AccountId: 011433970860
ContactId: b5fe2020-33de-4002-868d-240b831c10a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 704760 ms
Total Talk Time (AGENT): 197205 ms
Total Talk Time (CUSTOMER): 452392 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/b5fe2020-33de-4002-868d-240b831c10a7_20250610T16:22_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, did you say [PII]?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, [PII], sorry.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK. So, um, OK, I just need a little guidance here. So I have a
[CUSTOMER][NEUTRAL] Balance on a medical bill from last year, uh, I guess, well, not a guess, it was from last year. I talked to somebody.
[CUSTOMER][NEUTRAL] That that that um.
[CUSTOMER][NEUTRAL] Last month.
[CUSTOMER][NEGATIVE] I'm assuming this is supposed to be paid by APL. Um, whoever I talked to said that I needed to get an explanation of benefits. I, and I forget who told me what, but somebody told me I, I requested an explanation of benefits from somebody, and they told me it was gonna take like a week to get an email but I never to get it.
[CUSTOMER][NEUTRAL] And I'm like, I don't even understand why it's taking so long, but anyway, so, our, so we went with a different carrier at the beginning of this year. So I think that's where some of the confusion came in. But um anyway, I got online, I got my explanation of benefits.
[CUSTOMER][NEUTRAL] So, and I have my APL medley, I guess that this is the right form, the medley claim form filled out. So,
[CUSTOMER][NEUTRAL] I guess I just need to figure out what I need to do to get this bill paid because
[CUSTOMER][NEUTRAL] What SSM sent me was
[CUSTOMER][NEUTRAL] The insurance adjustment anthem apparently didn't pay anything. They just, I guess, basically wrote it off. I don't know. Oh, this is for a Doppler. So this is for a Doppler. Um, and I, I know I'm all over the map here. I'm just trying to weed through it. Um.
[CUSTOMER][NEGATIVE] They wrote off the original bill was 525. They wrote off or adjusted, I should say 520 or 428 12, which leaves me with a balance of 9688.
[CUSTOMER][NEUTRAL] So I'm guessing that's where the gap, the APL gap coverage would cover that portion.
[AGENT][NEUTRAL] OK, may I have your name please?
[CUSTOMER][NEUTRAL] Oh yeah, that would help. [PII]
[AGENT][NEUTRAL] And may I have a callback number?
[CUSTOMER][NEUTRAL] Yeah, my uh callback number is [PII].
[AGENT][NEUTRAL] And do you have that policy number with us?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] So it says policy policy slash number 02352944.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I do need to verify your date of birth with me.
[CUSTOMER][POSITIVE] Have a great
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][NEUTRAL] And I do need to verify the mailing address on file and the email address on file.
[CUSTOMER][NEUTRAL] So you should have [PII] from my mailing address and excuse me, OK, and then my email address is [PII].
[AGENT][POSITIVE] OK, that is correct.
[AGENT][NEUTRAL] OK, that is what we have in the system and do you have the date of service for the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the date of service looks to be [PII].
[CUSTOMER][NEUTRAL] And I know I'm way behind schedule here, but I'm, I'm, I got way too many things to take care of.
[AGENT][NEUTRAL] Is it [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, because I'm not seeing that we have a claim for 52.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So you may not, they may, and that's what I think the problem is. I don't think they submitted it. So I'm trying to submit a form to APL.
[CUSTOMER][NEGATIVE] So I can get reimbursed or I, I don't know how that works. I, I mean, should I just go ahead and pay this and then you guys will reimburse me or what's the best way to do that?
[AGENT][NEUTRAL] OK. So the way that it works, we will have to receive the, the medley claim form that you're talking about, the statement and primary EOB that primary EOB will have to show deductible, co-insurance, or co-pay for your responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So there's gonna have to be a dollar amount listed there. Then we will have to
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hang on a minute, let me see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Go, I'm sorry, go ahead. Now you're good.
[AGENT][NEUTRAL] And then we will have to have the diagnosis code, which is the reason of the visit from that provider.
[CUSTOMER][NEUTRAL] Oh, maybe, OK, I'm probably sure I don't have that.
[CUSTOMER][NEUTRAL] OK, hold on, let me write this.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Diagnosis code and I would get that from the provider, obviously.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, they rendered the services, so they will have to either they can submit that to you with something with their name listed on it either via email or something, but it's gonna have to have that data of service indicating it's that date of service and they're gonna have to put the diagnosis code there. So just in case when you ask them for that diagnosis code, let them know that you need the ICD pin code.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see [PII] pin code.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII], sorry.
[AGENT][POSITIVE] Oh, no problem.
[CUSTOMER][NEUTRAL] So the ICC, so the ICD code, I need that and the, and the what diagnosis, oh diagnosis code, is that
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The diagnosis for that is ICP 10 is the diagnosis code.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] OK, OK, um, [PII]ght, and then you said, so hold on, I'm looking at my EOB right now. Let me see if I can figure this out.
[CUSTOMER][NEUTRAL] If I can see which I can't. OK, so, um 2 pair of glasses.
[CUSTOMER][NEUTRAL] So that's where I'm at in life. So,
[CUSTOMER][NEUTRAL] On the OB it says cardiac ultrasound and then it says 525 and then it says 482. 0 here we go, tax bill total bills amount $525 discount 442812 allowed 9688. Other insurance payments 0000 so nobody oh this is the deductible. Do you guys pay deductibles? Is that what we do?
[CUSTOMER][NEUTRAL] I think you do. I think I'm responsible for co-pays and then APL picks up the deductible, is that right?
[AGENT][NEUTRAL] It's based off of what what benefits you do have, but if it's for, um, we normally cover deductible co-insurance or co-pay, but if it's for an office visit and you don't have that office visit, then we don't pay the copay for the office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah, it doesn't have offices around here at all. It just says, uh, what did I just tell you, deductible.
[CUSTOMER][POSITIVE] So, OK. All right. So, I think I have everything I need.
[CUSTOMER][NEUTRAL] I just need to get the diagnosis code from them. I don't think that's on here anywhere.
[CUSTOMER][NEUTRAL] Um, and then I have the form, sorry, you're gonna have to do a little hand holding here, please. Um.
[CUSTOMER][NEUTRAL] So is it best for me to go ahead and pay them and then submit this to you and you guys reimburse me I mean at this late date in the game probably so long.
[AGENT][NEUTRAL] It is your discretion of how you would like for that to be handled because if you were to submit the claim in, we will submit payment to you if it comes from you. But if it was to come from the provider, then we will send that payment to the provider.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Got it. OK. Well, I do remember, so I do remember this much. So when I went for this procedure, what do you wanna call it, um, the lady was having, she was struggling to find APL in her system. Like it took her quite a bit of time.
[CUSTOMER][NEUTRAL] And finally she's like, oh, and I'm like, well, you know, what do you need me to do, whatever. And she's like, oh, I think I found it, I think I found it. And I think that's what happened. I think, oh, I'm, I know that's what happened. She, it's all coming back to me. This has been an ongoing thing. So they submitted it to, you know, have it in front of me. Anyway, they submit oh to Nationwide, they submitted it to Nationwide and that's not my carrier obviously or my provider, so that's what happened.
[AGENT][NEUTRAL] OK, now if you would like for them, if you would like to contact them and give them the information or our telephone number they can call us and we will be able to verify the information and they can submit it if you would like for us to do that do it that way but.
[CUSTOMER][NEUTRAL] Oh God, they said that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, OK, OK, yeah, they did that with another bill too, and I think that's already been turned over for collections because I can't keep up with my own.
[CUSTOMER][NEUTRAL] Whatever. Um, all right, hon. Well,
[CUSTOMER][NEUTRAL] So I'm gonna submit the form to you guys and I guess there's directions on here where to do that. Do I email that to you? Is that what I do?
[AGENT][NEUTRAL] You have the option to submit it via fax, the secured portal, or by mail.
[CUSTOMER][NEUTRAL] We'll see, we're not here, we don't have. I mean we do, but I'm, I'll just do it by now. That's fine. I'll just do it by now. So do you feel?
[AGENT][POSITIVE] Now, you can do it.
[AGENT][POSITIVE] The secured portal is easy just to upload you would just um.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Submit the paperwork via the portal, you would just attach a document and then it will give you a uh confirmation code and then you will be able to check the status and everything on that portal if you would like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So go to [PII] and that's where I would do all that.
[AGENT][NEUTRAL] It should show secured. I mean [PII], is that not listed on the card?
[CUSTOMER][NEUTRAL] I'm looking at it, um.
[CUSTOMER][NEUTRAL] Uh, yeah, and [PII], so that's where I need to go, OK.
[AGENT][NEUTRAL] It, it does say security in the front of it.
[CUSTOMER][POSITIVE] And then I'll be able to upload it.
[CUSTOMER][NEUTRAL] Uh, no, don't say that. It just says [PII]. I'm just looking at the card. Oh wait, yeah, yeah, no, I got it. I got it. I see it now. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me just give you the correct one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Log in. OK. All right. I'll do that. OK, perfect. Thank you.
[AGENT][POSITIVE] Mm, you're welcome and I do wanna thank you so much, Miss [PII] for calling American Public Life. Have a great rest of your day.
[CUSTOMER][POSITIVE] Thanks. You too.
[AGENT][POSITIVE] Thank you bye bye.