AccountId: 011433970860
ContactId: 58c5f561-cbd5-4769-a7d6-2f804743f792
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 285670 ms
Total Talk Time (AGENT): 120418 ms
Total Talk Time (CUSTOMER): 180909 ms
Interruptions: 6
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/58c5f561-cbd5-4769-a7d6-2f804743f792_20250206T18:51_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] Yes, I was calling, um, I just got off the phone with my medical insurance, um, and they had recommended for me to contact um you guys at American Public Life, and I was just calling um to see I don't know if I should start with you or if I need to call a doctor's office directly, but I had a procedure done in [PII].
[CUSTOMER][NEUTRAL] And they have now ran the medical insurance um and showing patient responsibility and even though I did uh provide the medical and the gap card um at the time of the uh at the appointment, um, I don't know for sure whether the doctor's office filed my gap insurance, so I was wanting to see if you could provide me any information on that and then I may have to contact the doctor's office directly.
[AGENT][NEUTRAL] I'll be happy to verify claim status. May I have your policy number?
[CUSTOMER][NEUTRAL] OK. Yes, ma'am. Um, so that's gonna be 02564459.
[AGENT][NEUTRAL] May I have your name and a good callback number?
[CUSTOMER][NEUTRAL] Yes ma'am, so my name is [PII], and a good call back number is going to be [PII].
[AGENT][NEUTRAL] Thank you, can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] Yes ma'am, so [PII], um, address is [PII], and then my email should be [PII].
[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 in your history and I'm only seeing charges from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Looks like an office visit.
[CUSTOMER][NEUTRAL] Right, yes.
[AGENT][NEUTRAL] Let me see if there's anything prior to that.
[CUSTOMER][NEUTRAL] OK, alright, and the date of service specifically was um [PII] and I'm almost thinking that I don't think that they uh filed it with Gap um is what I'm kind of thinking, but I'm just trying to double check everything.
[AGENT][NEUTRAL] And there is no claims for data service since [PII] as of today.
[CUSTOMER][NEUTRAL] OK, OK, and what would be the correct, this is my um my first time having gap insurance so um they should have the card on file like I mentioned I gave it to them at the appointment. Should I call the doctor's office directly or do I need to try to get them to call uh how does the process work?
[AGENT][NEUTRAL] You can do 1 or 2 things.
[CUSTOMER][NEUTRAL] Or what information do you guys need? OK.
[AGENT][NEUTRAL] You can either call the provider and ask them to file with your secondary insurance, which will be us. They need to submit your primary insurance, EOB along with the claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or you can file yourself.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what is the process to file with myself and is there any type of like time frame difference versus information from a doctor information from myself?
[AGENT][NEUTRAL] No, whomever files first will receive the benefits unless you specify to pay the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Unless the provider does not accept benefits, then it will come to you, but whomever filed the claim will receive benefits if any benefits are due. But you would need 3 items if you submitted the claims, you would need the itemized bill from your doctor.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You would need your major medical explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you would need a Medli claim form, which you can obtain online at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And you can file the claim.
[CUSTOMER][NEUTRAL] OK, OK, alright, um, I'm gonna start probably with the doctor's office, so I'm gonna give them a call this afternoon and see if they can file it, and you said that they just need the, the primary insurance EOB, is that correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK perfect and then if they do file um what is the process for me to just be able to see the status of the claim and whether it's processed or not with American Public Life will.
[AGENT][NEUTRAL] You will receive an EOB whenever anything is submitted on your account, or you can go to secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] and you can register your account and you can walk through step by step everything that comes in on your account.
[CUSTOMER][POSITIVE] OK alright perfect alright well I will do that and I appreciate uh your information today.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life, [PII]. Have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye bye.