AccountId: 011433970860
ContactId: bcaad4b3-da71-4793-b0fd-04d6963dbdee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 427100 ms
Total Talk Time (AGENT): 146203 ms
Total Talk Time (CUSTOMER): 170544 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/bcaad4b3-da71-4793-b0fd-04d6963dbdee_20250530T16:01_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 [PII], yes, I had submitted some claims and I'm on the your APL uh website right now and it looks like two of my claims have been processed and it says amount paid, um, and I was just wondering if should I be expecting a check?
[AGENT][NEUTRAL] May I have your name and then the policy number?
[CUSTOMER][NEUTRAL] Name is [PII]
[CUSTOMER][NEUTRAL] Uh, policy number is 019.
[CUSTOMER][NEUTRAL] 756
[CUSTOMER][NEUTRAL] 87 M as in Mary, L as in Larry 7.
[AGENT][NEUTRAL] And may I have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And could you verify your date of birth and then the mailing address?
[CUSTOMER][NEUTRAL] Date of birth [PII].
[CUSTOMER][NEUTRAL] Email address
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that's not the email address that we have on file.
[CUSTOMER][NEUTRAL] Yeah, well, they just updated our email address is probably [PII].
[AGENT][NEUTRAL] Yes, and could you verify the mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And thank you so much, [PII] for verifying the policy. You were calling in regards to the previous claim that was just processed?
[CUSTOMER][NEUTRAL] Yeah, I had two of them. It shows, um, let's see here, do you want the claim number or the confirmation? I probably the claim number, correct?
[AGENT][NEUTRAL] The claim number please, yes.
[CUSTOMER][NEUTRAL] 36058999
[CUSTOMER][NEUTRAL] That was recently just completed.
[AGENT][NEUTRAL] OK, so it does look like we did receive it and process it on [PII] and a payment of $500 was issued to the provider.
[CUSTOMER][NEUTRAL] To the provider.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Me who?
[AGENT][NEUTRAL] The provider, the doctor, or facility that rendered the services?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I thought that would be back to me.
[AGENT][NEUTRAL] Let me see who we received the information to.
[CUSTOMER][NEUTRAL] So you paid them $500.
[AGENT][NEUTRAL] OK, so we received the claim from the provider. I'm not seeing that we received the claim from the from you as the insured. That's the reason why that payment went to the provider.
[CUSTOMER][NEUTRAL] Yeah, that's what's so confusing about this because let me see here.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], yeah, I'm the one that sent that.
[CUSTOMER][NEUTRAL] All that information.
[CUSTOMER][NEUTRAL] Because you've denied it at one point in time, I think.
[CUSTOMER][NEUTRAL] And you need additional information.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] We denied it requesting the primary ELB. The provider is the one that submitted it in first, so that's who that payment will go to, even though you submitted in that OB or the requested documentation.
[AGENT][NEUTRAL] Since that provider is the one that submitted it in the payment still has to go to that provider.
[CUSTOMER][NEUTRAL] OK, well that's the confusing part. I would imagine that all the information from my provider sent to APL would be sufficient enough, but then yet I have to send additional information on my end in order for it to process properly.
[CUSTOMER][NEUTRAL] It doesn't make sense to me, but.
[AGENT][NEUTRAL] What we requested was from the provider we requested for the and submit the primary EOB because when they submitted in the claim we didn't receive it so then you turned around and submitted in that primary EOB.
[CUSTOMER][NEUTRAL] Alright, um, what about claim number 3,594,420?
[AGENT][NEUTRAL] 3,594,420 show that it processed and made a payment to the provider in the amount of $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they're getting the OK, I, I again, I don't know why I have to do all the paperwork and leg work when all the information.
[CUSTOMER][NEUTRAL] I have, I, I, I did, I don't get it because I, I'm getting denied so much from ATL and I'm a little confused. I've, I've never really done this before, so when I see that I did not got denied, I just.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so that one, it does look like you have submitted it in and we requested the diagnosis code. Once the providers submit in the documentation, if you stated that the provider can submit the claim and get reimbursed for the, the money, you did a signature where you stated that they can file with your secondary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So once you did approve that, then if that provider submits that documentation in we have to submit that payment to the provider.
[CUSTOMER][NEUTRAL] OK, so if any money are owed to me, they, the provider should be returning those money to me, is that correct? Because it's overpayment on their end.
[AGENT][NEUTRAL] Yep.
[AGENT][NEUTRAL] If there's any money that's over and they did submit the pay the bill over to us, then you would have to contact a provider in regards to an overpayment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, a lot of like on the side of it, but all right, thank you so much for your help. I appreciate it.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Put back, Miss [PII]. Have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you, bye.