AccountId: 011433970860
ContactId: 972fa42c-5d2e-41bd-874f-a97a89cc2b71
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 359649 ms
Total Talk Time (AGENT): 173110 ms
Total Talk Time (CUSTOMER): 125479 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/972fa42c-5d2e-41bd-874f-a97a89cc2b71_20250422T15:48_UTC.wav
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[AGENT][POSITIVE] And thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Uh yeah, hi [PII], uh, this is [PII]. I just wanted to check on a claim and some documents that I had. I think it's all been processed and it doesn't look like I'm.
[CUSTOMER][NEUTRAL] Maybe not getting payment. I just wanted to know if you could look at it and sort of help me sort of understand uh what's what's what's what's what is that OK? I've got what information you need from me? You, you tell me what you need.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I have your policy number?
[CUSTOMER][NEUTRAL] Yeah, it is 225.
[CUSTOMER][NEUTRAL] 3356.
[AGENT][NEUTRAL] And may I have a good call back number for you?
[CUSTOMER][NEUTRAL] Sure, um, [PII].
[AGENT][NEUTRAL] Thank you. Then can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My email, uh, my, my address is [PII].
[CUSTOMER][NEUTRAL] And I think the email would be [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 up. How can I help you today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so I uploaded some documents. My wife had some a procedure done and a scan done, and I felt like, you know, I've used.
[CUSTOMER][POSITIVE] The last couple of years we've done some filings and gotten some payments and I felt like I sort of understand.
[CUSTOMER][NEUTRAL] When the gap insurance kicks in, it looks like maybe.
[CUSTOMER][NEUTRAL] And I'm not sure if it's completed or if it's sort of still in progress, but it looks like maybe there's not gonna be a payment. I just thought I would see if I could figure out if that's the case and if so, why not if it's possible to tell that.
[AGENT][NEUTRAL] OK, so it looks like there was a claim process for data service 213 and 228, and we are asking for the primary insurance, EOB.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Let me pull up the claim image and see what was submitted.
[AGENT][NEUTRAL] Looks like there were 2 different imaging.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. I'm just waiting on that to load.
[AGENT][NEUTRAL] And this one was 7 pages we received on [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I do apologize. Our system is slow.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK. So this was from the provider. It looks like the CPT codes, the diagnosis codes are here.
[AGENT][NEUTRAL] And the next page.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The diagnosis code, the CPT codes are here. So we are just missing the primary insurance explanation of benefits on this one.
[CUSTOMER][NEUTRAL] Oh, and so do I need to get that from my insurance company?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Who is your primary?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's Aetna.
[AGENT][NEUTRAL] Aetna usually they have a website and you can upload it from their website and submit it.
[AGENT][NEUTRAL] Let me see, I wanna make sure there's nothing else.
[AGENT][NEUTRAL] It looks like there's something for your wife for data service 37 in which they are asking for the diagnosis code. Oh, I'm sorry, 228 25 to 37.
[AGENT][NEUTRAL] So that is
[CUSTOMER][NEUTRAL] 228, that one. I thought I got, I thought I had all the diagnosis codes. No, are they still missing a diagnosis code?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It looks like 228. It looks like that might be the same diagnosis because that's the same date of service.
[AGENT][NEUTRAL] For 228, 228. OK. So it looks like they can use that one. I'll note that one. I'm just trying to go through and make sure I don't see anything else.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Looks like the hospital.
[AGENT][NEUTRAL] That was back in [PII]. OK.
[AGENT][NEUTRAL] So for the one.
[AGENT][NEUTRAL] Under claim number 3585892, I'll go back into that claim and write that one up because if that is the same date of service, you gave us the diagnosis code on the last claim. But for
[AGENT][NEUTRAL] This one, we need the EOB.
[CUSTOMER][NEUTRAL] And that is, so when I go to the website EOB is explanation of benefits, right?
[AGENT][POSITIVE] Correct. Correct. And you would need it to match the
[CUSTOMER][NEUTRAL] For both of them, for both of those, yeah.
[AGENT][NEUTRAL] Yeah, for data service 213-2025 and 228.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, my wife usually is the sort of insurance, uh, liaison, so I'll have her call or go online and see if she can get the EOB for both of those and then I can upload those documents.
[AGENT][POSITIVE] OK, and then we'll get them taken care of.
[CUSTOMER][POSITIVE] OK, that's great, that's great. Thank you so much for your help.
[AGENT][POSITIVE] Then you're so welcome. And thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye bye.