AccountId: 011433970860
ContactId: 7395519d-2113-4c52-9a06-c7f50e762386
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408429 ms
Total Talk Time (AGENT): 136837 ms
Total Talk Time (CUSTOMER): 161182 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/7395519d-2113-4c52-9a06-c7f50e762386_20250326T16:08_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] Yeah, hi [PII]. I have a couple of questions once I give you my information, so do you need to verify me first?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so what do you need to know?
[AGENT][NEUTRAL] May I have your policy number?
[CUSTOMER][NEUTRAL] I don't have that on me.
[AGENT][NEUTRAL] May I have your social security number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] First and last name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is not coming up. Can you spell your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your first name again.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hold on one second, hold on. Hey.
[CUSTOMER][NEUTRAL] Sorry, ma'am, go on.
[AGENT][NEUTRAL] You're fine, one moment, just pulling up the policy.
[AGENT][NEUTRAL] Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] [PII] [PII] [PII] [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised the verification of coverage does not guarantee the payment of a claim, and I have your file pulled up and how can I assist you today?
[CUSTOMER][NEUTRAL] OK, well, the main reason I'm calling right now is to find out, do you guys, if I have a Holter monitor that I wear for 30 days.
[CUSTOMER][NEUTRAL] Do you guys cover that if I submit that?
[AGENT][NEUTRAL] Let's see if you have the DME and you do have DME.
[AGENT][NEUTRAL] So yes, that
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] The durable medical equipment benefit on your policy, you do have that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] So I just, so when I go into a facility and I hand them the card you guys sent me, they take care of everything right at that point I don't have to, correct?
[AGENT][NEUTRAL] Yes, they should file it with your secondary insurance.
[AGENT][NEUTRAL] I'm not sure I
[CUSTOMER][NEUTRAL] OK, do you have anything that's been filed and anything that I'm being reversed reimbursed on or anything? What is happening so far with my anything that's I handed my card in for?
[AGENT][NEUTRAL] OK, so let me see under this one, I'm not showing any claims. Let me go to the previous policy.
[AGENT][NEUTRAL] So, under
[AGENT][NEUTRAL] The other plan, Data Service 1214 looks like a facility bill in which we ask for the primary insurance explanation of benefits from the provider.
[AGENT][NEUTRAL] And then on [PII].
[CUSTOMER][NEUTRAL] Do they send it?
[AGENT][NEUTRAL] As of today, I'm not showing any claims other than these two.
[CUSTOMER][NEUTRAL] Who is that that should have sent that to you?
[AGENT][NEUTRAL] Um, this was for.
[CUSTOMER][NEUTRAL] Well, who is that doctor? What's the one on [PII]?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] This is from Cleveland Clinic Imaging.
[CUSTOMER][NEUTRAL] Imaging? Oh, OK, got it. OK, so they never sent you my explanation of benefits?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And that's what you need?
[AGENT][NEUTRAL] Yes, for that claim, that is what we need to process that one.
[CUSTOMER][NEUTRAL] Alright, and who was the other one?
[AGENT][NEUTRAL] The other one was from Martin Health at Palm City for 11-27-2024. That was a wellness visit that was not covered under this plan.
[CUSTOMER][NEGATIVE] Yeah, I didn't think so. I don't know why they submitted it and you haven't received anything from anyone else?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Mm, OK. Um, then I have to call.
[CUSTOMER][NEUTRAL] Um, alright, so then once you get the explanation of benefits for the Cleveland Clinic.
[CUSTOMER][NEUTRAL] Then you guys will
[CUSTOMER][NEUTRAL] Reimburse it?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So if I send it then um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so it looks like
[CUSTOMER][NEUTRAL] I have to do most of the work.
[CUSTOMER][NEUTRAL] Um, alright, but you definitely will cover the um.
[CUSTOMER][NEUTRAL] The, uh, what you call it? um.
[CUSTOMER][NEUTRAL] The heart monitor.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I mean when I say definitely I know like you know you gave me your disclaimer before but um but it should be covered. OK, alright and then you just need from me the super bill for it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, your, um, major medical explanation of benefits.
[CUSTOMER][NEUTRAL] And what else?
[AGENT][NEUTRAL] And a claim form.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] What do you mean a claim form?
[AGENT][NEUTRAL] The claim form is what you would fill out anytime you submit a claim. It's just
[CUSTOMER][NEGATIVE] I have to fill out, every time I submit something, I have to fill out a claim?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Every time. So when they submit, when the doctor's office submits it, a claim still has to be filled out? I still have to fill out a claim?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] No, you do not. It's just when you submit a claim, you have to fill out a claim form.
[CUSTOMER][NEUTRAL] OK, but when they submit it, the doctor, I don't have to do anything.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so I just have to make sure that they're using my secondary insurance.
[AGENT][POSITIVE] Yes, ma'am. That is correct.
[CUSTOMER][POSITIVE] OK. All right, thank you so much. Have you, OK, all right, that's it. All right. Thank you. I think that's it. All right, thank you so much. Bye-bye.
[AGENT][POSITIVE] You're so welcome.
[AGENT][POSITIVE] [PII], you're so welcome, and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] OK, you too.