AccountId: 011433970860
ContactId: bcc365f1-d5e6-4763-abf6-2ccf96e81699
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 816030 ms
Total Talk Time (AGENT): 352566 ms
Total Talk Time (CUSTOMER): 318882 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/bcc365f1-d5e6-4763-abf6-2ccf96e81699_20250204T16:54_UTC.wav
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[AGENT][POSITIVE] Thanks for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from Specialty Ho. How are you?
[AGENT][POSITIVE] I'm great, thanks for asking. How are you?
[CUSTOMER][NEUTRAL] Good honey I have um one of our employees here that filed um a claim for the gap insurance that we provide for them, and he received a letter showing that the claim was declined. Are you able to look into that for me with his authorization?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, can I speak with them?
[CUSTOMER][NEUTRAL] Sure, yep, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello. You just gotta get her on Thursday.
[AGENT][NEUTRAL] Hello, how are you doing? My name is [PII]. Could I have your name and the policy number?
[CUSTOMER][NEUTRAL] Uh, my name's [PII], and the policy number?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Would that be on here with the
[CUSTOMER][NEUTRAL] Gap insurance card.
[CUSTOMER][NEUTRAL] I don't, uh.
[CUSTOMER][NEUTRAL] Our policy number should be 0203. 020375552 It should be.
[AGENT][NEUTRAL] No, that's the group number. I'm looking for the policy number. It should say cert or policy number on your card.
[CUSTOMER][NEUTRAL] Or it could be our group.
[CUSTOMER][NEUTRAL] This might be just directly for me.
[CUSTOMER][NEUTRAL] Cert or policy number on the card. Yeah, that's the number I just read off. Well, that's [PII]'s mine now.
[AGENT][NEUTRAL] Give it to me again.
[CUSTOMER][NEUTRAL] 02037552.
[AGENT][NEUTRAL] That's yours or the in the [PII], so I need yours. Do you have your policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that's
[CUSTOMER][NEUTRAL] I don't have a card.
[CUSTOMER][NEGATIVE] Tell her you don't have, you never received.
[AGENT][NEUTRAL] So what is your social?
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] [PII], could you verify your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] My date of birth, um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] City and state, zip code?
[CUSTOMER][NEUTRAL] Uh, yeah, [PII].
[AGENT][NEUTRAL] And what is the email address that we have? Well, we don't have one on file for you. What's a good call back number for you just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Yep, uh, [PII].
[AGENT][NEUTRAL] Thank you. And you want to check the status of a claim?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] For data service [PII].
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] So it looks like the services that was received, like your office visits or the treatment received in the office is not covered under your policy. Your policy doesn't provide benefits for those services.
[CUSTOMER][NEUTRAL] Yeah, that's why I put in the gap.
[AGENT][NEUTRAL] That's what I'm saying, your gap insurance does not cover those services office visits or services received in the office. Your policy only covers inpatient, outpatient services, DME services.
[AGENT][NEUTRAL] And also, it covers the cancer writers say if you were going to the doctor forbid that that happens, but if you went to the doctor for cancer diagnosis, then that would be covered. However, office visits are not covered or the treatment received in the office, but it does cover the outpatient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Benefits, the inpatient services cancer rider falls on the outpatient services. You have a lab service and you have DME doable medical equipment, but office visits and the treatment received in the office are not covered under the policy, so that's why there was no payment made on the claim.
[CUSTOMER][NEUTRAL] OK, so he doesn't have coverage for his, um, general office visits. Is that correct?
[AGENT][NEUTRAL] No, thank you. Can you give me permission to speak with you because I haven't made it to that part yet for me to be able to answer those questions.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], could you give me permission to speak with [PII] in regards to your policy?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You have permission.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, the policy doesn't cover those services, so apparently the entire group doesn't have those services covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so basic office visits uh underneath that category, none of the, the group doesn't have coverage for that specific one.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, so that's why it'll be declined, correct?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so does that, is that both of them on how his doctor did the coding on that?
[AGENT][NEUTRAL] Well, it looked like he submitted that information. He submitted an EOB. We didn't we didn't retrieve a UB from the facility itself. It looks like the insured submitted the EOBs from the, from the services from his primary insurance.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so they, that's how they built it. I get it. OK.
[CUSTOMER][NEUTRAL] All right honey I think that's the question we were looking for there.
[AGENT][NEUTRAL] Alright, is there anything else that I can assist you guys with today?
[CUSTOMER][NEUTRAL] I don't believe so at the moment.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] All righty. Well, thanks for calling APL. Go ahead. What were you about to say?
[CUSTOMER][NEUTRAL] Now, if
[CUSTOMER][NEUTRAL] I, I just have one more question, honey. So if his doctor would resubmit that for.
[CUSTOMER][NEUTRAL] Cause it wasn't just a basic, um, visit.
[CUSTOMER][NEUTRAL] Um, because you had therapy that day, right? All those days. So all of those were therapy. So if they would have built that for therapy and not just a general visit, would that make a difference?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] On how they coded that on the EOB or no?
[AGENT][NEUTRAL] So because he submitted it, he submitted the EOB here to American Public Life. The provider did not submit a UB. He only sent his primary EOB in from the primary insurance that he has. He sent just the EOB in to us, so we don't have an itemized bill, so I'm not, I can't answer that question because I'm not sure what type of, you know, how the provider would submit the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because we don't have one of those, we don't have a UB on file, but he can contact the facility where he did receive services from to verify if they would submit a claim on his behalf or if they did, but we don't have a claim on file from a.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Provider itself, we just have the EOB submitted by the insured.
[CUSTOMER][NEUTRAL] OK, so if he calls his physician and ask them to submit one, would you guys relook at that or is it actually officially disclosed now?
[AGENT][NEUTRAL] No, we look at every claim that's been submitted, even if it's a duplicate, we still have to process it and say that it's a duplicate.
[CUSTOMER][NEUTRAL] OK, OK. I was just trying to get clarification. I don't want to have paperwork you're doing over and over again for no reason, so.
[AGENT][POSITIVE] Mm, no, we, we, trust me, that's why we're here.
[CUSTOMER][NEUTRAL] So, all right, honey, I
[AGENT][NEUTRAL] However, it's just, see the EOBs that he sent in, it doesn't have um.
[AGENT][NEUTRAL] Is this
[AGENT][NEGATIVE] Therapeutic services, however, it does not give like
[AGENT][NEUTRAL] If it was in an office visit or if it was because it says that it was an office visit on.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yeah, it's on, and then it says the treatment received, so it's like this treatment received in the office versus.
[AGENT][NEUTRAL] A physician like physical therapy.
[AGENT][NEUTRAL] But see if the physician submitted then it'll have more detail versus on the EOB that's submitted by your primary insurance company because the primary insurance company is just gonna show the description of.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Services received in by the doctor, so it looks like it's received in the doctor's office versus a physical therapy facility.
[CUSTOMER][NEUTRAL] OK, so, um, I guess could you lead me in the direction of what we should tell the physician's office what they need?
[AGENT][NEUTRAL] Oh, you just tell them that you need them to submit a UV to American to his gap insurance so he can basically contact them and request for them to submit a claim here at American Public Life on his behalf for the dates of services of [PII] and [PII].
[CUSTOMER][NEUTRAL] OK, so [PII] or [PII], and [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right honey, I will, and you said an E.
[AGENT][NEUTRAL] And he probably would have to, cause if he submitted this claim on his own behalf and they did not submit the claim, it looked like he did not give them his secondary insurance, but he said he don't have a card. Did he ever receive a card in the mail and he just misplaced it?
[CUSTOMER][NEGATIVE] He's never received a card, unfortunately.
[AGENT][NEUTRAL] That's weird. What is his email address?
[CUSTOMER][NEUTRAL] Do you have an email address? Um, yes, it's [PII].
[CUSTOMER][POSITIVE] Oh you're gonna spell it for me, yeah, I'm gonna have you give him, he's gonna give you his email address.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So, I missed the first letter, so could you provide it to me again? And when you give it to me, could you do um [PII], so that way I can clearly understand.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What's your email address here let me just.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII]? OK.
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[CUSTOMER][NEUTRAL] Y as in yellow, S as in Sam.
[CUSTOMER][NEUTRAL] O N as in Nancy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] B as in boy, R as in red, A N.
[CUSTOMER][NEUTRAL] D as in dog, ON 2.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So it's [PII]?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, hold on one moment. I'm gonna send a copy of his card to his email.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Well we were yeah.
[AGENT][NEUTRAL] Mm mm mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] we don't.
[AGENT][NEUTRAL] Well I guess I am the system allow me to.
[CUSTOMER][NEUTRAL] And it'll be done.
[CUSTOMER][NEUTRAL] She's gonna send a copy of that card to your email, then you have it.
[AGENT][NEUTRAL] And he can provide that to the um facility where he received the services at to them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you'll provide them that info from that or
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] They do.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] That's sounds good.
[CUSTOMER][NEUTRAL] What is it?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I think I need that.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] I didn't know.
[CUSTOMER][NEUTRAL] We do
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I've sent it over. Could you verify if he's received it?
[CUSTOMER][NEUTRAL] Let me check your email for me. He's checking it for you right now.
[CUSTOMER][POSITIVE] Yeah. Yes, he did receive it.
[AGENT][NEUTRAL] Alright, is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No, [PII], I think that's everything.
[AGENT][NEUTRAL] And could you ask him if he could fill out the survey in regards to his customer service that he received today?
[CUSTOMER][NEUTRAL] Yes, I will ask him. Can you fill out the survey? Quick questionnaire. You can do that so.
[AGENT][NEUTRAL] R
[AGENT][NEUTRAL] Thank you. Is there anything else that I could assist you guys with? I probably already asked you that, but it's, it's a habit.
[CUSTOMER][POSITIVE] You're welcome
[CUSTOMER][POSITIVE] Yep, no, we're good on our end.
[AGENT][POSITIVE] Alrighty well thanks for calling APL and you have a great day table with the.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome. Goodbye.
[CUSTOMER][NEUTRAL] Bye bye.