AccountId: 011433970860
ContactId: a9ef0187-42de-4f2f-8520-ac7918dac9bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 473540 ms
Total Talk Time (AGENT): 208479 ms
Total Talk Time (CUSTOMER): 234966 ms
Interruptions: 8
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/a9ef0187-42de-4f2f-8520-ac7918dac9bc_20250109T16:37_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, my name is [PII]. I am wanting to find out possible benefits for, uh, my husband, um, went to the ER in December, and I think he forgot to give them his APL card.
[AGENT][NEUTRAL] OK. Can I get
[CUSTOMER][NEUTRAL] And I don't know if I can file a claim for help him file a claim or what.
[AGENT][NEUTRAL] OK, I can take a look at it for you. Could I get a callback number for you?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you and what is the policy number? It would be the outpatient certificate number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Are, are you talking about on the card?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The group number on the card is 15562.
[AGENT][NEUTRAL] The outpatient.
[AGENT][NEUTRAL] The outpatient certificate number is on the card.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] 000000 OK, that's OK 01850634 ML 8.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] If you could verify your date of birth.
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying the account and you did say you were calling uh in reference to him uh having an emergency room visit.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, he went to, um, a West Pole Medical Center.
[CUSTOMER][NEUTRAL] On, um, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you're looking to file a claim for the emergency room visit?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Well, yeah, I know, I know he, um, he had imaging done, so I didn't, I, I thought that APL helps with that. I don't know, we don't haven't filed a claim in a very long time and his insurance, which is over, his birthday was yesterday, and he's going on Medicare, but this visit he was, it still has Aetna.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And APL and Aetna so uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so I do show for emergency room that would be covered under his outpatient benefit, uh, which pays up to $5000 a calendar year, so he does have the benefit available. Um, you can, uh, file the claim or, uh, you can provide the information to the hospital for them to file the claim on your behalf, um.
[AGENT][NEUTRAL] That's up to you and you know the facility um but I can give you the information, uh, let you know what would be needed if you decide to file the claim yourself.
[CUSTOMER][NEUTRAL] OK, if I, yeah, can you give me
[CUSTOMER][NEUTRAL] Uh, I don't know if they would take it or not if I call them. I'll just try to do it myself if you can tell me what I need to do.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what we would need um when filing the claim is, uh, the itemized bill from the emergency room visit.
[CUSTOMER][NEUTRAL] OK, so I would need to call them on that, right? Uh, they sent a bill, but I don't get the itemized bill.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] You would need to request the information, uh, whoever, um, that bill is billing you, uh, this is the information you would need to request from them if they're not willing to file the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you'll ask for the itemized bill.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And make sure you ask for the ICD 10 code.
[CUSTOMER][NEUTRAL] ICD 10 code.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And then we will need the explanation of benefits from the primary for the service state showing uh the patient's responsibility.
[CUSTOMER][NEUTRAL] So explanation of benefits from primary the Aetna.
[CUSTOMER][NEUTRAL] I wish I could think I could go online and get that um and then what what what else did you say after that?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, that, that's it. We would need the explanation of benefits, the itemized bill with the ICD 10 code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then there's a claim form that I go on APL.
[CUSTOMER][NEUTRAL] To fill out or?
[AGENT][NEUTRAL] Uh, so it looks like, um, with the policy, let me take a look, make sure. So it looks like the policy has been canceled.
[AGENT][NEUTRAL] So you wouldn't be able to create an account, uh, online, uh, to file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Well, I, well, OK, so we're also our employees have APL, so you know I go, you know, I have an account to go on there that way, but I don't know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If it's been so long.
[AGENT][NEUTRAL] OK, so to file a claim, it would need to be under the individual's account?
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] OK, so you're saying I can't get into that now because it was closed.
[AGENT][NEUTRAL] Hasn't, have you already, has one already been created?
[AGENT][NEUTRAL] Like did he already have an account previously?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I think so. I just, we just haven't, I just haven't been in it in a long time, yeah, it should have all his.
[AGENT][NEUTRAL] OK, so if it's already created, then that wouldn't be a problem. You can upload those documents, but you can't create a new account under a um
[AGENT][NEUTRAL] A policy that's been dropped.
[CUSTOMER][NEUTRAL] OK, so if I can't get into it, then what, what would I do? and I'm gonna try.
[AGENT][NEUTRAL] Uh, you could fax the information, uh, or mail, uh, the documents in.
[CUSTOMER][NEUTRAL] Mail it to [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh, the updated mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And so that was OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That was [PII] there department or put APO claims.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, what did I write [PII].
[AGENT][NEUTRAL] And you would attend American public life claims.
[CUSTOMER][NEUTRAL] 73124
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, otherwise I can download it if I can get in if I have my credentials there because I did have them, um, OK, um.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, alright, well thank you so much and also I, I broke.
[AGENT][POSITIVE] You're welcome, [PII]. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Well I'm, I'm thinking too um our broker could do it if I sent him that stuff as well, yeah, OK.
[AGENT][POSITIVE] He can. Yes, yes, he can.
[CUSTOMER][POSITIVE] OK, alright, sounds good. OK, thank you so much, appreciate it.
[AGENT][POSITIVE] You're welcome. Have a wonderful day. Thank you for calling APL. Bye bye.
[CUSTOMER][POSITIVE] Thank you, uh huh thank you.