AccountId: 011433970860
ContactId: 67f8dc01-f81c-421d-a52f-4e74f9dabc75
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 458559 ms
Total Talk Time (AGENT): 171905 ms
Total Talk Time (CUSTOMER): 202508 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/67f8dc01-f81c-421d-a52f-4e74f9dabc75_20250217T18:25_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] Hi, I have some questions. So I have this new gap insurance and um
[CUSTOMER][NEUTRAL] I'm finding that no one really accepts it, so my question is.
[CUSTOMER][NEUTRAL] Um, if I have something that I've paid a bill or something, can I submit that at for a claim.
[CUSTOMER][NEUTRAL] Or how does that work?
[AGENT][NEUTRAL] OK, I will have to pull up your policy to see what type of policy you have.
[AGENT][NEUTRAL] May I have your name, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I have a group number.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you do have the card with you?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] May I have the outpatient benefit certification number?
[CUSTOMER][NEUTRAL] Outpatient benefit OK. 02.
[CUSTOMER][NEUTRAL] 553.
[CUSTOMER][NEUTRAL] 293.
[CUSTOMER][NEUTRAL] M as in Mary. L as in Larry 8.
[AGENT][NEUTRAL] And [PII], I do need to verify your date of birth and the mailing address listed on file.
[CUSTOMER][NEUTRAL] OK, uh, date of birth is [PII].
[CUSTOMER][NEUTRAL] And the address on file is that what you said?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 665 Washburn.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and we don't have an email address. Would you like that to be entered in the system?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's your first and last name [PII]?
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, I will get that updated in our system.
[AGENT][NEUTRAL] And upon pulling up your policy, you're welcome. It does show that you can submit the claims and if the provider is not accepting the insurance and what will be needed for submission, that will be the primary insurance EOB.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Showing that they did go ahead.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm just writing it down.
[AGENT][NEUTRAL] OK, that they.
[CUSTOMER][NEUTRAL] Showing, showing a.
[AGENT][NEUTRAL] If they did apply it to your deductible, co-insurance, or co-pay.
[CUSTOMER][NEUTRAL] OK, wait a minute was applied.
[CUSTOMER][NEGATIVE] To deductible.
[AGENT][NEUTRAL] Co-insurance.
[CUSTOMER][NEUTRAL] Coinsurance
[AGENT][NEUTRAL] Or co-pay.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] For copay.
[AGENT][NEUTRAL] Co-pay. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then, uh, so I would just need to like
[CUSTOMER][NEUTRAL] Cause most everything's online now, you know.
[AGENT][NEUTRAL] Yes, you should be able to go online for that data service and download that from your primary insurance and if you would like, if you have that statement.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, download
[AGENT][NEUTRAL] For the date from the provider, you can submit that in. But the only other issue is if that statement or that EOB don't have the diagnosis code, which is the reason of the visit, you would have to call that provider to get that.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, so I have to have a diagnosis.
[CUSTOMER][NEUTRAL] Code.
[CUSTOMER][NEUTRAL] OK. And then,
[CUSTOMER][NEUTRAL] How far back can I go on that?
[AGENT][NEUTRAL] As long as your policy was active, you have that option to submit those claims in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is it best to go on like the insurance site or the doctor?
[CUSTOMER][NEUTRAL] I or.
[AGENT][NEUTRAL] Are you
[CUSTOMER][NEUTRAL] Like I pay everything through doctor's portal.
[AGENT][NEUTRAL] You're talking about to get the EOB?
[CUSTOMER][NEUTRAL] But I would need the
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The EOB will come from your primary insurance, so it will come from your insurance portal.
[CUSTOMER][NEUTRAL] OK, I have to get it from there. OK, as long as, OK, and then I wrote as long as policy.
[CUSTOMER][NEUTRAL] What were you telling me as long as policy.
[AGENT][NEUTRAL] Is active, you can submit the claim.
[CUSTOMER][POSITIVE] Oh great.
[CUSTOMER][NEUTRAL] So I can go back to October or whenever it was.
[CUSTOMER][NEUTRAL] That I started.
[AGENT][NEUTRAL] Yes, it's showing 101 of 24.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, um, anything else you can tell me just so I.
[CUSTOMER][NEUTRAL] And then I do that on do I submit the claim online or?
[AGENT][NEUTRAL] Yes, you can submit it via the portal which is the, I believe it should be listed on your card which is showing secured. [PII].
[CUSTOMER][NEUTRAL] OK, great. And then I have to register.
[AGENT][NEUTRAL] Will
[AGENT][NEUTRAL] Yes, you will set up your username and password.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And let and let me make sure.
[AGENT][NEUTRAL] To get your email address entered in.
[AGENT][NEUTRAL] Have that request would be entered in and then you should be able to enter that information in.
[AGENT][NEUTRAL] Once that's loaded into the system.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, I'll wait a day or so and make sure, uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have to they'll take probably a little while to get those.
[CUSTOMER][NEUTRAL] Uh, listed anyway.
[AGENT][NEGATIVE] Uh, it shouldn't, it shouldn't take too long. It is just a quick entry. No.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So do you, you don't just take bills then you have to have the EOB?
[AGENT][NEUTRAL] Yes, we have to have your primary insurance explanation of benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because I, I have this imaging consultant thing, but I don't remember it's been a while or integrated imaging consultants.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I don't remember
[CUSTOMER][NEUTRAL] I don't remember how that came about, so I'm sure it was part of an EOB, but I just don't remember.
[AGENT][NEUTRAL] Yes, cause normally the, the provider is going to submit it over to your insurance company, so you still, they still should have that date of service.
[AGENT][NEUTRAL] List it
[CUSTOMER][NEGATIVE] Yeah I'm not, I, I gotten something right? or do they just do it on the portal now? They don't send you any anything for that.
[AGENT][NEUTRAL] Now I'm not sure if it's set up, how you have it set up if you receive paper EOBs or do you receive.
[CUSTOMER][NEUTRAL] Like in your
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, I don't do, I don't do papers, so, but I would have thought they would have emailed me something and that, but I might have, and I don't remember, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'll figure it out, but thanks for your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're so welcome, and I do wanna thank you so much for calling American Public Life, Ms. [PII]. Have a great rest of your day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, you too, thank you.
[AGENT][POSITIVE] Thank you, bye.
[CUSTOMER][NEUTRAL] Uh-huh.