AccountId: 011433970860
ContactId: 94f75365-1a7f-4892-af46-acafaceffca0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1015830 ms
Total Talk Time (AGENT): 311899 ms
Total Talk Time (CUSTOMER): 383919 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/94f75365-1a7f-4892-af46-acafaceffca0_20250617T17:31_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 [PII]. I was looking to file a claim for a deductible I paid to my dermatologist, um.
[CUSTOMER][NEUTRAL] They didn't want to take my APL card because they said that they always have issues getting reimbursed I guess from APL so they're having me do my own claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So first I guess I just wanna know that I can even file the um deductible amount.
[CUSTOMER][NEUTRAL] Because it was for uh like in office uh in office procedure.
[AGENT][NEUTRAL] OK, may I have your name, please?
[CUSTOMER][NEUTRAL] Yes, [PII] Last name [PII]
[AGENT][NEUTRAL] And may I please have a callback number and then your policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the policy number is 02620113.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And could you please verify your date of birth and the mailing address listed on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And we do have an email address. Could you verify that for me please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying your policy. You're calling in to see if office procedure benefits are covered under your plan?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, yeah, it was a, uh, they did like, uh, like scraping and freezing.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it was a procedure that required a deductible.
[CUSTOMER][NEUTRAL] Of I paid a copay and a deductible.
[AGENT][NEUTRAL] OK, I'm pulling that information up for you now.
[AGENT][NEUTRAL] And in regards to your policy, verification of coverage does not guarantee the payment of your claim. For the office procedure, you do have up to $2500 per calendar year in which that will go towards your primary insurance deductible, co-insurance or co-pay for the procedure. Now for the office visit co-pay, you do not have the office visit copay benefit rider.
[AGENT][NEUTRAL] But we will go towards
[CUSTOMER][NEUTRAL] Yeah, no, it wasn't the, the copay, the copay. I'm not looking for reimbursement. I'm looking for reimbursement just for the deductible that I paid for the procedure that they did.
[AGENT][NEUTRAL] Yes, and that the 2500 is going towards the office procedure benefit.
[CUSTOMER][NEUTRAL] Oh OK mhm.
[CUSTOMER][NEGATIVE] So I, how do I submit this 60? I mean, I'm looking at I got an EOB from United Healthcare who's my primary, but it just doesn't make so like it doesn't show the deductible on it like I, I don't really even understand how to read that, um.
[CUSTOMER][NEUTRAL] And I have the claim form that they put in for.
[CUSTOMER][NEUTRAL] UnitedHealthcare claim, I guess which would have whatever codes and everything that would be needed for you.
[CUSTOMER][NEGATIVE] So I can submit all that, but really I'm just looking for $60 back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you said in the claim form that you have is at the at the bottom to the bottom right where it says form 1500.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. And so that will, in box 21, it has those diagnosis codes listed.
[CUSTOMER][NEUTRAL] Box 21, wait, let me put my glasses on.
[CUSTOMER][NEUTRAL] Box 21.
[AGENT][NEUTRAL] It's like in the middle of the claim.
[CUSTOMER][NEUTRAL] OK. Mhm. I see 22 different ones. I see. Uh, diagnosis of nature or illness, that one?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that's the line that we will need, yes.
[CUSTOMER][NEUTRAL] L
[CUSTOMER][NEUTRAL] OK, L 570.
[CUSTOMER][NEUTRAL] That's in in line A and then in line B is B as in boy 079.
[AGENT][NEUTRAL] OK, so though that is one of the documentation that we will need, which is the diagnosis code. We will need that data service which the total bill, which they should have it as well. Now, for the EOB now the EOB is going to have to show that it did apply to your deductible co-insurance or co-pay. Does the EOB has like PR1 or PR2 anywhere listed on there?
[CUSTOMER][NEUTRAL] Um, it shows provider bill amount saved payment applied, your total amount owed, amount applied to your deductible, but see here it shows the amount applied to my deductible is 107, but I only paid 60 to the, you know, to the office.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, you're looking for what pay what?
[AGENT][NEUTRAL] If, if it says amount applied to deductible and that is your primary EOB then once you just submit that in that examiner will review that documentation and if that is the needed documentation, then your claim will be reviewed and or processed once the examiner receives that information.
[CUSTOMER][NEUTRAL] OK, but where, where do I show that like, because I don't know what the additional amount applied to my deductible because that really I'm not looking for back but nowhere like it doesn't show that I paid 60 to the provider other than the receipt I have that show I have a receipt also from my provider, you know, from the doctor's office, um.
[CUSTOMER][NEGATIVE] And it does show on there the data service, uh, it shows my copay, it shows the deductible I paid, and then I, uh, taped the receipt from my credit card showing.
[CUSTOMER][NEUTRAL] The amount
[AGENT][POSITIVE] Yes, you're more than welcome. You can submit that in as well.
[AGENT][NEUTRAL] And the way that you was submitted, go ahead.
[CUSTOMER][NEUTRAL] OK, so should I write that that's all I'm looking for reimbursement on or?
[AGENT][NEUTRAL] Now, that is the choice of the examiner. She will, that he or she will decide it based off of what your primary insurance states is your responsibility.
[CUSTOMER][NEUTRAL] OK, I'm just gonna circle deductible just because that's what I'm looking for.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so now that I've, I, I know I have all the paperwork I need and then I also um downloaded off of the website the meddling claim form.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] OK, so now that I've got all these fancy forms for some reason the website isn't loading properly.
[AGENT][NEUTRAL] OK, so we did do an update on our website. Did you do did you set up a new website recently or are you still trying to access the old one?
[CUSTOMER][NEUTRAL] Yeah, the like within the last week.
[AGENT][NEUTRAL] OK. So, once you sign in, what information is it giving you?
[CUSTOMER][NEGATIVE] Uh, well, I'm gonna sign in again because it was just kind of spinning, wasn't really loading anything. It was just the dashboard page was empty.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I've got to send a verification code again.
[CUSTOMER][NEUTRAL] That's what takes the longest to get this code.
[CUSTOMER][NEUTRAL] OK there we go.
[CUSTOMER][NEUTRAL] Uh it's doing the same thing.
[CUSTOMER][NEGATIVE] It shows it shows I'm in it shows my initials in and then it's just the dashboard just says dashboard but then it's just kind of a blank page.
[AGENT][NEUTRAL] So once you log in it says dashboard and then it's a blank page.
[CUSTOMER][NEUTRAL] Yeah, it, it looks like on the right it says need to file a wellness or traditional claim start your claim, but the dashboard itself is just kind of like showing like waves. Let me see if I click on here. OK, let me, it'll let me click on start your claim.
[AGENT][NEUTRAL] Yes, it's gonna be on your far left hand side where it's showing dashboard my profile.
[AGENT][NEUTRAL] Is that, that's where you're at?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. And what
[CUSTOMER][NEUTRAL] But on the right side there's like a little box that says start your claim.
[AGENT][NEUTRAL] Yes, once you start your, that's where you will submit your claim there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So traditional or injury or illnesses?
[AGENT][NEUTRAL] It will be your traditional claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, and information about the claimant no claimant available.
[AGENT][NEUTRAL] It's saying no claiming is available when you go to.
[AGENT][NEUTRAL] Select claim it.
[CUSTOMER][NEUTRAL] Yeah, it says traditional claim. It says to expedite the claims process. Please gather these documents gives me documents and it says next step.
[CUSTOMER][NEUTRAL] And it's claimant details, enter the information about the claimant.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But where do you put it in?
[AGENT][NEUTRAL] It should be right there. It should, is it a box that popped up at the bottom where it says select claimant name.
[CUSTOMER][NEGATIVE] No, nothing's showing up.
[AGENT][NEUTRAL] Cause it should be.
[AGENT][NEUTRAL] Where it says claimant detail and the information about the claimant, there's nothing below that.
[CUSTOMER][NEUTRAL] No, it says no claimants available.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Maybe I should log in under this other search engine for some reason is there an issue with Google?
[AGENT][NEUTRAL] I'm not actually sure if it's based off of Google or if you should use Microsoft Edge.
[CUSTOMER][NEUTRAL] That's what I'm gonna do now. I'm gonna go into Microsoft Edge.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] I'm gonna wait for the code again.
[CUSTOMER][NEGATIVE] It's annoying.
[AGENT][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, it's doing the same thing on edge.
[AGENT][NEUTRAL] Let me pull it up to see if we're having any issues.
[CUSTOMER][NEUTRAL] Like anything I click on on the left, it just, it's like a like I can see boxes but there's like oh wait now it's loading OK there we are.
[CUSTOMER][NEUTRAL] Now it loaded.
[CUSTOMER][POSITIVE] That's where it's just taking a really long time like now I so I switched back to dashboard now I go back to my policy and it's doing this waiving the waves.
[CUSTOMER][NEUTRAL] OK, so there it shows me it shows me active.
[CUSTOMER][NEUTRAL] OK, so let's see if I click on start my claim.
[CUSTOMER][NEUTRAL] Yeah, it's still showing no claimants available.
[AGENT][NEUTRAL] OK, now for this email is this email your personal or is this your business email?
[CUSTOMER][NEUTRAL] My personal.
[AGENT][NEUTRAL] OK, and is that the one that you did set up?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When you set this up
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see if I can get someone that can assist you with that because if you can't submit it via the secured portal, you do have the option to submit it via fax or mail as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't mind faxing it.
[CUSTOMER][NEUTRAL] There's really nothing personal on here I mean as far as.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean just my date of birth I don't really see.
[CUSTOMER][NEUTRAL] Like my social or anything on here.
[AGENT][NEUTRAL] No, normally the social is not listed on the claim form, so if you would like, you're more than welcome to submit it via fax and I can enter the information in and also let them know that you were having issues with accessing the OSC and if they need to call you back, is it OK to call you at this number that you gave me?
[CUSTOMER][NEUTRAL] Yeah, so I don't see any.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh huh, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I will send that request over as well, and I will notate that you're you're faxing it in as well. And would you like that fax number?
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Um, I is it the [PII]?
[AGENT][NEUTRAL] Yes, and it is attention claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Attention so I can just write on top of the form attention claims department.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and then can I just write like the number of pages at the top or?
[AGENT][NEGATIVE] You don't have to write that as long as you're saying you're submitting the claim form, which that is 2 pages, then the claim itself from the provider and then an EOB that's what, about 4 claims.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 4 pages? OK.
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][NEUTRAL] And my receipt mhm.
[AGENT][NEUTRAL] OK, so 5, OK.
[CUSTOMER][NEUTRAL] OK, so I'll go ahead and fax that over then.
[AGENT][NEUTRAL] OK. And I would, I'll go out there as well and try to see if we, when we do receive it.
[AGENT][NEUTRAL] And if I'm able to pull it as a courtesy, I will review it for you and try to process that claim for you.
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][POSITIVE] Excellent thank you so much.
[AGENT][NEUTRAL] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Nope, I'm gonna fax it right now.
[AGENT][POSITIVE] Alright, well thank you so much for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Alright bye thank you.