AccountId: 011433970860
ContactId: db0a63ad-c890-467f-9bb0-568d2c2cc775
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 230270 ms
Total Talk Time (AGENT): 89457 ms
Total Talk Time (CUSTOMER): 122783 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/db0a63ad-c890-467f-9bb0-568d2c2cc775_20250619T15:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Lives. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I submitted a claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, no, actually, I had, um, I asked.
[CUSTOMER][NEUTRAL] I asked, um,
[CUSTOMER][NEUTRAL] My physical therapist to submit the claim for me.
[CUSTOMER][NEUTRAL] Um, and it's been processed, but I got the letter that says, um, they need more information.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, let me.
[CUSTOMER][NEUTRAL] But our policy, our policy ended, so.
[AGENT][NEUTRAL] OK, let me take a look at uh the claim. Could I get uh a callback number for you, please?
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is your policy number with us?
[CUSTOMER][NEUTRAL] Um, it's
[CUSTOMER][NEUTRAL] 1931074
[AGENT][NEUTRAL] OK, if you could verify your name and date of birth, please.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying the policy. And so you said that they submitted the claim and we are requesting additional information?
[CUSTOMER][NEUTRAL] Uh, yeah, it's, yeah.
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] OK. And this is a total of 1100.
[CUSTOMER][NEUTRAL] I, I have
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEGATIVE] Yeah, so that's incorrect. Yeah, that's incorrect. Um, yeah, when I looked at it, they submitted 1000 something, but really the um initial, my, my, my, the primary insurance already paid for some of it, and my
[CUSTOMER][NEUTRAL] Um, responsibility came to um $402. And so that's what they should be.
[CUSTOMER][NEUTRAL] Um, asking for and so I got the letter that said that.
[CUSTOMER][NEUTRAL] It was, I guess it was denied maybe because I'm trying to upload some documents but I can't upload because it's been already been processed. So I'm just wondering what I can do to expedite this or, you know what I mean like um I called another time and somebody told me, OK.
[AGENT][NEUTRAL] OK, I can let you know what.
[AGENT][NEUTRAL] Um, so it looks like for this one we requested a detailed explanation of benefits. What they sent didn't show us what your patient responsibility was. So if you do have that information,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Unfortunately, because your policy is no longer active, you can't use the online service center, but you can um submit it either by fax or mail. You can mail in the, if you have the correct explanation of benefits that shows the amount you owe, then we can reprocess the claim.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But they should also be doing this, right? Correct?
[AGENT][NEUTRAL] Yes, ma'am. We did send the request out to them also, so you can follow up with them to make sure they got that request, let them know what we're requesting, and uh they'll just resubmit the claim with the information we um.
[AGENT][NEUTRAL] We request it from them.
[CUSTOMER][NEUTRAL] OK, so I can, I can do this. I can submit these documents, but um.
[CUSTOMER][NEUTRAL] They also got the same request which they should also be, OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome. You have a wonderful day. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye bye.