AccountId: 011433970860
ContactId: 86fac48c-5aa8-46a3-81dd-d01a8d32a8b6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344380 ms
Total Talk Time (AGENT): 164052 ms
Total Talk Time (CUSTOMER): 129655 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/86fac48c-5aa8-46a3-81dd-d01a8d32a8b6_20250512T15:01_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] Hi, good morning. My name is [PII]. Um, I just went to get an MRI done. They charged me a $40 copy and I gave them the APL card, but they did not take it, um.
[CUSTOMER][NEUTRAL] How can I make a claim? I paid for it with my credit card already.
[AGENT][NEUTRAL] OK. May I have your policy number, please?
[CUSTOMER][NEUTRAL] Sure, um, policy, policy, it says, it says group number in hospital benefit cert.
[AGENT][NEUTRAL] It should say the benefit
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] In in hospital or outpatient?
[AGENT][NEUTRAL] You can give me either one. They're both the same. You would just stop at the number before ML.
[CUSTOMER][NEUTRAL] Got it, got it. 01792018 M as in Mary, L as in L 7.
[AGENT][NEUTRAL] And may I have your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], I do need to verify the mailing address that is listed on file and an email address.
[CUSTOMER][NEUTRAL] Sure, uh, my address, my home address is [PII].
[CUSTOMER][NEUTRAL] [PII]. Email address is [PII].
[AGENT][NEUTRAL] May I have a callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. You were calling in to see how to submit a payment for a claim?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so for this policy it will have to go to your primary insurance first. Your primary will have to state that if you did have a patient's responsibility for your deductible co-insurance or co-pay. Once you receive that, you can submit in that information that you have, the primary EOB.
[AGENT][NEUTRAL] And the diagnosis code from the provider. Once you submit that in, we will review it and then if it's eligible, it will be processed and a payment will be submitted to you.
[CUSTOMER][NEUTRAL] OK, so let's, let's start over, um, tell me slowly what again? I'm gonna start writing this down.
[AGENT][NEUTRAL] First, the provider has to submit it to your primary insurance.
[AGENT][NEUTRAL] Once your primary insurance receives it.
[AGENT][NEUTRAL] You will receive an EOB showing how much they pay or how much you're responsible for.
[AGENT][NEUTRAL] In which that will show deductible, co-insurance, or co-pay.
[AGENT][NEUTRAL] Once you receive that,
[CUSTOMER][NEUTRAL] No question. I
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Um, I'm, I'm not using, um, I'm using Humana.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that a problem or is that OK or?
[AGENT][NEUTRAL] It's your primary insurance, whoever your primary insurance is, is who the provider will submit the claim to first.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Once whoever your primary insurance is, they process it. You should receive something either in the mail or if you have to have it set up on online, you can go on there and check that data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, and then I get that information that you'll be OK, and, and after that you said?
[AGENT][NEUTRAL] After you get the EOB, you will have to submit in that EOB to us. If you still have that receipt or statement, you can submit that in as well. But you do have to contact the provider to get the diagnosis code for that data service.
[CUSTOMER][NEUTRAL] OK, did the provider meaning uh like Acumen where I went to.
[AGENT][NEUTRAL] Your, your doctor, yes. And the reason why you have to contact, yes, whoever the doctor is that you went to, you will have to get something with their letterhead or a note with their letterhead stating for that date of service, this is the diagnosis code.
[CUSTOMER][NEUTRAL] Oh, from the doctor.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and that's it?
[AGENT][NEUTRAL] Yes, and you will have to
[CUSTOMER][NEUTRAL] And who do I submit it to and where?
[AGENT][NEUTRAL] You will submit it either via the secured portal.
[AGENT][NEUTRAL] fax or mail that is listed on the card.
[CUSTOMER][NEUTRAL] OK, there is a fax number here. OK, and there's also is it to check your claim of view you'll be registered is [PII]. [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, found slash log in, right?
[AGENT][NEUTRAL] Yes, you can go on there and that's where now you will have to set up a username and password to access the portal.
[CUSTOMER][NEUTRAL] That's where it goes or no.
[CUSTOMER][NEUTRAL] OK, I'll probably better off just faxing everything over and it's better that way, and the fax number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, and that is attention claims department.
[CUSTOMER][NEUTRAL] Oh, attention.
[CUSTOMER][NEUTRAL] Claims
[AGENT][NEUTRAL] Department
[CUSTOMER][NEUTRAL] The part, right, I think I have enough information there.
[AGENT][NEUTRAL] OK, is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][POSITIVE] No, that's it. Thank you very much.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] Thank you. You have a blessed day. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye. Thank you. Bye-bye.