AccountId: 011433970860
ContactId: 69cfd38c-4178-4af3-8080-6d2e93ad01d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1070060 ms
Total Talk Time (AGENT): 565285 ms
Total Talk Time (CUSTOMER): 441153 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/69cfd38c-4178-4af3-8080-6d2e93ad01d6_20250123T15:57_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] Hi, [PII]. I'm calling because I need help with um doing a name change. Um, also, um, change of address because I got married. And also I need to file a few claims.
[AGENT][NEUTRAL] OK, I can help you with that. May I have your name and a callback number, please?
[CUSTOMER][NEUTRAL] So the number that you have on file is [PII]
[CUSTOMER][NEUTRAL] And what was, what was the next requirement?
[AGENT][NEUTRAL] A callback number.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is your policy number with us?
[CUSTOMER][NEUTRAL] Policy number, is that the same as the group number?
[AGENT][NEUTRAL] The outpatient certificate number.
[CUSTOMER][NEUTRAL] Outpatient certificate number, I don't have that because I don't have the card.
[AGENT][NEUTRAL] OK, could I get your social please?
[CUSTOMER][NEUTRAL] Um, but
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And if you could verify your date of birth, please.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying the account um and.
[AGENT][NEUTRAL] I'd like to also I need to verify your email address we should have on file.
[CUSTOMER][NEUTRAL] You should have [PII].
[AGENT][NEUTRAL] OK. Thank you for that. And you said today you need to um do a address change and a name change, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is the new address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and the zip code is [PII].
[AGENT][NEUTRAL] OK, I have [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you did say also a name change. What is the
[AGENT][NEUTRAL] Uh, name change.
[CUSTOMER][NEUTRAL] My new last name is [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] [PII], correct?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK, OK, I will put in a request for the change and then you also are looking to file claims.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] And so, have you registered to our the online service center?
[CUSTOMER][NEGATIVE] Not yet. I was actually trying to do that this morning, but it was not accepting my information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's try it now, um.
[CUSTOMER][NEUTRAL] I'm not sure why it was not that.
[AGENT][POSITIVE] Yeah, let's try it now and see if we can get it uh set up.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Now should I enter my new last name or still still the old one?
[AGENT][NEUTRAL] It's still gonna be the old one.
[CUSTOMER][NEUTRAL] OK, so let me put my my.
[AGENT][NEUTRAL] So, uh, when you first go in, are you signing up as an individual?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so what is the information it's asking for just to make sure.
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][NEUTRAL] It's asking me for my last name which I input the old last name [PII] It's asking me for my social or member ID and so I'm putting my
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let's try the member ID instead of the social.
[CUSTOMER][NEUTRAL] And I have that as 241-5296.
[AGENT][NEUTRAL] Oh, OK. I thought you didn't have the policy number when I asked. OK, so, but
[CUSTOMER][NEUTRAL] I didn't, I didn't know that that was the policy number. I have it as a contract member ID alright.
[AGENT][NEUTRAL] OK. That's OK. OK. OK, so when you put that in, put a 0 in front of the number.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Alright, and then my zip code is, it was [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My date of birth and uh my email, let's see if it was that 0 no no user was found with the information that was entered. Please try again or.
[AGENT][NEUTRAL] OK, so are you logging in or creating an account?
[CUSTOMER][NEUTRAL] Oh, I'm sorry, no, I, I did, I said new user. I'm an individual. Step one, go to next step 2 is asking me for that information. I'll put it one more time.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2415296.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So is it not asking for your email address? Because it should ask for your email address. OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, and I'm, I have it there I was [PII].
[CUSTOMER][NEUTRAL] I'm just doing it again.
[CUSTOMER][NEUTRAL] [PII]. My date of birth [PII].
[CUSTOMER][NEGATIVE] Next, no, it's not letting me in.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you have [PII] [PII] spelled [PII]?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me make sure this is within the Gmail account. Let me see.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, so you're missing the A.
[CUSTOMER][NEUTRAL] That's what it is.
[AGENT][NEUTRAL] Where's the A.
[CUSTOMER][NEUTRAL] Is after the H, is [PII]
[AGENT][NEUTRAL] Where should the A be?
[AGENT][NEUTRAL] OK, would you like
[AGENT][NEUTRAL] Well, what we can do.
[AGENT][NEUTRAL] Go ahead and put it in as we have it so it'll let you in and then I'll update it and going forward you'll use it with the AEL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] It still didn't take me.
[AGENT][NEUTRAL] So you put in IRIS.
[CUSTOMER][NEUTRAL] It still didn't take.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. It's not taking.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What's going on? Let me get out of this cloud. Hold on for one second.
[AGENT][NEUTRAL] And what is the message you're getting?
[CUSTOMER][NEUTRAL] That it that I'm not found but let me get out of the of the company's cloud. Let me go to.
[CUSTOMER][NEUTRAL] What is it? A APL secure is that what?
[AGENT][NEUTRAL] So you want to do do secured secured with a D.
[AGENT][NEUTRAL] Dot
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, sounds good. So let's go in here.
[CUSTOMER][NEUTRAL] APL secured.
[CUSTOMER][NEUTRAL] The user individual.
[CUSTOMER][NEUTRAL] Let me try it here.
[CUSTOMER][NEUTRAL] 241
[CUSTOMER][NEUTRAL] 5296.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hold on for 1 2nd.
[CUSTOMER][NEUTRAL] Is that the zip code that you have for me [PII]?
[AGENT][NEUTRAL] Mm yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what I figured.
[AGENT][NEUTRAL] So last name social.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Or member ID.
[AGENT][NEUTRAL] Email, date of birth.
[CUSTOMER][NEUTRAL] No, it's telling me.
[CUSTOMER][NEUTRAL] No user was found with the information that was entered please try again.
[CUSTOMER][NEGATIVE] And please contact customer service with the error purchases.
[AGENT][NEUTRAL] OK, yeah, OK, let me get you over to customer service, uh, they will have to um.
[CUSTOMER][NEUTRAL] An option for.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Oh gosh, what is it? They're, they're going to have to like redo your account.
[AGENT][NEUTRAL] So you're able to start fresh. um did you before I transfer you over, did you have any questions regarding filing the claim because they'll show you how to do it, but are there any questions as far, I guess I need to let you know what is needed to file the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] So what I do have a question. So the, the, the, I've never had this type of insurance before, so, uh, excuse me if I sound stupid, but um, do you, OK, so do I have to pay first and then they reimburse me?
[AGENT][NEUTRAL] No, you do not have to pay first.
[CUSTOMER][NEUTRAL] Because I also have medical insurance. OK, so I submit the bill and then they'll send me the reimbursement.
[AGENT][NEUTRAL] Yes, so based on the explanation of benefits from your primary, that is one of the documents we will need. Let me just first let you know what's needed for uh for filing a claim. So you need the explanation of benefits from your primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we will also need the ICD 10 code for the uh services rendered. Uh, that code.
[CUSTOMER][NEUTRAL] I see D as in David T.
[AGENT][NEUTRAL] Uh, yeah, well, ICD.
[AGENT][NEUTRAL] And then the number 10.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] ICD 10 code.
[CUSTOMER][NEUTRAL] Co.
[CUSTOMER][NEUTRAL] Or what is it that you call it, the services?
[AGENT][NEUTRAL] Uh, that information.
[AGENT][NEUTRAL] For, so let's just say you had an office visit on [PII]. You wanna call your doctor and ask them what is the what is my ICD 10 code for my [PII] uh service. They'll provide you with the code and you can write it on the explanation of benefits. So for every service you're wanting reimbursement for, we will need the explanation of benefits and the ICD 10 code for that service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And and when it's like the ER or the hospital, is it referred to the same I have to call their billing department and get the same information.
[AGENT][NEUTRAL] No, no. So if, uh, let's just say you went to the emergency room for that visit, you had several doctors billing you. It's going to be the same ICD 0 code. It's the same condition, the same reason why you were being treated. So, um, if you, so let's just say you went to the emergency room and after you have follow-up visits that you're trying to get reimbursed for, but there are follow-up visits for the emergency room visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, you can put, um, this is my IC ICD 10 code for emergency room visit and services after and maybe, you know, list those dates. So you don't have to call every doctor. If they're all related, just make sure when you submit your information, you're letting us know this ICD pin code is related to all services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Related to OK that's good that's helpful to all services.
[CUSTOMER][NEUTRAL] OK. And um I also stayed at the hospital overnight.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, is it the same as the ER?
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] The, so you started with the ER visit and then you stay overnight. So are you being billed emergency room and inpatient stay?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So, again, that's still related. It, it is a different, um, now, if the emergency room, did you, were you admitted into the same hospital you went in for emergency room visit? OK. So what will happen is your emergency room visit will all be put under inpatient because if you, even if you went in as emergency room and stayed over, it's all under your inpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK. Last year I had a surgery and before the surgery, I had to be cleared for the surgery.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I have to get um a testing, a sleep apnea refresher testing so that I could be clear for the surgery. Is that all related or would it be considered different?
[AGENT][NEUTRAL] It would be different, however, uh, where, where was the sleep test done?
[CUSTOMER][NEUTRAL] It was at a, at a, at a doctor's, at a doctor's uh private facility.
[AGENT][NEUTRAL] Was it an at a
[AGENT][NEUTRAL] OK. So it, it looks like unless you have
[AGENT][NEUTRAL] Um, your policy would not cover the sleep study.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so that would be a benefit. You would not be able to uh.
[CUSTOMER][NEUTRAL] Um, OK, but it will cover the, the surgery itself, it will cover it.
[AGENT][NEGATIVE] Receive reimbursement.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Surgery, OK, fine, fine. And anything related to the follow up after the surgery?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh. Now, in, in terms of seeing a specialist, for instance, my surgery was performed because I went to see a gynecologist who is a specialist that was referred to by my PCP and my um my gynecologist decided to do that surgery. Uh, those visits from the gynecologist prior to the, um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To the uh surgery, are they covered?
[AGENT][NEUTRAL] Yes, so please be advised verifying benefits does not guarantee payment. Uh, your policy does have a physician visit writer, so you do have benefits for going to the, the doctor, uh, the physician office. Uh, the policy pays $25 towards the visit and you have 4 of those to use per year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 4 per year, OK.
[CUSTOMER][POSITIVE] Definitely wanna get that last year was very active for me.
[CUSTOMER][NEUTRAL] OK, um, I think those are the only questions that I have and then in terms of that, and once they have me into the portal, I can go in there and download the forms for the claims and get start working on it.
[AGENT][NEUTRAL] Yes, and also, um, I know you called for um.
[AGENT][NEUTRAL] Uh, excuse me, um.
[AGENT][NEUTRAL] Name change and address, the customer service because I would have put in a request to customer service to get that updated. Uh, once you're on the line and I'll let them know before sending you over, uh, that you're, because what they can do is go ahead and get it updated immediately, like, like they can do it while you're over the phone. So when you get into the portal at that point, you'll be using Walker.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Instead of uh so um just make sure they get that updated um like I said I will let uh the representative know before sending you over but make sure you know they're doing that while you're on the phone with them.
[CUSTOMER][NEUTRAL] Oh, got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And you can get that taken care of. So is there anything else I can help you with before transferring?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You have been tremendously helpful. I appreciate your patience and explaining everything to me.
[AGENT][POSITIVE] Oh, no problem, [PII]. You have a wonderful day and hold one moment, I'll transfer you over.
[CUSTOMER][POSITIVE] Thank you you as well.
[CUSTOMER][NEUTRAL] Referring.
[AGENT][NEUTRAL] No, no
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] in the claims department. Uh, I have an insured. I am getting ready to transfer. I've helped her with um information she needs to file the claim. Um, we tried to get her in the portal. She is getting the error message stating she needs to contact customer service, uh, and she also needs, she's recently married, she needs a name, update and a address update.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, of course, I was about to do the portal on that, uh, but are you able to do that prior to her?
[CUSTOMER][POSITIVE] I do believe I can.
[AGENT][NEUTRAL] Oh OK. That's what I told her you will maybe be able to do that prior to um her doing her whole portal thing that way her information is already updated.
[CUSTOMER][NEUTRAL] OK, what's that number, Miss [PII]? Policy number.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Policy number 2415296.
[AGENT][NEUTRAL] Uh, you're speaking with [PII].
[CUSTOMER][NEUTRAL] And she is uh the main insured.
[AGENT][NEUTRAL] She is the main insured, yes.
[CUSTOMER][NEUTRAL] OK, I was gonna say cause only she can update and change anything.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I, um.
[AGENT][NEUTRAL] Do you need a callback number for her?
[CUSTOMER][NEUTRAL] Is it the same as what we have on file or?
[AGENT][NEUTRAL] Hm, uh, I, you know what, I never go in. I just, just for our notes. I, um, put it in the notes, so her.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] No, no, not the number she's calling from. So let me give you that. It's [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, alright, put Miss [PII] on through and I will do my best to assist her.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Thank you, [PII]. Here she comes.
[CUSTOMER][POSITIVE] Thank you, dear.