AccountId: 011433970860
ContactId: 6d1fd549-8e24-4d49-8d57-8a4f9c6ff5ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 662580 ms
Total Talk Time (AGENT): 225553 ms
Total Talk Time (CUSTOMER): 175047 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/6d1fd549-8e24-4d49-8d57-8a4f9c6ff5ca_20250312T22:12_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] Yes [PII], I was calling to make sure that they got my uh.
[CUSTOMER][NEUTRAL] Paperwork for the claim I filed.
[AGENT][NEUTRAL] OK. May I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have your policy number?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] 21
[CUSTOMER][NEUTRAL] Hold on let me get my.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 021 92.
[CUSTOMER][NEUTRAL] 119.
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] And Mr. [PII], could you please verify your date of birth and the mailing address listed on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My mailing address is [PII].
[AGENT][NEUTRAL] And one more thing, we do have an email address on file. Could you verify that?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And thank you so much Mr. [PII] for verifying your policy. You were calling to see if we received the claim.
[AGENT][NEUTRAL] When was this submitted in?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Excuse me?
[AGENT][NEUTRAL] When was the claim supposedly submitted in?
[CUSTOMER][NEGATIVE] It was already submitted and I had to send the papers for uh.
[CUSTOMER][NEUTRAL] Explanation of benefit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This was a recent submission.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do look like we did receive.
[AGENT][NEUTRAL] Some EOBs that was submitted on 310.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And those are for.
[AGENT][NEUTRAL] Date of service.
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] In [PII], yes, we do have them on file.
[AGENT][NEUTRAL] Now, I see.
[AGENT][NEUTRAL] So for the EOB for 26.
[AGENT][NEUTRAL] I have that, but.
[AGENT][NEUTRAL] Let me make sure this because this EOB for 16 looks different.
[CUSTOMER][NEUTRAL] Well, that's what they gave me.
[CUSTOMER][NEUTRAL] They said they have all the codes, the procedure and.
[CUSTOMER][NEUTRAL] The findings or whatever.
[AGENT][NEGATIVE] OK, I see we have it, but this is, this image is not an EOB image.
[CUSTOMER][NEUTRAL] What do you mean an EOB?
[AGENT][NEUTRAL] So the image, OK, so once we receive the it shows explanation of benefit and then it shows the total bills and different things listed on there. But then when you go to the next page to look at the EOB.
[AGENT][NEUTRAL] This is not indicating an EOB. It does have the deductible co-insurance or co-pay listed on here.
[AGENT][NEUTRAL] But this is just
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Because one of them I paid, well both of them I paid over $500.
[CUSTOMER][NEUTRAL] Out of pocket.
[CUSTOMER][NEUTRAL] The receipt should be with it too.
[AGENT][NEUTRAL] Let me pull up this image.
[CUSTOMER][NEUTRAL] And I did just what the other lady told me I had to do, go to the doctor's office, give them that letter that they sent me.
[CUSTOMER][NEUTRAL] And let them read the letter and then they will put the paperwork together and I get it and fax it back and that's what I did. So that's what they gave me.
[AGENT][NEUTRAL] OK, so when I'm looking at this EOB or the submission that they submitted in, this is actually just.
[AGENT][NEUTRAL] A statement from the provider and it looks like it says good Visit a Waverly company.
[CUSTOMER][NEUTRAL] A what?
[AGENT][NEUTRAL] It this would this just the title that it has up there at the top, but it's showing the CPT codes is not showing the complete total bill.
[AGENT][NEGATIVE] And then it's just showing just you're out of pocket. So it's not even indicating what is actually your deductible.
[AGENT][NEUTRAL] For the services.
[CUSTOMER][NEUTRAL] And that's for when?
[AGENT][NEUTRAL] This is for data service of [PII].
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] I sent all that in before.
[CUSTOMER][NEUTRAL] They should already have all of that. The papers that I just sent was the rest of what they told me they needed.
[AGENT][NEUTRAL] Let me pull up the other image.
[AGENT][NEUTRAL] Yes, and what I'm saying is for the data service of [PII] what they submitted in is not your EOB.
[CUSTOMER][NEUTRAL] OK then
[AGENT][NEUTRAL] They submit your EOB for 2526.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Then you're not looking at, then you're not looking at all of the papers and all of the stuff that I sent them. I sent them some stuff before that.
[CUSTOMER][NEUTRAL] I just want to know if they got the faxes that they had me to send after I sent all the other stuff.
[CUSTOMER][NEUTRAL] Because they should have it all.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] And I'm gonna go through and highlight it.
[AGENT][NEUTRAL] Just in case when the next examiner looks at it.
[AGENT][NEUTRAL] So this is 26.
[CUSTOMER][NEUTRAL] Who was the first examiner that looked at it?
[AGENT][NEUTRAL] I can't disclose who the examiner is that looked at it, but I'm just going through it for you.
[CUSTOMER][NEUTRAL] They have all the paperwork.
[CUSTOMER][NEUTRAL] They, they had all they had all the paperwork and then they just told me that I needed that what I just sent them.
[CUSTOMER][NEUTRAL] I just sent the fax on the [PII].
[CUSTOMER][NEUTRAL] Because I was waiting on the explanation of benefit papers to come in.
[AGENT][NEUTRAL] Cause I'm seeing the CPT codes.
[CUSTOMER][NEUTRAL] So someone down the line.
[AGENT][NEUTRAL] Now, did they advise you that you needed the diagnosis codes?
[CUSTOMER][NEUTRAL] Yes, they did, and I, I got that. That's what they sent you.
[CUSTOMER][NEUTRAL] That's what I said.
[AGENT][NEUTRAL] So 26.
[CUSTOMER][NEUTRAL] There's two different doctors, so their paperwork ain't gonna look the same.
[AGENT][NEUTRAL] OK, so I see the diagnosis code and the procedure code for the 26 data service, and I did highlight that for you.
[AGENT][NEUTRAL] Then I see the receipt of paying the $500.
[CUSTOMER][NEUTRAL] Yeah I gave him a cup. I wasn't gonna send him.
[CUSTOMER][NEUTRAL] Yeah, I faxed it to me.
[AGENT][NEUTRAL] 161.
[CUSTOMER][POSITIVE] Like the action.
[CUSTOMER][NEUTRAL] The paper I went and got it from Doctor [PII] office.
[CUSTOMER][NEUTRAL] Um, for the [PII].
[CUSTOMER][NEUTRAL] When I tell you I had to go to [PII].
[CUSTOMER][NEUTRAL] That's what I went to [PII] for to get that paper.
[CUSTOMER][NEUTRAL] And gave them that letter, the same letter that they sent me, the lady told me to take the letter with me, give it to them and let them read it and they'll know what to give me. So that's what I did.
[AGENT][NEUTRAL] OK. So I see, I did highlight the diagnosis for your data service of 16 and I highlighted the data service of 26 and I also went in and indicated the EOB for the data service of 16 and 26. So we do have that information on file.
[AGENT][NEUTRAL] So once the examiner pulls this.
[AGENT][NEUTRAL] Your documents then they will process that claim, but I'm making sure that everything is highlighted so they would know that the needed information is received.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else that I can assist you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. Well, I do wanna thank you so much for calling American Public Life. You have a great rest of your day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You have a blessed day too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank