AccountId: 011433970860
ContactId: a1a40e69-092f-44c1-8686-75b37d6620f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 574820 ms
Total Talk Time (AGENT): 213213 ms
Total Talk Time (CUSTOMER): 188702 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/a1a40e69-092f-44c1-8686-75b37d6620f6_20250218T17:40_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I have um
[CUSTOMER][NEUTRAL] I have a claim that it keeps on getting rejected. I used to be a member for a couple of years, like, I don't know, 8 years maybe with American Public Life.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But um,
[CUSTOMER][NEUTRAL] Uh, I keep on now this, this is, is not working, so can I give you my, um, what do you need from me?
[AGENT][NEUTRAL] Do you happen to have your policy number available?
[CUSTOMER][NEUTRAL] Let me look here.
[AGENT][NEUTRAL] Or claim number?
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] I have a claim, it should be.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] CO 296-726
[AGENT][NEUTRAL] That is not gonna be the APL claim number.
[CUSTOMER][NEUTRAL] Let me see if I have it anywhere, yeah.
[AGENT][NEUTRAL] If not, I can look it up by your policy up by your social if that would be easier.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Let me look here hold on.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, what you call it, so, um,
[CUSTOMER][NEUTRAL] 3PL
[CUSTOMER][NEUTRAL] Here it is.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] We'll log in and see if that helps me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, it was 246.
[CUSTOMER][NEUTRAL] 4755.
[AGENT][NEUTRAL] And what is your name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your date of, are you sorry, give me your date of birth. I'm sorry, Ms. [PII], and what is the current mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] And do you also mind verifying your current mailing I'm sorry, email and phone number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][POSITIVE] Perfect, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And do you know what that claim date of service was or?
[CUSTOMER][NEUTRAL] Yes, um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me take a look
[CUSTOMER][NEUTRAL] I'm looking here on my end.
[AGENT][NEUTRAL] Except for durable medical equipment?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] August
[CUSTOMER][NEUTRAL] It's [PII] [PII]. 0, I'm sorry.
[AGENT][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] I, I think I found it. Let me take a look at this claim.
[CUSTOMER][NEUTRAL] Oh, OK, it's on Spot dermatology. I did that at a fair.
[CUSTOMER][NEGATIVE] And supposedly they were gonna cover it 100% and then they keep on sending me a $60 bill.
[AGENT][NEUTRAL] OK, so let me take a quick look.
[AGENT][NEUTRAL] It looks like they are needing what's called the diagnosis code.
[AGENT][NEUTRAL] In fact, there's several dates of service that they're needing that for. I see you have an active online account.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If you look at um on your account it claimed 3505833.
[CUSTOMER][NEUTRAL] What is that?
[AGENT][NEUTRAL] That's the claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Um, what is it that, what is it that you guys need from me? Because I think I'm owed some money, I think, but, uh, maybe not.
[CUSTOMER][NEGATIVE] But um this onspot dermatology I have not paid it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Can we start with that and and see why yeah thank you.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Absolutely. And then for future reference just to let you know, Ms. [PII], um, well your policy looks like it's terminating on [PII], so no longer active, but, um, providers can file claims for you too for past services so just be aware of that as well. They can send a claim to us. They normally have all the documents needed.
[AGENT][NEUTRAL] With our policy, we have to have the diagnosis code.
[AGENT][NEUTRAL] Because this policy only pays towards sickness or injury.
[AGENT][NEUTRAL] So the diagnosis code would therefore indicate that the claim is payable if it is for a sickness or an injury.
[CUSTOMER][NEUTRAL] OK, hold on.
[AGENT][NEUTRAL] So that's what we're needing.
[CUSTOMER][NEUTRAL] Hold on operations.
[CUSTOMER][NEUTRAL] Can I have, can I have the address please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What your name?
[CUSTOMER][NEUTRAL] Your name?
[CUSTOMER][NEUTRAL] OK, do you have a cell phone or what do you do?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Can you hold on for a second? Just a moment. Yes, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] So I'm not, I've not, yeah, so I'm so busy all I'm sorry, but so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] 14
[CUSTOMER][NEUTRAL] OK. So, basically, uh, first, nobody's ever told me that it was for sickness or
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] I just thought that
[CUSTOMER][NEUTRAL] APL pay for all my deductibles because.
[CUSTOMER][NEUTRAL] Supposedly, we have free insurance not free insurance, but we have a gap to cover all our copays.
[CUSTOMER][NEUTRAL] At no time did they tell me that it's only for this or that.
[AGENT][NEUTRAL] Mhm. It, this policy does cover sickness or injury. So it like, for example, if you're going to a doctor's office for, say, your annual physical.
[AGENT][NEGATIVE] Or a screening, then that would be not be considered for a sickness, so it would not be covered. So that is not.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, I had a wart. I had a wart on my hand and it hurt me, and so she asked me, I can take it off for you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So she took it off.
[AGENT][NEUTRAL] Yeah, and that, see, that's not a screening, so it definitely could be covered.
[AGENT][NEUTRAL] But we will need the diagnosis code. And was that for an Alexander Herbst? Was that the provider's name?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, you can contact that provider and ask them for the um there's a form called a CMS 1500.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that should have your diagnosis codes and procedure codes all listed for that data service.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] My pleasure. Is there now there's more dates of service that we need those diagnosis codes?
[AGENT][NEUTRAL] Um, if you pull up your claims online, if you click on the claim number, you'll be able to see the code, um, if it is has a code DM 182.
[AGENT][NEUTRAL] That means we need the diagnosis code for that data service. Once we get those codes, we can go back and repro.