AccountId: 011433970860
ContactId: 801085a2-da2b-4d5b-a479-859a9cbafd9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 534340 ms
Total Talk Time (AGENT): 254902 ms
Total Talk Time (CUSTOMER): 250679 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/801085a2-da2b-4d5b-a479-859a9cbafd9b_20250310T17:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], hi. This is [PII] calling. How are you?
[AGENT][POSITIVE] I'm doing well how are you?
[CUSTOMER][POSITIVE] I'm, I'm good. I'm good. Um,
[CUSTOMER][NEUTRAL] A couple of weeks ago I sent, I sent you guys, I don't know if it was to you guys or for my insurance.
[CUSTOMER][NEGATIVE] Uh, some claim and, uh, I did get a letter from you guys, American Public Life Insurance Company, saying that, um, I don't want, I mean, I don't know what you, what are you guys saying, uh, what that means like we are unable to use balance for statement.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What that is.
[AGENT][NEUTRAL] OK, so you received a letter from us regarding a claim we just need clarification on our response essentially.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, yeah, I can get that pulled up. I'm sorry, did you say your name was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, sorry about that. And then can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, 0251.
[CUSTOMER][NEUTRAL] 3502.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] And I do have a reference probably uh number if you.
[AGENT][NEUTRAL] Um, that's OK. Um, really quick though, uh, if I could, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we have on file for you. uh, looks like it is a Hotmail account.
[CUSTOMER][NEUTRAL] It's my name and my last name, [PII] [PII].
[AGENT][POSITIVE] Perfect, thank you so much for verifying that [PII]. All right, bear with me just a moment. Let me take a look at this claim. I think we've just got the one on file for you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like, and I know this is uh it can be very confusing wording, um, but essentially we are missing some information that we need. So what we need for these kinds of claims and you can get this from the provider wherever you went for treatment, um, let me know when you're ready if you'd like to write it down and I can tell you.
[CUSTOMER][NEUTRAL] Hold up.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But so.
[CUSTOMER][NEUTRAL] What happened? OK, let's, I'm gonna finish then I can have a question. OK, you can tell me. I'm ready.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we need the itemized statements.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That show diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Diagnosis.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Proc.
[CUSTOMER][NEUTRAL] Code.
[AGENT][NEUTRAL] Yes, and that's it. You can call um your provider again where facility wherever you went for treatment and ask them for that information. They should be able to send that to you, um, electronically and then you could just send that right to us and we can continue getting this processed for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So whatever I send to you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It's not enough. It was not enough.
[AGENT][POSITIVE] Correct. Correct.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Yeah it can be a bit confusing um but most again the provider will have that and then once we have that we'll be able to continue getting this process for you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so on my policy, um, so, um, I have no deductibles, so that means this whole bill you guys pay for.
[AGENT][NEUTRAL] Um, up to the amount, the benefit amount, um, I'm not sure what it is and until we actually receive the claim, of course I wouldn't be able to tell you one way or the other, but this is a limited indemnity medical plan. So in short, what that means is it pays a set dollar amount per covered procedure or office visit.
[AGENT][NEUTRAL] So while there's no copays or deductibles, um, it's not something that it would pay 100% regardless.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right. OK. So I will call them right now and ask them to uh email me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh and then I can let's see uh not uh where is it? Should I email you guys or should I um.
[CUSTOMER][NEUTRAL] What should I do? Because I don't see any.
[AGENT][NEUTRAL] How did you
[AGENT][NEUTRAL] Sure, how did you send us this uh information initially?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, by email.
[AGENT][NEUTRAL] You did by email? OK, you can, um, or if you do you have access to a desktop or a laptop computer?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, um, I was going to.
[CUSTOMER][NEUTRAL] Like, everything I use, I, everything I use is my phone.
[AGENT][NEUTRAL] Sure, um, which that's common nowadays, but our website I would say you could use our website to upload that information, um, but it really doesn't have much support for mobile devices, um, it really works with desktop or laptop so yes you could do that of course we have a mailing address, um, fax number however you prefer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK. Yeah, she, she told me also fax number, which is I don't have a fax either, so it's better to do email the way I did.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, whatever is easier for you.
[CUSTOMER][NEUTRAL] All right, well, I'm gonna call them right now and um and let you guys know later, OK?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, yes, sounds good. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] No, thank you so very much. Uh, uh, well, actually, so after this doctor, I went to the family doctor and I did a bone checkup thing. So I'm pretty sure the bill is gonna come. Um, so, do I have to go through all this again, or?
[AGENT][POSITIVE] All right, you are very welcome. Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Typically, for any claim information that you file, that's what we need. That itemized statement that shows those diagnosis and procedure codes. Now, you can also, wherever, if you go to, for treatment anywhere in the future, uh, any physician's office or.
[AGENT][NEUTRAL] Um, facility you can give them this information and ask if they'll file the claims on your behalf. It really is going to depend on each provider whether they would or not um accept this insurance, you know, and that basically just means they would file the claim for you but if they don't you still absolutely can I just, you know, always try to see if it's, it's easier if you don't have to worry about it, you know.
[CUSTOMER][NEUTRAL] Yeah, no, I, I, I filed the the claim because the bill came to me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I, I didn't know because this is my first time that I use those kind of things so but because you got the, the company, the insurance company did not pay the bill, so they send the bill to me.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So why, why is that? It's normal? Or like when did
[AGENT][NEUTRAL] I'm not showing that we've received sure I'm not showing that we've received any other claims besides this one that you filed with us, so I either they got information incorrect, um, but we don't have anything from them at all but I would still going forward I would try presenting this information at the time of treatment just to see if they would be able to do that for you.
[CUSTOMER][NEUTRAL] OK. All right. Well, I will let them know because I was like, so I did that, like I said, I did that because they say they sent to me and they said the insurance is not paying for that. I was like, what?
[CUSTOMER][NEUTRAL] So, I don't, I, yeah, they, they, as you can see that.
[AGENT][NEUTRAL] Oh man.
[AGENT][NEUTRAL] Yeah, I don't have anything from them that they've tried filing any sort of claims. I just have this information from you.
[CUSTOMER][NEUTRAL] OK. All right. I will talk to them too. Maybe they have some missing uh information or numbers wrong or.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Maybe, I'm not sure. Yeah.
[CUSTOMER][POSITIVE] Yeah, I will, I will try to do something. All right, thank you so much.
[AGENT][POSITIVE] Of course, thanks for calling APO up. You have a great rest of your day, [PII].
[CUSTOMER][POSITIVE] OK you too bye bye.
[AGENT][NEUTRAL] Bye bye.