AccountId: 011433970860
ContactId: 7dcf84eb-bca1-4f0f-b2f9-1f3e3114a14d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378410 ms
Total Talk Time (AGENT): 135009 ms
Total Talk Time (CUSTOMER): 145216 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/7dcf84eb-bca1-4f0f-b2f9-1f3e3114a14d_20250520T13:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Health. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling because I have, I've had this insurance with you guys through my office for a while now, and I've just come across two incidents where, um, I guess my main insurance is not covering for certain things, and I wanted to see how do I file a claim for these.
[AGENT][NEUTRAL] OK. May I have, may I have your name, please?
[CUSTOMER][NEUTRAL] With you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], may I please have a callback number and then your policy number?
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII].
[AGENT][NEUTRAL] And your policy number?
[CUSTOMER][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] Is that the one that says payer ID on the card or group number?
[AGENT][NEUTRAL] It, it would be the benefit certification number.
[CUSTOMER][NEUTRAL] Hm mm, OK, in hospital or outpatient?
[AGENT][NEUTRAL] They're both the same. You will stop at the number before the letter M.
[CUSTOMER][NEUTRAL] So outpatient, right?
[CUSTOMER][NEUTRAL] OK, 02352943.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] I'm pulling that up for you now.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] May I have your date of birth and then the mailing address listed on file?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the one on file I think it's my old address [PII].
[AGENT][NEUTRAL] OK, and that needs to be updated?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. May I have the current one?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII] altogether.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the city is [PII].
[CUSTOMER][NEUTRAL] The state is [PII].
[CUSTOMER][NEUTRAL] And the zip code is [PII].
[AGENT][POSITIVE] Thank you, I will get the request submitted in for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And thank you so much [PII] for verifying your policy. You were calling in to see how to submit a claim.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so with this policy you do have the option to submit it in via mail, fax, or the secured portal listed on the on the card, which is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you have not set up a secured portal, password or username, you will have to set that information up first before you can access that portal.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Now, the documentation that will be needed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To submit a claim
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] would be a claim statement an EOB from your primary insurance.
[AGENT][NEUTRAL] The EOB has to show that you did have a deductible, co-insurance, or co-pay for your patient's responsibility.
[AGENT][NEUTRAL] The other information that is needed, you would either have to get something from the provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For that date of service showing the diagnosis code, which is the reason of that visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I just wanna make sure for one of them that I have it and for the other one. OK, alright.
[CUSTOMER][NEUTRAL] Yeah, one has it completely and the other, both of them have it.
[AGENT][NEUTRAL] Both of them have which information?
[CUSTOMER][NEUTRAL] Of the documentation I have.
[CUSTOMER][NEUTRAL] No, no, no, both have the diagnosis code on it, so I would probably just need to call my insurance to get the EOB and what else do I, and just that, right?
[AGENT][NEUTRAL] Yes. Now, does it have the diagnosis or does it have the CPT or procedure code?
[CUSTOMER][NEUTRAL] I have, on one, it has a code, like um the orthopedic one has codes and the description of what it was.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the let me see.
[CUSTOMER][NEUTRAL] And then the other one which is a lab has a CPT code, plus a test description.
[AGENT][NEUTRAL] OK. Now, if it doesn't have the ICD 10 or diagnosis, once we receive that claim,
[AGENT][NEUTRAL] We may, if that's not the correct information, we will request that information from you again.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So it is the what? The ICDP?
[AGENT][NEUTRAL] ICD it is called I as in igloo, C as in Charles, D as in Delta, and the 10 and the number 10. That is the diagnosis code that the provider will submit.
[CUSTOMER][NEUTRAL] OK, alright, from provider. Alright, I'll get all these and I will submit via the portal. um, anything else I should know?
[AGENT][NEUTRAL] That would be it.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] That would be it. Thank you.
[AGENT][POSITIVE] Well, you're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.