AccountId: 011433970860
ContactId: d9d938e1-c828-4fe9-af6a-d055f3be4a12
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 642950 ms
Total Talk Time (AGENT): 313305 ms
Total Talk Time (CUSTOMER): 229614 ms
Interruptions: 3
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/d9d938e1-c828-4fe9-af6a-d055f3be4a12_20250226T15:46_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. See, I received a letter from you.
[CUSTOMER][NEUTRAL] Uh, stating that you've received the claim on my policy and a review of the claim has been started.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So can you help me figure out what plane that is? Because I'm not really familiar with you, your company.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. Can I get your first name?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, and [PII], uh.
[AGENT][NEUTRAL] What is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And let's see, do you have your policy number with us?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, just one second please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got my card reach here.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, on the insurance I have my member number is 68.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 26
[AGENT][NEUTRAL] Is this for American Public Life?
[CUSTOMER][NEUTRAL] Oh, I don't have insurance with American Public Life, so I was confused when I got this letter from you. It's got my name and address.
[AGENT][NEUTRAL] OK, let me try.
[AGENT][NEUTRAL] On the letter, is there, there should be a certificate number or policy number? You don't see anything?
[AGENT][NEUTRAL] With the policy, OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Let's see, and if you could spell out your last name for me please.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, let's see.
[AGENT][NEUTRAL] OK. And what is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying your information. I do show that you have a policy with us, um, a medical policy. It looks like this policy is through your employer Business Workers of America.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well, I'm retired, so.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] I haven't worked since last I, I retired the end of last April.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it looks like we received something. Let me pull up what we got, uh.
[AGENT][NEUTRAL] Let's see client.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK. So, it looks like a hospital indemnity claim was submitted.
[AGENT][NEUTRAL] Um, someone did fill out a, a, uh, a statement.
[AGENT][NEUTRAL] For reimbursement. Um, this is handwritten in.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And signed
[AGENT][NEUTRAL] Uh, back on [PII].
[CUSTOMER][NEUTRAL] I wonder if that is.
[CUSTOMER][NEUTRAL] OK, I'm thinking what that is is um.
[CUSTOMER][NEUTRAL] I've been, I was doctoring, went to my doctor on 2 different occasions, two different dates of service.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And for the longest time I never got a bill from anything.
[CUSTOMER][NEUTRAL] And here recently,
[CUSTOMER][NEGATIVE] I got a notification from the provider that my bill is overdue and they sent my insurance company.
[CUSTOMER][NEGATIVE] A couple of claims and they hadn't responded so they wanted me to get a hold of them.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you have a different insurance company?
[CUSTOMER][NEUTRAL] And so
[CUSTOMER][NEUTRAL] Well, um, they told me I could, they, they emailed me a form to fill out to see if I qualify for assistance, and I wonder if that's what this is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Yeah, it looks like it was, I guess, completed by you. It looks like the uh statement from the doctor was submitted also from Asia Ayia Health.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Uh, OK. OK. Uh, so it looks like we requested.
[AGENT][NEUTRAL] You know, there may be some benefits for uh this we requested, let me see what we requested.
[AGENT][NEUTRAL] OK, so it looks like we requested um.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] An itemized statement with your procedure codes and diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, and so you can reach out to Ayia uh Health and ask for a claim, uh, that has your procedure codes and your diagnosis code.
[AGENT][NEUTRAL] And you can submit that and and uh they will uh will be able to uh you know, take a look at your claim for benefits but it looks like uh these services are at least would be a covered service um because they did, you know, request additional information.
[AGENT][NEUTRAL] So once we get that additional information, uh, we can take a look at those codes to see if they're cover cover codes and if we can allow benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if you can
[CUSTOMER][NEUTRAL] God, I thought I sent in an itemized statement.
[AGENT][NEUTRAL] Uh, well, this is just a statement of service. So it has, um, it doesn't have the diagnosis code, um, or the procedure code. So if you write that down and I can tell you exactly what to ask for and they'll know what to give you and you can submit it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. OK. I have a pen so I'm ready.
[AGENT][NEUTRAL] OK, so you wanna ask them for the, uh, a claim?
[AGENT][NEUTRAL] Copy of a claim with.
[AGENT][NEUTRAL] The procedure codes, P R O C E D U R E.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the ICD 0 code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And they will know exactly what you need um and then you can submit that and they'll uh reconsider your charges.
[CUSTOMER][NEUTRAL] OK, so if I get that, where do I send it to?
[AGENT][NEUTRAL] Uh, so you did you not submit this? Did someone else submit it on your behalf?
[CUSTOMER][NEUTRAL] No, no, I submitted it.
[AGENT][NEUTRAL] OK, so you submitted to, I'm not sure, did you upload it or did you mail it in? Are you familiar? It looks like you uploaded it.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To the um
[AGENT][NEUTRAL] Online service center.
[CUSTOMER][NEUTRAL] I thought I mailed it in to you guys or whoever.
[AGENT][NEUTRAL] OK, I can give you, I can give you the mailing address.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, there's an address on the bottom of this letter. I don't know if it's the same.
[AGENT][NEUTRAL] What is that address?
[CUSTOMER][NEUTRAL] Uh, it's [PII], OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] That is the that's the mailing address you would use.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you just ask them for that.
[CUSTOMER][NEUTRAL] And do I
[AGENT][NEUTRAL] The procedure code.
[CUSTOMER][NEUTRAL] Like yeah.
[AGENT][NEUTRAL] And ICD can come for these two, these two dates. So I show you have a
[CUSTOMER][NEUTRAL] So I put in anything I can.
[AGENT][NEUTRAL] Uh, [PII], date of [PII] and [PII].
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do I put anything in the subject line or anything when I mail this in or if it's got my name on it?
[AGENT][NEUTRAL] Let me give you, let me give you your policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, your policy number is 251.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3314.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you want to reference the claim and the claim number is 356.
[AGENT][NEUTRAL] 7006.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is um the only thing you need to uh.
[AGENT][NEUTRAL] Reference when you mail it in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I will start working on getting that info and try to get it to you as soon as I can because they just sent me an email this morning, the second one that I'm responsible for.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, so much and.
[CUSTOMER][NEGATIVE] I just don't wanna get turned in the collection or anything.
[AGENT][NEUTRAL] Oh, OK, yeah, just, uh, if you can request that information and get that mailed in to us, uh, we can definitely take a look and see if there's, uh, a benefits that will apply to these services.
[CUSTOMER][NEUTRAL] So if I go ahead and pay my bill, what they say I owe, um, do you, do I get reimbursed from you guys then?
[AGENT][NEUTRAL] Well, uh, because you are the one submitting the claim, if any payment is made, it will be made directly to you.
[CUSTOMER][POSITIVE] OK, great. Good to know.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Oh, no, I think that will cover it.
[AGENT][POSITIVE] OK, [PII], you have a wonderful day. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] I know.