AccountId: 011433970860
ContactId: bb154b4c-0d5e-497b-aae7-65de0f35b5b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 589409 ms
Total Talk Time (AGENT): 208940 ms
Total Talk Time (CUSTOMER): 246249 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/bb154b4c-0d5e-497b-aae7-65de0f35b5b2_20250516T13:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh yes, ma'am. I'm calling regarding a claim that I submitted and I'm not sure why it was denied. Um, I have a policy number whenever you're ready.
[AGENT][NEUTRAL] May I have your policy number?
[CUSTOMER][NEUTRAL] It's 025516-007.
[AGENT][NEUTRAL] May I have your name and a good callback number?
[CUSTOMER][NEUTRAL] Yeah, my name is, her name is [PII]
[CUSTOMER][NEUTRAL] [PII] and then the last name is [PII]
[AGENT][NEUTRAL] OK. May I have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Can you verify your date of birth, your mailing address, and your email please?
[CUSTOMER][NEUTRAL] Yeah, [PII]. Address [PII] and the email is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised the verification of coverage does not guarantee the payment of a claim. So it looks like this claim was processed under claim number 3601661, and we are asking for the diagnosis code, which is the reason for the services.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Like, so that was from when I deliver a baby told me how do I even get the paperwork.
[AGENT][NEUTRAL] OK. So, yes, we would have to have in writing the delivery or birth of a newborn. However, the provider wears it, we just have to have that in writing.
[CUSTOMER][NEUTRAL] And that's all what you need from everything else?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So, and where do I send that? I just update it to that and how long do I have?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Let me double check. It looks like they need the diagnosis code for data service 1221-2024, and then for 11/14, they are asking for your primary insurance explanation of benefits and you can submit them the same way via the web. You can upload them there, you can fax or you can mail.
[CUSTOMER][NEUTRAL] And the one that EOV, I already sent that one.
[AGENT][NEUTRAL] It looks like
[CUSTOMER][NEUTRAL] On the documents.
[AGENT][NEUTRAL] Let me get them pulled up for you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, it's 12 pages. One moment and I'll go through and see if we have this EOB.
[CUSTOMER][NEUTRAL] Yeah, the primary one would be Blue Cross. They're all mixed when my husband scanned them, but they're there.
[AGENT][NEUTRAL] OK. So this EOB indicates the claim total is 7239.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK. I do see, looks like there was a fetal stress test for $225 on 11/14, but there is no matching EOP. I don't see for that one.
[AGENT][NEUTRAL] It's, there's two EOBs for the 1221.
[AGENT][NEUTRAL] But there is no EOB to match.
[AGENT][NEUTRAL] The 225.
[AGENT][NEUTRAL] So we do have to.
[CUSTOMER][NEUTRAL] I guess.
[CUSTOMER][NEUTRAL] The one that I'm submitting I'm not wrong, it's just the 221, the 215, I don't think that's.
[CUSTOMER][NEUTRAL] I don't think that I'm submitted for that was just the 221.
[AGENT][NEUTRAL] For data service 1114.
[CUSTOMER][NEUTRAL] Let me open the paperwork, give me one second because I don't have in front of me, so that was it.
[CUSTOMER][NEUTRAL] So the, the one that I'm submitted for in the Blue Cross Blue Shield, the only one I'm using it for is the 1221.
[CUSTOMER][NEUTRAL] That's $7,239. So $715 is 1215, I'm sorry. I'm trying to see maybe that just, yeah, let me go ahead in the bill and check.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, in [PII], I don't need that one. Let's take care of the only one I need is the 1221.
[AGENT][NEUTRAL] OK. So since it was received.
[CUSTOMER][NEUTRAL] And the one is this?
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So just explain a little more, so Carroman Medical Group is where I went that's the hospital. And if you see in the bill that will be on the page it says Carroman, the 1221 it says OB care underpartum for 7,239. That's the one that I'm putting the claim. So the one on there it says [PII], that I don't need that cause that I already paid that.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it needs to be take off, and there, there was not a way to explain there that that's what I was applying for. And then if you see in the ELV that the Blue Cross is my, it was, I don't have that anymore. It says right there how much they pay in the ELV. That will be, I believe, the page number 4.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for data service 1221 to 7,239, we would just need the diagnosis code in order to process that claim, and we can get that claim processed.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, so do you need something from the doctor saying you know is good, or can I can just give him the phone to you or just call back and be they say it's this cold.
[AGENT][NEUTRAL] We cannot take it over the phone. We have to have something in writing. So if you can obtain that from the doctor and then submit that, we can process the claim. We can't take it over the phone.
[CUSTOMER][NEUTRAL] I understand, but it, well I guess my question is like, it can come from me or it has to come from the doctor's office.
[AGENT][NEUTRAL] It has to come from the doctor's office.
[CUSTOMER][NEUTRAL] OK, so they should be able to.
[AGENT][NEUTRAL] Unless you have paperwork.
[AGENT][NEUTRAL] Yes, if you have paperwork at home that has the maternity or the delivery or the diagnosis, something like that in writing, you can submit that.
[CUSTOMER][NEUTRAL] Well, they gave me, they gave me a paper when they discharged me. Will that work?
[AGENT][NEUTRAL] And does it have on there the delivery or newborn baby?
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Mm, yeah, but it doesn't say that code, that's the only thing.
[AGENT][NEUTRAL] OK, so what you could do, you could write.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Anything on there that helps indicate that this was for the delivery of the newborn and submitted with that paperwork.
[CUSTOMER][NEUTRAL] OK, I'll do that then. How many days do I, do I have before they close this claim?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] No, ma'am, there's no time limit to submit a claim. So as long as your policy is active the claim, even though we processed it and asked for additional information, it won't close.
[CUSTOMER][NEUTRAL] Oh, OK. I'm asking because this was from work and I stopped working, so this policy was closed [PII], but this happened before the policy was closed.
[AGENT][NEUTRAL] Oh, OK. So,
[CUSTOMER][NEUTRAL] So, will I still be able to get it?
[AGENT][POSITIVE] Yes, ma'am, you will.
[CUSTOMER][POSITIVE] Yeah, OK. Alrighty, well, thank you so much for your guidance. I appreciate it.
[AGENT][POSITIVE] You are so welcome. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, the only thing you said, as long as I get the paperwork, I just update it to the, to the portal, and that's all I have to do, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK. No, that should be everything. Thank you.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. You too. Bye bye.