AccountId: 011433970860
ContactId: 90a3792a-d31e-4619-a95f-325761dabc18
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 790090 ms
Total Talk Time (AGENT): 299387 ms
Total Talk Time (CUSTOMER): 390714 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/90a3792a-d31e-4619-a95f-325761dabc18_20250320T20:35_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] Hey [PII], how are you? My name's [PII].
[AGENT][POSITIVE] I'm great, [PII]. How are you?
[CUSTOMER][POSITIVE] Good good thank you for your time. I have a couple questions. You need me to give you my um.
[CUSTOMER][NEUTRAL] My number first or?
[AGENT][NEUTRAL] Yes, your policy number?
[CUSTOMER][NEUTRAL] OK. OK, let me see here which one in hospital or the
[CUSTOMER][NEUTRAL] I guess we do it in hospitals. It's uh 0246.
[CUSTOMER][NEUTRAL] Excuse me, 5032?
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 7.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] It's [PII] and email you might have um [PII] or [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. And I have your file pulled up and how can I help you today?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, so I, I guess I, I must have done something wrong. I did a lot of claims, uh, a couple of weeks ago, about a month ago, uh, going back, uh, this year, 24, 23, and 22, and every single one of them like doctor's claims and stuff like that cause I, I think on my.
[CUSTOMER][NEUTRAL] The APL, they, they pay up to 88 doctors visits um for the family.
[CUSTOMER][NEGATIVE] So, every single one of them was, was, uh, denied, and I'm thinking maybe I must have done something wrong.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Because they, it, it, it doesn't quite make sense to me why if I'm sending like the EOB claiming for the EOB and then it's denied.
[AGENT][NEUTRAL] OK, do you have a claim number?
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Oh my goodness, I have about 20 of them. Um, let's see here, yeah, I'll see it right now claim number, for example, uh, 356-549-5.
[AGENT][NEUTRAL] OK, let me get that pulled up. One moment.
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][NEUTRAL] 28 different claim numbers.
[AGENT][NEUTRAL] OK, so this one is for [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] It looks like the urgent care, they're asking for the diagnosis code.
[AGENT][NEUTRAL] And looks
[CUSTOMER][NEUTRAL] How like where do I get that like I send it, I send the EOB like what else?
[AGENT][NEUTRAL] The diagnosis code is the reason for the visit to the urgent care?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that you can obtain from your provider.
[CUSTOMER][NEUTRAL] That takes about.
[CUSTOMER][NEUTRAL] OK, so that, so that wouldn't mean that you'll be right.
[AGENT][NEUTRAL] No, no, no, that's not your EOB. When you submit a claim, you do need 3 items for your, each claim. You need your itemized bill, which you have from the doctor. You need your major medical EOB which you have, and then you would need the diagnosis. And the diagnosis just says [PII] went to the urgent care because she had a stomach ache, backache, headache, broken arm, whatever the treatment or reason was for the treatment. That's the diagnosis.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I wonder if, I wonder if that's what, like they're all doctor's visits. So I wonder if that's what's like all of them are missing, you know what I mean?
[AGENT][NEUTRAL] Cause I'm looking at your claims, it looks like the majority are asking for a diagnosis code on yours.
[CUSTOMER][NEUTRAL] Right, right, right.
[CUSTOMER][NEUTRAL] I guess I didn't realize that, you know.
[AGENT][NEUTRAL] Yeah, so if you see.
[CUSTOMER][NEUTRAL] So do I file the, do I file the claim again? Do I file the whole claim again or I just kind of?
[AGENT][NEUTRAL] No, sir. You can just submit your diagnosis codes for whichever data service they are asking for.
[CUSTOMER][NEUTRAL] And I can do it online, right?
[AGENT][POSITIVE] Yes, yes, you can.
[CUSTOMER][NEUTRAL] OK, so I'm gonna have to.
[CUSTOMER][NEUTRAL] Call my insurance and, and kind of go through everything and now, OK, thank you so much. Now my, my, my last question is
[CUSTOMER][NEUTRAL] Is there any thing that you guys have paid out from 22 on to this year?
[CUSTOMER][NEUTRAL] Yeah I just I figured I haven't.
[CUSTOMER][NEUTRAL] I have all 8
[CUSTOMER][NEUTRAL] A visits available for 2223 24.
[CUSTOMER][NEUTRAL] And for 25.
[CUSTOMER][NEUTRAL] Unless you guys have paid something already to me, but I, I, I, I just don't have a record of that, you know.
[AGENT][NEUTRAL] OK, let's see. So once you go online, you can always view the claims whether they were submit by yourself or the provider. Let me see if I see anything.
[CUSTOMER][NEUTRAL] So that's
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] But most of the time when we go to the doctor, we, we, we give in the APL and they're like, yeah, we don't take that here. We'll just, you, you can build your, your, you can build them yourself. And I was like, what's the whole purpose of me doing the work, you know what I mean?
[AGENT][NEUTRAL] Yes, I understand.
[CUSTOMER][NEUTRAL] So I don't know if they've, I, I don't know if they actually, if they actually just don't take it or they don't wanna kind of go through the hassle of it or, you know.
[AGENT][NEGATIVE] Sometimes the provider will bill and sometimes they will not.
[CUSTOMER][NEUTRAL] The, OK, OK.
[AGENT][NEUTRAL] Let's see, so it looks like.
[AGENT][NEUTRAL] There was a claim that was processed for [PII].
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] [PII] looks like this was an urgent care visit. benefits were paid to the provider on that one.
[CUSTOMER][NEUTRAL] The the pay the provider?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But in [PII]?
[AGENT][NEUTRAL] Yes, this was for data service [PII].
[AGENT][NEUTRAL] MDow Medical Center.
[CUSTOMER][NEUTRAL] OK, so I'm just kind of writing it was paid, I guess the $50 or $60 whatever it is.
[AGENT][NEUTRAL] This one paid a benefit amount of $170.
[CUSTOMER][NEUTRAL] OK, so then that means that for that specific date I wouldn't be able to file a claim for the $50 that we have to turn in.
[CUSTOMER][NEUTRAL] Is that what that means or how, what is that? If you guys pay.
[CUSTOMER][NEUTRAL] Then
[AGENT][NEUTRAL] Right, because they submitted the claim first.
[AGENT][POSITIVE] The provider received the benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So now, now you say every now.
[CUSTOMER][NEGATIVE] Yeah and then I was paid 170. If I would have done the claim first, all I get back is $50.
[AGENT][NEUTRAL] It will pick up your co-pays, co-insurance, and our deductibles.
[CUSTOMER][NEUTRAL] So, but if they, if they make the claim,
[CUSTOMER][NEGATIVE] Then I do not get my my deductible or my co-pay.
[AGENT][NEUTRAL] Let me see what, let me pull up the actual claim image because it's processed.
[CUSTOMER][NEUTRAL] It it
[CUSTOMER][NEUTRAL] Cause I also, cause I also have, uh, I also have my regular insurance Aetna, so for back then I think it was uh.
[CUSTOMER][NEUTRAL] Cigna.
[AGENT][NEUTRAL] OK. Just waiting on the claim image to load. One moment.
[CUSTOMER][POSITIVE] Yeah, no problem, thank you, appreciate it.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so on this one.
[AGENT][NEUTRAL] It looks like the providers submitted, the providers accept assignments on it and
[AGENT][NEUTRAL] This was from Aetna and it shows.
[AGENT][NEUTRAL] The deductible amount of 170.
[CUSTOMER][NEUTRAL] Wow, yeah, so, it should only be $50.
[CUSTOMER][NEUTRAL] My deductible for stuff like that I like, I mean, unless they did some other type of procedure there, but like MD now when we go is $50 regular doctor's $10 and like specialists are $60.
[AGENT][NEUTRAL] Yes, and I
[CUSTOMER][NEGATIVE] So I don't know, I don't know why they would charge it from 70.
[AGENT][NEUTRAL] Yes, on this one, the uh deductible amount was 170.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then I will be not, not, not to keep on bothering you then, I will be able to go online.
[CUSTOMER][NEUTRAL] And like [PII] and see, see if you guys have paid something then obviously that wouldn't.
[CUSTOMER][NEGATIVE] Out of my 8 visits that I can get, if you guys pay 3 then I only have 5 available to.
[CUSTOMER][NEUTRAL] To ask for the
[CUSTOMER][NEUTRAL] For my deductible back, right?
[AGENT][NEUTRAL] Correct. For your office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, yeah, exactly.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, yeah, that makes sense. I I I understand that.
[CUSTOMER][NEUTRAL] OK, yeah, even for, even for the once this year, like I've had, I've had to like like 7 or 8 specialists already this year.
[CUSTOMER][NEGATIVE] And I filed for for me and, and they were all denied I guess they're missing the diagnostic code as well.
[AGENT][NEUTRAL] The, yes, the diagnosis code.
[CUSTOMER][NEUTRAL] Is that something that, uh, I mean, I, I'll call, I'll call [PII], but I'm wondering if that's something that I can kind of get online.
[CUSTOMER][NEUTRAL] Myself going in there or is that's something that I actually have to speak to somebody to.
[CUSTOMER][NEUTRAL] Go through 28 of these, you know what I mean, it's just um.
[AGENT][NEUTRAL] On the patient, on your patient portal with that provider, do they give you a MyChart?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What's it called?
[AGENT][NEUTRAL] MyChart, sometimes the provider will have a portal and you can access your medical records there for your visits and sometimes they do offer that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's called MyChart or it might be different, but they do have a portal for some providers and you can actually register your account and see your doctor's visit, hospital visits and things like that.
[CUSTOMER][POSITIVE] Right, right, right. OK, well, buddy, thank you so much for your help. It's, it's, it's, it's been very helpful, to be honest with you. I'm gonna go ahead and call it and then find out what how I can get the, uh, like diagnostic codes.
[AGENT][NEUTRAL] OK. You would get them from your provider. Aetna wouldn't have your diagnosis codes. Aetna is your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what what do you not provide them?
[CUSTOMER][NEUTRAL] What do you mean my provider though, like my doctor?
[AGENT][NEUTRAL] Yes, your provider will be the doctor.
[CUSTOMER][NEUTRAL] Oh, OK. Wow. Wow. Some of those doctors are 33 years ago.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So how I can even I wonder how like to call the doctor and ask him for that is.
[CUSTOMER][POSITIVE] That's gonna be good.
[AGENT][NEUTRAL] And some
[AGENT][NEUTRAL] Sometimes the provider will have a portal.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So the, the insurance company Aetna wouldn't actually know.
[CUSTOMER][NEUTRAL] What the diag diagnostic code is.
[AGENT][NEUTRAL] Correct, because they're the insurance, so they would be just like us, we wouldn't know until it's received what that diagnosis code is.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] That will come from your provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because for the insurance to pay them, they're gonna, they're gonna need that code anyway.
[AGENT][NEUTRAL] Correct, because they have to know what services were rendered.
[CUSTOMER][NEUTRAL] Right, right, right, and when I go online to to your to to to the uh APL.
[CUSTOMER][NEUTRAL] Uh, website, it's, it's clearly like.
[CUSTOMER][NEUTRAL] Just go in there and uh and, and see like prior claims and
[CUSTOMER][NEUTRAL] Just type that in or do I have to scan something else and put it up in?
[AGENT][NEUTRAL] Have you registered your account?
[AGENT][NEUTRAL] Did you register?
[CUSTOMER][NEUTRAL] Yeah, no, yeah, yeah, yeah, I have.
[AGENT][NEUTRAL] Yeah. So once you go in, you should be able to see and you might notice you have different policy numbers based on the calendar year. So you will notice that numbers changed, but you should still be able to see all claims that were submitted for yourself and your family.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But how do, how do I add the, the diagnostic code? Is that something that I have to like scan it and, and, and drag it in or?
[AGENT][NEUTRAL] Yes, you would do it just like you submitted your claims in the past. You will start a new claim and upload it there. You don't have to submit all the claims, just that information.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh, I see. I don't have to redo the EOB. All I gotta do is kind of.
[AGENT][NEUTRAL] Correct. We would just need the diagnosis codes for those dates of service, yes.
[CUSTOMER][NEUTRAL] I see. I
[CUSTOMER][NEUTRAL] Zip code
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, OK. Will do. Thank you so much, [PII]. I appreciate you.
[AGENT][POSITIVE] OK, you're so welcome and thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Take care you too bye bye.
[AGENT][NEUTRAL] Bye-bye.