AccountId: 011433970860
ContactId: c4f17873-25a8-4406-8305-10b024bc91ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 697950 ms
Total Talk Time (AGENT): 229949 ms
Total Talk Time (CUSTOMER): 348412 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/c4f17873-25a8-4406-8305-10b024bc91ea_20250610T19:45_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] Hi, um, this is [PII]. I'm calling from our broker's office, American Bank of Oklahoma.
[CUSTOMER][NEUTRAL] On behalf of a client trying to help them, uh, an employee with a claim.
[AGENT][NEUTRAL] I can help you with the claim status. May I have a policy number?
[CUSTOMER][POSITIVE] Just tell me where, thank you.
[CUSTOMER][NEUTRAL] Yes, 24542 Wagner County.
[AGENT][NEUTRAL] OK, so that's the group?
[CUSTOMER][NEUTRAL] That's a group. Did you want the, the, the person, sorry, um, I'm so used to starting with the company 1st 262-1965 [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And can you verify her date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim, and I have her pulled up and how may I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, we helped her get everything submitted we called to check on it and then they said that.
[CUSTOMER][NEUTRAL] They needed the doctors to put the codes they needed something. So we, she got us the paperwork and we reuploaded um that I can't see the date because I can't log in currently because.
[CUSTOMER][NEUTRAL] It the the log in however APL is doing it now has changed and we need our main producer to.
[CUSTOMER][NEUTRAL] To do that, but anyway.
[CUSTOMER][NEUTRAL] I just wanna see she says she's still getting letters saying that the the claim was already filed.
[CUSTOMER][NEUTRAL] What did she say?
[AGENT][NEUTRAL] It looks like it processed.
[CUSTOMER][NEUTRAL] Keep getting the same paperwork?
[AGENT][POSITIVE] That's a dope I believe. Let me see.
[CUSTOMER][NEUTRAL] Well, it, it, it is duplicate paperwork, but they wanted the, the rate codes in there more officially from the, from the doctor's office or something, so, and there's nowhere to state that.
[CUSTOMER][NEUTRAL] When we upload it.
[AGENT][NEUTRAL] OK. So they're asking for the diagnosis code and
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] And so on the paperwork that was submitted again I don't know what date that was, it was a couple of weeks ago.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] All of that information was on there.
[AGENT][NEUTRAL] OK, let me see if I can.
[AGENT][NEUTRAL] Vie any notes on this one?
[AGENT][NEUTRAL] OK, so it looks like.
[AGENT][NEUTRAL] Someone spoke with you in May regarding the diagnosis code. It was typed on there and they need the actual.
[AGENT][NEUTRAL] Documentation from the provider.
[AGENT][NEUTRAL] And on this one, it was received on [PII].
[AGENT][NEUTRAL] But I'm not seeing.
[AGENT][NEUTRAL] Let me go back through. I don't see the diagnosis code on this information from its fire.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Let me see if I can find the paperwork that she sent over.
[AGENT][NEUTRAL] Cause I see the EOP.
[AGENT][NEUTRAL] This is from Blue Cross.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK, OK, so I was able to pull up her thing it's, it said under service description.
[CUSTOMER][NEUTRAL] Surgery R2-1.
[AGENT][NEUTRAL] OK, let's see, and what page are you on?
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, this is the, the, the Blue Cross form I found the in our.
[CUSTOMER][NEUTRAL] Piles the
[AGENT][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Let me rotate it where I can see it.
[AGENT][NEUTRAL] It's R2.
[CUSTOMER][NEUTRAL] That she sent over
[AGENT][NEUTRAL] That one being.
[CUSTOMER][NEUTRAL] The yeah.
[CUSTOMER][NEUTRAL] That's what they sent back with the.
[CUSTOMER][NEUTRAL] The diagnosis code.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, cause this, let me see.
[CUSTOMER][NEUTRAL] Blue Cross also confirmed that for me, but they said something um.
[CUSTOMER][NEUTRAL] There was a rep from APL that did an open enrollment meeting with our other brokers and she said.
[CUSTOMER][NEUTRAL] Have Blue Cross get a health statement but when I called Blue Cross they were like.
[CUSTOMER][NEUTRAL] We don't even know what you're talking about. We don't, there's, we don't do like separate things.
[AGENT][NEUTRAL] Yeah, it's getting hard to verify because a lot of times when we get this information in, we need to call and verify with the provider. If we're not on there, they're not gonna give us any information.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] oh yeah, trust me, I get, I trust me I get it all the time because I, I, I call about some things where I'm like, look, this isn't even a situation where I'd have PHI but I'm gonna call and ask and hopefully I can.
[CUSTOMER][NEUTRAL] Be super sweet and they'll help me out because yeah and these codes are getting harder and harder because they don't wanna give them to the providers are they're so difficult.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] They don't wanna file they're lazy and don't wanna file and we're and then we say fine, then we'll help the the member out but then they don't help the member out by giving them all the information they need then it's like, look, this is all I need. You don't have to file it but give me this information.
[AGENT][NEGATIVE] Exactly. We spoke with a lady last week in which she was just frustrated. She was frustrated because she could not obtain it. So what she did was she went to her Cigna website and pulled up the actual statement.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Of that service for that date and her diagnosis codes were there. So I told her to print those and upload those and send them over because the provider was not giving her any information. It was not on the super bill. And in this case, with this uh [PII], it looks like we made several attempts to call to verify the diagnosis code and they cannot provide any information without the the patient's consent.
[CUSTOMER][NEUTRAL] Right, because, yeah.
[CUSTOMER][NEUTRAL] Yeah, like how do you get the patient's consent? Like we, and we have um this particular group, um.
[CUSTOMER][POSITIVE] We have something I wish we had on every single one of our groups and it's called blanket PHI so we automatically have PHI on every single member we call in about so we never have to worry that do we have that with this particular person and we can call on their behalf which it just it just speeds up things so fast when and here's the thing you you all see this too the information.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And we're getting it doesn't tell you on there what I mean what happened it's like it's just it's all numbers we're it's all numbers we're looking at we already have their social their date of birth and all they want is help and yeah.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Yes, and in her case, you can put this diagnosis code and it can go one or two different ways and you don't wanna give them a diagnosis code. So that's why we on our end have to verify.
[CUSTOMER][NEUTRAL] And they just
[AGENT][NEUTRAL] We might put in that she had a headache and she had a backache or we put in she had a stomach ache and she had.
[CUSTOMER][NEUTRAL] Oh, so every so every time you have, so every time you have to call Blue Cross to verify that's the.
[AGENT][NEUTRAL] We try, we tried to call the provider. If we can't get anywhere with the provider, yes.
[CUSTOMER][NEUTRAL] Right. Oh, the provider.
[AGENT][NEUTRAL] Then we'll reach out to Blue Cross and see. It's just hard to get any information.
[AGENT][NEGATIVE] If we don't have a sent or if APS is not on file with them, it's hard.
[CUSTOMER][POSITIVE] Yeah, I don't I just don't know how going forward because I mean we're using this with more and more groups because it it legit saves them so much money and we're one of the few brokers around that uses it like in our area and because there's so many people are like what is this? and um it's just yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So have you actually saw the Blue Cross website?
[CUSTOMER][NEUTRAL] But this, I think this.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Have you ever seen the
[CUSTOMER][NEUTRAL] Got on to the Blue Cross website.
[AGENT][NEUTRAL] Uh-huh. Have you ever saw the website?
[CUSTOMER][NEGATIVE] No no you're not talking about my portal where I have access to member information right?
[AGENT][NEUTRAL] For Blue Cross. I was just wondering if they're like Cigna and they have that information there.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Because she can, she can upload that as well.
[AGENT][NEUTRAL] And I didn't know it until the lady told me yesterday that on her Cigna is where she obtained that information from.
[CUSTOMER][NEUTRAL] And that's surprising because that's not another one that's.
[CUSTOMER][POSITIVE] Super awesome to work with um.
[CUSTOMER][NEUTRAL] Blue Cross Blue Shield. I'm just gonna do diagnosis codes, see if that.
[CUSTOMER][NEUTRAL] OK. 00, OK.
[CUSTOMER][NEUTRAL] Well, I found a whole long list of I see, yes, but.
[AGENT][NEUTRAL] And does it match her date of service?
[CUSTOMER][NEUTRAL] Except these, except, well, these are, that these are social determinants of health, but surely if they've got that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then the next thing would be to get that uploaded from from them.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alrighty then, so I will, but if that can be noted that that wasn't a duplicate it's not a duplicate can't claim it just that's what she sent over with the code so um but I will see if I can work on this.
[AGENT][NEUTRAL] And that's all we need.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] So, alright. Thank you, I appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] [PII], you're so welcome, and once we get those calls, we can get our claims processed.
[CUSTOMER][POSITIVE] OK, sounds great. Have a good rest of your day. Bye bye.
[AGENT][POSITIVE] Thanks you as well and thank you for calling American Public Life, [PII]. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.