AccountId: 011433970860
ContactId: d3128937-ca39-4d22-8764-72aafd1e31e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 700659 ms
Total Talk Time (AGENT): 314898 ms
Total Talk Time (CUSTOMER): 270835 ms
Interruptions: 4
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/d3128937-ca39-4d22-8764-72aafd1e31e3_20250109T18:42_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, um, this is [PII]. I put in a claim for my husband. He had had shoulder surgery, and, um, and he didn't know, but they had a second coverage, which we knew we had paid for, but we didn't, we just thought it was, um, part of when we did the intake that.
[CUSTOMER][NEUTRAL] It was on the card that he had, and apparently there was another card. Anyway, um, I started receiving all kinds of bills, and I had called previously, and I had submitted a claim form and all of the doctor bills. And um I'm still getting bills and I just wanted to know if the, the status on it. I have um a note to myself. I'm uncovering this through some other paperwork of his on medical and um.
[CUSTOMER][NEUTRAL] I have um
[CUSTOMER][NEUTRAL] I guess this diagnosis from the doctor. I don't know if you guys received that or if that was just sent to me. Anyway, I'm just kinda trying to check out what the status of it is because now things are going into collections.
[AGENT][NEUTRAL] OK, yeah, let me look at that for you, Ms. [PII], and do you have that policy number handy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it says the policy number is 4899, which is the last four digits of his social.
[AGENT][NEUTRAL] OK, let me see I'm gonna search with um are you, is he the subscriber on the account or is it under you?
[CUSTOMER][NEUTRAL] It's his account.
[AGENT][NEUTRAL] OK, I'm gonna search it with his uh first and last name, [PII]
[CUSTOMER][NEUTRAL] Yes, and there's a middle initial [PII] it's [PII].
[CUSTOMER][NEUTRAL] Um, [PII]
[AGENT][POSITIVE] Perfect. And would you be able to let me know what city and state he would be out of?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] All right. And
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Alright my friend I was able to find the account um and then.
[AGENT][NEUTRAL] There's unfortunately though I don't have you listed on the account so I'm not really able to I think give you the information you're looking for.
[CUSTOMER][NEUTRAL] Can I have you talk to him?
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] OK, hold on just a second.
[CUSTOMER][NEUTRAL] Hey [PII].
[CUSTOMER][NEGATIVE] Um, I've got the insurance company on the phone that was supposed to cover the balance of the stuff on your shoulder, and she doesn't wanna talk to me. I asked her if she could talk to you.
[CUSTOMER][NEUTRAL] I talked to him before. I don't know if something changed or. Hello?
[AGENT][NEUTRAL] Hi, Mr. [PII].
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Hey this is [PII] and I, I, your wife is on the phone and she was calling for some information about claims unfortunately I would just need to have you verify the account and give me verbal authorization to speak to her because she's not on the account. Is that OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's fine. Yeah, she handles all the, uh, money and pays the bills and stuff.
[CUSTOMER][NEUTRAL] So yeah she's she handles all that for me.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Unfortunately it's just like our policy it's just to protect your health information but if you could verify for me please your date of birth.
[CUSTOMER][NEUTRAL] Yeah, I get it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Hey, I really appreciate that. Thank you. And then could you just verify your mailing address for me as well?
[CUSTOMER][NEUTRAL] At [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect. Thank you so much, [PII]. And then would you be able to verify the email on file? It looks like it might be your wife's.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] Perfect, thank you so much. And then [PII], do you give me verbal authorization to speak to your wife on your behalf as far as your claims and your policy goes? Anything.
[CUSTOMER][NEUTRAL] Every all the any time, any time you guys call please talk to her. She'll handle it and you'll do better getting paid from her than you owe me or whatever.
[AGENT][POSITIVE] OK. Absolutely.
[AGENT][NEUTRAL] Well [PII], we do have to get it we have to hear it from you every time you call the verbal authorization only lasts for the call, yeah, thank you.
[CUSTOMER][NEUTRAL] Yeah, OK, all right.
[CUSTOMER][POSITIVE] OK, right, yeah, she, she handles that for me.
[AGENT][POSITIVE] Perfect, thank you.
[CUSTOMER][NEUTRAL] You wanna talk to her now?
[AGENT][NEUTRAL] I can, yes, if you'd like.
[CUSTOMER][NEUTRAL] OK, here you go.
[AGENT][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hey, thank you so much. We just have to get that verbal authorization every time, but I appreciate you waiting through that. And let's see. So it does look like, yes, for that claim we were waiting for, we needed your explanation of benefits from your primary insurance carrier and then we were just needing the um a copy of that medical record with the diagnosis code.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so.
[CUSTOMER][NEUTRAL] Alright, I'm, I'm looking at something with a code that's highlighted. I don't know if this is it it says, um, notification prior authorization case.
[CUSTOMER][NEUTRAL] And it gives a case number there procedure codes.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Diagnosis code.
[AGENT][NEUTRAL] The diagnosis code, yeah, that one, it would be like an I-10 code and typically um
[CUSTOMER][NEUTRAL] Looks like S46.012A.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Yes, so that would be it that is a diagnosis code and so we would need whatever record has that diagnosis code on it and.
[AGENT][NEUTRAL] The explanation of benefits.
[AGENT][NEUTRAL] From the primary insurance.
[CUSTOMER][NEUTRAL] OK, I have an explanation.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have an explanation of benefits from American Public Life, isn't that you guys?
[AGENT][NEUTRAL] That's us, yeah, so because we're secondary insurance, um, we work to help pay the copay, the deductible and the copay, um, that is determined by the major medical, but without their explanation of benefits showing us what was applied to the co-pay, the co-insurance, or the deductible, we're unable to process our claims because we follow them. So if you can send us the one from your major medical and along with whatever paper has that diagnosis code on it, we'll be able to reprocess that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and um where do I send it and is there something I attached to be identified?
[AGENT][NEUTRAL] Yes, um, so whenever you send it in, if you want, you can, um, put the policy or the claim number or the even the explanation of benefits you have that you received from us, um, for the claim stating what's needed, so you're welcome to put any of that on there to identify who it goes to and then you can upload that through our online service center if you use the online portal. Alternatively you could fax or mail it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what's the online portal?
[AGENT][NEUTRAL] Yeah, so we have um an online portal and it is um.
[AGENT][NEUTRAL] It's kind of just like a all in one stop place you can upload um your files straight from your computer and just upload them to the portal uh for claims you can view and check your claims in real time you can update your direct deposit, change your address or phone number anything like that and if you want um it looks like I have your email address on file for this account. I could, I could send you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Like, um, a guide that talks to you about how to set up the portal, how to get it started, but then how to do all the different functions um that are available on there and that way you would be able to check the claim status in real time, get alerts and upload documents without having to worry about waiting for fas, waiting for mail it just, it's pretty instant you get confirmation right then and there.
[CUSTOMER][NEUTRAL] Yeah, I think the stuff I had sent before I must have sent through regular mail because I don't see an email address on this. OK, yeah, if you wanna send that to my um email address, then I'll go through that and I guess I could just call. I have to see if he still has his other card for United Healthcare. He's not working with the same company any longer, um, but he had the insurance with, um, was kind of a bad situation. He had the surgery and they dropped him.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Oh my gosh, that is rough.
[CUSTOMER][NEUTRAL] So it was
[CUSTOMER][NEGATIVE] Yeah. So, and he needs further assistance, but our needs further medical, uh, care, and he doesn't have the insurance anymore, and he's out of work because of the surgery. So we're kind of in a bad place and collectors are hounding us, and I'm trying to weed through some of this stuff. And I had found all the paperwork that I had sent previously. And then in the same paperwork, I have an explanation about.
[CUSTOMER][NEUTRAL] Benefits, but that's now I know from you guys and then I have this document from his doctor that um I may not have sent that to you yet, so I'm gonna get that sent out to him.
[AGENT][POSITIVE] And you're welcome to send that to us at any time. We do not have a time limit. I know you want things moving quickly because of your situation, but there's no pressure on our side as far as time goes.
[CUSTOMER][NEUTRAL] OK. OK. Well, it's.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] If you can uh get that to my email, that'll be a good starting place, and then I'll get a hold of United Healthcare also and see how to go about getting the evidence of benefits from them.
[AGENT][NEUTRAL] Yes, and sometimes they can just email you that explanation of benefits too you might even ask if you can have them do it that way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, that sounds great. Excuse me.
[AGENT][NEUTRAL] No, you're OK. No, um, and then is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, I don't think so. Thank you.
[AGENT][POSITIVE] Hey, it's my pleasure. Thank you so much for reaching out to us, Ms. [PII], and I really hope you have a great day. And then I did send that email with that user guide. If you're on the computer and you're like, hey, I need help, just call us, we'll talk you through how to set up the portal and go through it, OK?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, that sounds great.
[AGENT][POSITIVE] Oh thank you and then you have such a wonderful day.
[CUSTOMER][POSITIVE] OK, you too. Thanks.
[AGENT][POSITIVE] My pleasure. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye.