AccountId: 011433970860
ContactId: bf34fd8c-6fe2-4112-b2a5-2c08ba7e07b6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 506980 ms
Total Talk Time (AGENT): 264841 ms
Total Talk Time (CUSTOMER): 151576 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/bf34fd8c-6fe2-4112-b2a5-2c08ba7e07b6_20250623T20:02_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi [PII], how are you doing today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] Alright, my name is [PII]. I'm new, new, but I just wanted to see about going to um.
[CUSTOMER][NEUTRAL] Doing a claim?
[AGENT][NEUTRAL] OK, I can take a look at your policy and help you with that. Could I get a callback number for you, [PII]?
[CUSTOMER][NEUTRAL] Sure it's area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And do you have your policy number with us?
[CUSTOMER][NEUTRAL] I do. Hold on one second for me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, I was doing two jobs I want. I had to go to the bathroom real quick. My policy number is.
[CUSTOMER][NEUTRAL] OK, 02.
[CUSTOMER][NEUTRAL] 605354
[AGENT][NEUTRAL] OK. And if you could verify your date of birth and mailing address, please.
[CUSTOMER][NEUTRAL] Um, date of birth is [PII].
[CUSTOMER][NEUTRAL] Now the address, it was a [PII] address that was temporary. I just changed that today.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and let me check, um, I do show, uh, at this point I show we do not have an email address on file, um, you will need to add an email address to file a claim.
[CUSTOMER][NEUTRAL] OK, can I give you that or I have to add it on my own?
[AGENT][POSITIVE] Yes. No, you can give it to me now.
[CUSTOMER][NEUTRAL] OK, it's [PII], my first and last name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] Mhm, it's [PII], yep.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I have that updated for you and you said you're calling about filing a claim?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, so in order to file a claim, um, I can let you know what information is needed.
[AGENT][NEUTRAL] Um, and then now that I've added your email address, you can go online and create an online account. So that will be one of the options to submit the information through the portal, online portal, or um you can fax it or mail it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so, um.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I guess I'll be going to create this is my first time, right?
[AGENT][NEUTRAL] Right, you will be creating your account.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I can walk you through that to make sure.
[CUSTOMER][POSITIVE] Alright, I'm going on to do this.
[AGENT][NEUTRAL] It goes through.
[CUSTOMER][NEUTRAL] I'm doing it right now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But yes, I was in, uh, the reason why I'm calling because um I was in.
[CUSTOMER][NEUTRAL] The hospital, so I have to file a claim and I didn't want it to be too late, but I was so busy that I'm just now like really getting around.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, well, let me ask you this because the easiest way is to always have them file the claim and we will pay them directly.
[AGENT][NEUTRAL] Um, are they not willing to file a claim on your behalf or did you not uh provide your
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I just did, I
[CUSTOMER][NEUTRAL] Yeah, I did. I'm just now getting all this information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I think I'm gonna have to wait because my address hasn't been changed yet.
[AGENT][NEUTRAL] OK, now once you create your portal.
[AGENT][NEUTRAL] Um, you can go in and update your mailing address, I believe.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, but it's asking me for me to sign up to put in my zip code.
[AGENT][NEUTRAL] Go ahead and put in because you can, yeah, you can update it. So go ahead and put in what we show in the system at this time.
[CUSTOMER][NEUTRAL] And I'm putting what I am now.
[AGENT][NEUTRAL] Which is the uh
[CUSTOMER][NEUTRAL] I don't know what that is.
[AGENT][NEUTRAL] The Palmetto
[AGENT][NEUTRAL] Um, we show zip is [PII].
[CUSTOMER][NEUTRAL] I don't even know how I was in there. I was already at my new address by the time I even.
[CUSTOMER][NEUTRAL] Go
[CUSTOMER][NEGATIVE] The insurance that's what I don't understand.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] What is it doing now?
[AGENT][NEUTRAL] Is it giving you an error?
[CUSTOMER][NEUTRAL] Yeah hold on let me check.
[CUSTOMER][NEUTRAL] It's just telling me to verify my email and stuff.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] 419.
[CUSTOMER][NEUTRAL] Oh, looks like I'm in.
[AGENT][NEUTRAL] OK, good. OK, so, um, so now you're in the online portal. So if you need to.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Your easiest way to go about uh filing the claim, honestly, is to have the, the hospital. I will contact them and let them know you have a secondary insurance. I wouldn't say, uh, a lot of times they don't understand the gap insurance, so they, they feel that that's something you have to file yourself. So just let them know you have a secondary insurance payer and you need to provide your information to them so that they can submit secondary to us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, now, if there's any issue into where the facility is saying, OK, we will not file a claim, you have to do that. Um, what you will need is, uh, the itemized bill. Was this an emergency room visit or?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It an emergency room visit turned into a hospital visit, yeah.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] You should have received discharge, a discharge summary.
[CUSTOMER][NEUTRAL] Yep, I have that.
[AGENT][NEUTRAL] OK. OK. So you would want to uh submit that because on there, it will give us information as to why you were uh admitted into the hospital, like what the illness was, and we will need that.
[AGENT][NEUTRAL] So you can uh submit the uh admit and discharge summary and then we will also need the explanation of benefits from your primary showing they received the claim, process it in what your patient responsibility is. So, uh, the explanation of benefits would be the, you know, the sheet of paper. I don't know if you're on the portal with that, with your primary, which says, uh, this is not a bill, we received the claim for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, this is what we pay, this is what we, what you owe.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you familiar with that statement that comes in the mail once you go to the doctor after they've received the claim? OK, that is what we'll need because on there it'll show uh what you owe, you know, what was either applied to your deductible, co-pay, co-insurance, and so we know what we're paying. Uh, but like I said, the easiest thing is to have them file it and it would be paid, you know, directly to them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, the only time you want to file a claim is if the doctor is, doctor or facility is saying we will not file the claim for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK. All right, no problem.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] Thank you so much [PII].
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] OK. You have a wonderful day. Thank you for calling APL.
[CUSTOMER][POSITIVE] You too. Thank you, bye bye.
[AGENT][NEUTRAL] Bye bye.