AccountId: 011433970860
ContactId: 67e0c32f-776a-4357-9786-3a359d3a933e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1187130 ms
Total Talk Time (AGENT): 513462 ms
Total Talk Time (CUSTOMER): 446023 ms
Interruptions: 9
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/67e0c32f-776a-4357-9786-3a359d3a933e_20250106T19:26_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. Um, I had, I was trying to uh place a claim in the system.
[CUSTOMER][NEUTRAL] But it's um I I'm not sure if I'm, this is the first time I do it, so I'm not sure if I'm doing it correctly.
[AGENT][NEUTRAL] OK, um, I can help you with that. Could I have a callback number for you?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And do you have your policy number with us?
[CUSTOMER][NEUTRAL] And uh let me get it. I said in the invoice group number is that it?
[AGENT][NEUTRAL] Is that, it's the outpatient certificate number.
[CUSTOMER][NEUTRAL] Outpatient certificate number.
[CUSTOMER][NEUTRAL] Policy number. OK, for, um, it's 0255.
[CUSTOMER][NEUTRAL] 4566.
[CUSTOMER][NEUTRAL] For a metal colo.
[AGENT][NEUTRAL] OK. If you could verify your full name and date of birth.
[CUSTOMER][NEUTRAL] My name is [PII], [PII].
[CUSTOMER][NEUTRAL] But uh, I was trying to place uh a claim for my husband [PII].
[AGENT][NEUTRAL] OK. OK. So, um, that, let me look here.
[AGENT][NEUTRAL] OK, we will need uh authorization to speak with you regarding the policy. Uh, I may be able to help a little bit, but um there's certain, um, I may not be able to provide certain information, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, so you said you are having an issue trying to file the claim online?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Um, and what, where are you, what part are you having an issue with? Like, where are you getting stopped?
[CUSTOMER][NEUTRAL] Well, I want it.
[CUSTOMER][NEUTRAL] I went into, I can see the company, we, we have a small business. It's, it's only 3 employees. It's my husband, my daughter, and myself. So I don't know if it's because I'm doing it from the company. I'm not doing it from the, I go to my employees.
[AGENT][NEUTRAL] So you'd have to do it as the individual. If you're filing a claim, it has to be done through uh the portal as an individual, not uh the company.
[CUSTOMER][NEUTRAL] In the 8
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] OK, so that's what's happening, I guess.
[CUSTOMER][NEUTRAL] So he would need to sign in.
[CUSTOMER][NEUTRAL] And do
[CUSTOMER][NEUTRAL] As an employ as his individual account.
[AGENT][NEUTRAL] Right, and so, um,
[AGENT][NEUTRAL] Um, it's gonna ask for an email address, um, his social, and then his policy number to create an account.
[AGENT][NEUTRAL] Um, he would have to
[CUSTOMER][NEUTRAL] OK, can you send me, because I, I, I would need to do it for myself and my daughter, uh, we have to do that. Is there, um, how do we create it?
[CUSTOMER][NEUTRAL] individual account.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So, are, are you on the individual, uh, so I can, I can walk you through it.
[CUSTOMER][NEUTRAL] I, mm, no, no, I mean the company, I mean, uh, it.
[AGENT][NEUTRAL] OK, so you would have to go in, you would have to go to [PII] and then you will see uh to create an account.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, because I'm already in a [PII] account, but it says uh Welcome Eco Colum PWM Inc. is the company.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you'll have to log out and log back in and as I stated choose individual if you're in as the company then.
[CUSTOMER][NEUTRAL] So I created Dell.
[CUSTOMER][POSITIVE] Love
[AGENT][NEGATIVE] The steps would not work.
[CUSTOMER][NEUTRAL] OK, so create a new user, go to a new user.
[AGENT][NEUTRAL] Mhm. Create a new user. Correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, OK. OK. So, I think.
[AGENT][NEUTRAL] So you said you do have a policy with us?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Let me try to pull you up. Uh, do you have your policy number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what is your policy number? And I can walk you through it and you can use the exact same thing for him to create, create his account.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, perfect. OK.
[CUSTOMER][NEUTRAL] It's um 025545.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 67.
[AGENT][NEUTRAL] 67. OK, if you could verify your date of birth, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you so much for that and then also uh if you could verify the email address uh well I show you don't have an email address on file so you will need to create it, you know, put an email address on file because that is what you will use to create the account.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, so I need to go back and log in as the company again.
[AGENT][NEUTRAL] What is your personal email address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's my last name on my first name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] I can, I can put it in.
[AGENT][NEUTRAL] So it's [PII]?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] And still this with an eye, both eyes and no white.
[AGENT][NEUTRAL] Yes, [PII]
[CUSTOMER][POSITIVE] Perfect. Yes, yes.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK, so now, so just know for your husband when he creates his account, whatever email address he has on file needs to match what it, you know, once you create an account for him. Uh, so, but we, I would, he would have to verify the account unless he gave you third party authorization to speak on his behalf. So, but without that, we can't verify that email address. So that's, that's how you get.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Create your account. So you're gonna use your policy number, your email address, and then I believe it as for uh possibly the last four of your social.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see on my spam.
[CUSTOMER][POSITIVE] Last name. I'm trying to create mine. I'm doing mine. I, I, I think it it's asking me for the social, the whole social.
[AGENT][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] OK, so you'd enter your entire social.
[CUSTOMER][NEUTRAL] The ZIP code [PII]. The email.
[CUSTOMER][NEUTRAL] I'm entering that.
[CUSTOMER][NEUTRAL] And then the date of birth, [PII].
[CUSTOMER][NEUTRAL] Next.
[CUSTOMER][NEUTRAL] The username could be anything.
[CUSTOMER][NEUTRAL] Email can be the username or no?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I'm sorry, the the username?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is the username not oh yeah once you've uh created yeah you can it's whatever you know just make sure you um.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] Remember it so it can be any anything you'd like to use.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Probably my email it's OK.
[AGENT][POSITIVE] Yes, ma'am. That would be fine. Yes.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] For the password I can do my own password, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] My own password perfect.
[CUSTOMER][NEUTRAL] Um it needs to be an uppercase.
[CUSTOMER][NEUTRAL] Mm OK, no, it's not letting me use they email us the username.
[AGENT][NEUTRAL] OK, so you'll have to create um.
[AGENT][NEUTRAL] A username.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK, so got it it's already.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Safe password.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I, I'm already signing as myself.
[AGENT][NEUTRAL] OK, so you're in?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So if you look to the top um of the screen, kind of to the left, it'll say claims in
[AGENT][NEUTRAL] Uh, I, I think it says file a claim or.
[AGENT][NEUTRAL] Do you see a tab, the claim form, you see that?
[CUSTOMER][NEUTRAL] Plain for let me see.
[CUSTOMER][NEUTRAL] Claim forms. Yes.
[AGENT][NEUTRAL] OK, if you click it, it'll drop down.
[AGENT][NEUTRAL] And you're, you
[CUSTOMER][NEUTRAL] Oh, wait, wait, wait, wait, wait.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim forms and
[CUSTOMER][NEUTRAL] It, it go, mm wait wait wait. It, it takes me out somewhere else.
[AGENT][NEGATIVE] If you click it, it should drop down.
[CUSTOMER][NEUTRAL] Mhm. Uh, I think.
[AGENT][NEUTRAL] You should get a list of claim forms.
[CUSTOMER][NEUTRAL] This is what I'm seeing. I see my coverage.
[CUSTOMER][NEUTRAL] Uh, it says my Med link select group Med and my policy number.
[CUSTOMER][NEUTRAL] And then upload documents my claims down there it says upload documents upload files.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so when you click upload documents that is how you would upload the information to file a claim.
[CUSTOMER][NEUTRAL] Oh, and when you upload, you upload just a copy of the receipt.
[AGENT][NEUTRAL] Uh, so for a claim, we will need, uh, not the receipt, we'll need the itemized bill.
[AGENT][NEUTRAL] The itemized bill will need to show the procedure and ICDI code. You may want to write that down. Uh, the ICD 10 code is important. Uh, you can get that from the doctor or whoever, um, provided the services. You can call them and ask them what is the ICD 10 code for the data service. They can provide you with that code and you will need to um submit that information.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So either write it on your itemized bill.
[AGENT][NEUTRAL] Uh, or you know, you can upload a letter or something and saying my ICD pin code for data service.
[AGENT][NEUTRAL] I and then you can put the code there.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we will need your explanation of benefits from your primary insurance showing that they received the claim and processed it and showing what the patient responsibility is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, but this is like the co-payment. This is uh an invoice for a co-payment.
[CUSTOMER][NEUTRAL] Still you need um.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] We will still need the, uh, explanation. I'm sorry, we still need, we'll need the ICD 10 code.
[CUSTOMER][NEUTRAL] OK, you need the ICD code and an itemized billed with the date of service.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And the explanation of benefits showing that uh the in your primary received the charges and uh co-pay was the patient responsibility, how much the copay is.
[CUSTOMER][NEUTRAL] OK. The explanation of benefits for my insurance, it's um like a copy of the policy?
[AGENT][NEUTRAL] No. So when you, uh, I don't know, in the past when you've gone to the doctor, uh, you'll receive a statement, a statement from your doctor, I, I'm sorry, from, from your primary insurance saying we received the claim. This is not a bill. This is what you owe. Do you recall getting that?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, yeah, I guess, I guess I can go online, look for it, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, right. So that we need the explanation benefits, uh, that matches the, the date that you're trying to be reimbursed for, uh, showing that they did receive the claim, they processed it, and then what you owe. We need that part of the, uh, statement.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, OK, OK.
[CUSTOMER][NEUTRAL] And then it's ICD, so I as in igloo, C as in Charles, D as in David.
[AGENT][NEUTRAL] Yes, and the number 10.
[CUSTOMER][NEUTRAL] 1010, the number 10. OK, very good. OK and then when I when I go into.
[AGENT][NEUTRAL] And let me ask you, is this for a doctor's office visit, the co-pay for the doctor's visit? Oh, chiropractic. OK. OK. Yes, ma'am. OK.
[CUSTOMER][NEUTRAL] Chiropractic, chiropractic.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK and then um so I would go into the upload documents, upload file and upload copies of.
[CUSTOMER][NEUTRAL] These two things, the.
[CUSTOMER][NEUTRAL] Yeah it must be on the explanation of benefits.
[AGENT][NEUTRAL] Yes, and then make sure you write the ICD pin code uh on uh one of those documents before they're uploaded.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, yes, perfect. OK dokey. Sounds good. I would need to forget that. Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] And, uh, I wanted to, the other thing I wanted to do was to set up a like an automatic payment to see if uh the, the payments would.
[AGENT][NEUTRAL] So if you look
[AGENT][NEUTRAL] Go to direct deposit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that what you're wanting?
[CUSTOMER][NEUTRAL] And, ah, you mean if it's for the reimbursement?
[AGENT][NEUTRAL] Right. Are you asking that when we make payment that it goes to your banking account, when you say automatic payment? OK, so if you
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, no, I want, uh, OK, OK, go ahead, go ahead. Yeah, it's 22 questions, but that's fine. No, it's OK, go ahead.
[AGENT][POSITIVE] OK, sorry about that.
[AGENT][NEUTRAL] OK, so if you
[AGENT][NEUTRAL] OK, so if you look also on the screen, there should be a tab that says claims and forms. Do you see that anywhere?
[CUSTOMER][NEUTRAL] I see it I have a message that popped out. I'll set up your direct deposit.
[AGENT][NEUTRAL] OK, so if you click that, yes, you'll be able to uh enter bank information. So you're, anytime you submit a claim. Yes, ma'am.
[CUSTOMER][NEUTRAL] So I guess if I follow that.
[CUSTOMER][NEUTRAL] My, my banking information.
[CUSTOMER][NEUTRAL] OK, so it goes directly into a bank account. It doesn't go into like a credit card or it's just a checking account.
[AGENT][NEUTRAL] No, no, it's payment to your, yeah, so it's either uh direct deposit or you're sent a paper check. So if you want it to go into your account, yeah, you uh just uh enter your um direct deposit information, but if you don't do that, it will come as a paper check.
[CUSTOMER][NEUTRAL] Oh, I
[CUSTOMER][POSITIVE] Very good.
[CUSTOMER][NEUTRAL] OK, very good. If we don't enter this information, OK, and then the other question I had the one that I had was as a company we want, we're paying this uh policy monthly.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And, and I, and I get an invoice from IPO, but I wanted to set up either a like an automatic payment.
[AGENT][NEUTRAL] For your premiums to come out?
[CUSTOMER][NEUTRAL] For them to withdraw.
[CUSTOMER][POSITIVE] Yes, yes, yes.
[AGENT][NEUTRAL] OK, OK. So I will have to get you over to our billing department, uh, to see about how to go about doing that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, can we, can you tell me?
[AGENT][NEUTRAL] OK, would you like, do you have any uh other questions for me before transferring you over?
[CUSTOMER][NEUTRAL] No. No, that's it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. You have a wonderful day, uh, [PII].
[CUSTOMER][POSITIVE] Very good. Thank you so much. You too. You were very helpful.
[AGENT][POSITIVE] Thank you. You have a wonderful day. Hold one moment.
[CUSTOMER][POSITIVE] You too. Thank you.
[CUSTOMER][NEUTRAL] Sing.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. Can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] and claims. Um, I have an insured on the line, which they are also the group, um, small group, they have a policy with us. She is wanting to see if she can set up direct withdrawal for their premiums monthly.
[CUSTOMER][NEUTRAL] We don't think draft group uh we don't think draft groups.
[AGENT][NEUTRAL] Group
[AGENT][NEUTRAL] OK. OK. I will let her know.
[CUSTOMER][POSITIVE] All righty.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Right.