTRAL] Because I was [PII] in the the MB yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And this is for the mother delivery, not the child's?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, the
[AGENT][NEUTRAL] OK. And so with this now, the thing that we're going to need would be the diagnosis code. So I do see that we do have the EOB but we don't have the diagnosis code to process this claim.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK, also.
[CUSTOMER][NEUTRAL] OK, um, on the, on the, the, one second, I wrote, um, or, because I did it once before they told me I can, I can put the diagnosis code on there. I put the diagnosis code on the, the, the second one I, I submitted of the itemized. It says DS code and it has, it has it on there. Um, I'm not sure. Do you see it? It was the one where I sent them up where I submitted one document.
[CUSTOMER][NEUTRAL] The, the, the, the other page. I submitted the EOB and itemized and I submitted the other itemized separately. The DS code is on the one I submitted separately.
[AGENT][NEUTRAL] OK, so I'm looking at the page that is showing the itemization of hospital services.
[AGENT][NEUTRAL] And I'm not seeing anything written just on that page so I'm gonna go to the next one.
[CUSTOMER][NEUTRAL] Yeah, it should be on the next one then.
[AGENT][NEUTRAL] Cause I'm not sure if they, and they informed you that we do not take written diagnosis codes. They have to come from the provider and it, and it has to indicate that provider's name listed on there.
[CUSTOMER][NEUTRAL] Like
[AGENT][NEUTRAL] And I do see on this when it does say diagnosed.
[AGENT][NEUTRAL] It is called childbirth slash labor.
[AGENT][NEUTRAL] Excuse me. And I do see that, but that's not a diagnosis code.
[CUSTOMER][NEUTRAL] OK, because our previous um claims I filed, they, they, um, they said I was fine and I actually did that, so, um.
[CUSTOMER][NEUTRAL] I don't know if it changed or not, but I literally, um, I did that on previous ones, um.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Um, because.
[CUSTOMER][NEUTRAL] So I have to get a, a DS code for what, which means childbirth.
[AGENT][NEUTRAL] You will contact that provider or facility and they will give you what you possibly had already received which would be the discharge papers for that date of service.
[CUSTOMER][NEUTRAL] Or that that is
[AGENT][NEUTRAL] And those discharge papers would normally have the reason or diagnosis codes listed. If you do still have that, you can submit that in or you can contact the provider and have them to submit that discharge papers to you or a statement with their letterhead showing the diagnosis code for those dates of service.
[CUSTOMER][NEUTRAL] OK, I have a um a discharge paper for her.
[CUSTOMER][NEUTRAL] It says maternal age has parental lab, hepatitis screen, community screen. I estimated day of delivery, pregnancy medications. It says labor hospital, it has the, the provider on there, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's, it's actually, and it says it has the whole breakdown of, of the thing. Would that be, um, you know, I have the this paper that they gave her, would that be um
[CUSTOMER][NEUTRAL] Eligible.
[AGENT][NEUTRAL] As long as you submit that discharge paper, once that examiner receives it, they will be able to distinguish if it has that detailed information for that diagnosis code. I can't see the paper, so I can't process or give you information over the phone.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] So how do I go about submitting it? Can I just go in like I'm, I'm doing another claim and just upload these?
[AGENT][NEUTRAL] Yes, and once they, they, they will review it and they will be able to know that this is for the same previous submission claims.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, so I, I'm gonna do that now and so you do it, so you did get the ones that I recently filed because for whatever reason it wasn't up on popping up online, I wanna make sure you did receive it, the ones I just, uh, filed today.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, for the dates of service of [PII], yes, we have three images that we did receive.
[CUSTOMER][NEUTRAL] Yes, OK, so I'm gonna redo it now and I'm gonna upload this discharge summary with it and I guess we can go from there. It can I call back to make sure that it's the correct thing?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, you're more than welcome to call back. You do just have to allow a total of 30 to 45 minutes, possibly up to an hour before we can say that we have received that information.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Um, no thank you, that's all.
[AGENT][POSITIVE] Thank you so much for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] Thank you.