AccountId: 011433970860
ContactId: df2b1104-db86-414b-aff1-c2cb4ee3f341
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1208890 ms
Total Talk Time (AGENT): 206660 ms
Total Talk Time (CUSTOMER): 643750 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/df2b1104-db86-414b-aff1-c2cb4ee3f341_20250613T16:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEGATIVE] Hi, yes, um, I was speaking to someone a few minutes ago and um she told me she was gonna call me back and she did but I didn't pick up the phone. I, I didn't get to it on time, so.
[CUSTOMER][NEUTRAL] But I don't know what extension she's at.
[CUSTOMER][NEGATIVE] Um, because I was talking to her about my claims that, um, I see them on the site, but there's nothing like I uploaded them and but I can't see anything else like it my name doesn't come out, uh, nothing is coming out it just says the date that it was received but nothing else.
[CUSTOMER][NEUTRAL] So is there any way that you can see who was attending me?
[AGENT][NEUTRAL] OK. May I have your name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], can I have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02502.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 44
[CUSTOMER][NEUTRAL] 4 ML 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And could you verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I do need to call back number just in case the call is disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I'm not seeing.
[AGENT][NEUTRAL] Any notification of someone that returned the call?
[CUSTOMER][NEUTRAL] OK, this is like you're gonna be like my 4th person I spoke to in the last week. This person I spoke to a few minutes ago, she told me that I, I can't see anything on your new website. I've already signed up for the I, I used to have the old website then, um, when I went to file a claim, you guys had changed the website or changed the way you enter so I had to.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do this whole authentication system. I did this. I have access to the new, I guess dashboard that you guys are using, so on and so forth.
[CUSTOMER][NEUTRAL] I submitted the claim through there back on [PII], which was last Thursday.
[CUSTOMER][NEUTRAL] The claims come out as like,
[CUSTOMER][NEGATIVE] Like nothing's been, it's, it's just pending but there's nothing else. My name doesn't come out, confirmation number doesn't come out, nothing. It's says status uploaded. So she told me that, oh, that she sees in the system that um that has been denied because it doesn't the diagnosis code it you can't write it in anymore apparently in the form. It has to be like a doctor written thing. Is that correct?
[AGENT][NEUTRAL] That would be correct. We no longer take written.
[CUSTOMER][NEUTRAL] OK, so then I, I asked her, OK, if I provide the script for the MRI this is the diagnosis code, would that be sufficient enough, obviously signed by electrically signed by the doctor that I went to see to to that referred me to get the MRI to get the procedure done and all of this and that and she told me, yeah, that was fine, so um.
[CUSTOMER][NEGATIVE] But I'm asking her why is it that I can't see anything on your website?
[AGENT][NEUTRAL] So even the claims that has been processed.
[CUSTOMER][NEUTRAL] So she's telling me that, that, that, that.
[CUSTOMER][NEGATIVE] Yeah, like I can see the claims back in the day, like the old ones from like last year or the last one that was [PII]. I can see that, but the claims that I submitted a week ago, nothing comes out like it says pending, it doesn't even say my name, doesn't give me a confirmation number, it doesn't give me anything. It doesn't even tell me that it's been denied because she says, oh you're gonna get a letter in the mail because we're, you know, stating that you need diagnosis code. I, I can't see that online.
[CUSTOMER][NEUTRAL] So what's the issue? Is it a glitch or is it?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] That the website's not working.
[AGENT][NEUTRAL] Let me see if I can, hold just one second, let me check something for you.
[AGENT][NEUTRAL] And I'm still here on website.
[CUSTOMER][NEGATIVE] But at least with the other website, when you upload the claim, you, you got like a, a thing that it, you, you could see it there pending, or you could see the confirmation number, but this doesn't give you anything. It doesn't even like, how do I trust that.
[CUSTOMER][NEUTRAL] Like that, that it was even, that what I'm doing, you're receiving is my question.
[AGENT][POSITIVE] Yes, because I see we received something on today.
[CUSTOMER][NEUTRAL] Because I mean I understand it's not gonna show.
[CUSTOMER][NEUTRAL] Uh, well, I just submitted something new because she told me I needed to get the script. So what I did was I attached everything again. I attached the form, the script, the explanation of benefits, all of that. The script says the diagnosis code for the MRI for the visit and the MRI treatment that I, the MRI test that I had done.
[CUSTOMER][NEUTRAL] So I just literally submitted that today, like maybe 10 minutes ago. But prior to that, I had submitted on January on [PII].
[CUSTOMER][NEUTRAL] Um, what I used to prior before I guess you guys changing this diagnosis code issue that now needs to be in written form, um, we used to just be able to write it in, that's how it's always been. I, I've been with, I've had this gap insurance for over 6 years with my employer.
[AGENT][NEUTRAL] OK. Cause, um, now with the diagnosis issue, that was updated at the beginning of the year, so we no longer can accept any written.
[CUSTOMER][NEUTRAL] Right, so like I guess when they did the open enrollment here in my, when they did the open enrollment with the city, I, I work for a municipality, the brokers did not mention that.
[AGENT][NEUTRAL] So that that was implemented then.
[CUSTOMER][NEGATIVE] So, obviously, I mean, some people don't use it, but I do because, I mean, I'm paying out of supposedly what I am paying out of pocket, I'm supposed to be getting back with this secondary insurance. So, I don't get that much stuff done throughout the year, but when I do, like I had to pay out of pocket for my MRI so I, I want my co-pay back. But like I said, you know, there was no communication sent at least to us as an employee.
[CUSTOMER][NEUTRAL] From APL or anything like that but.
[CUSTOMER][NEUTRAL] It is what it is. I mean, now is when I, when I found out about it.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so when you
[CUSTOMER][NEUTRAL] Which is fine. I mean, like I said, I don't, I, I.
[CUSTOMER][NEUTRAL] But I, when I asked her now, is the script from the order form stating to get an MRI cervical without contrast assessment, and then it gives you the, the, the cervical spondyliosis um diagnosis. Is that enough? And she told me yes. It's signed by the, the, the doctor, like electronically signed. She told me that that was sufficient to put with a claim. Is that correct?
[AGENT][NEUTRAL] I'm pulling that image up that you did see it and I'm looking at the claims that were submitted as well.
[CUSTOMER][NEUTRAL] I'm sorry, I didn't understand what you said. I'm sorry.
[AGENT][NEUTRAL] I'm pulling up the claim that you submitted in today and I'm also looking at the claim that was submitted previously as well.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And could you verify your mailing address for me as well, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and did they ask if you wanted to update your email address?
[CUSTOMER][NEUTRAL] Uh, yes, I gave it to the last person that I was um.
[CUSTOMER][NEUTRAL] That I was um talking to.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And they did advise you that it would have to be a personal and not your work email.
[CUSTOMER][NEUTRAL] Yes, I gave her a personal email. Yes, I did.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'm looking now.
[CUSTOMER][NEGATIVE] Yeah because I can't even see like the claims. I can't even see what I've uploaded like before you could you could you could see like your paperwork and stuff but you can't even see that anymore on this new website.
[AGENT][NEUTRAL] OK. So I did find the person that's
[CUSTOMER][NEGATIVE] Like before you could even like read the comments, like with the comments you guys have put on, like if it was pending, whatever, but this is not, this website's not working like the other one used to work. I don't know if it's a glitch or, or it's just that.
[CUSTOMER][NEUTRAL] It's not
[CUSTOMER][POSITIVE] Being worked on. I, I don't know.
[AGENT][POSITIVE] I did find the person that you spoke with. I'm reaching out to her now for you.
[AGENT][NEUTRAL] And I do see for this claim the date of service of 5-165-13. I do see that.
[AGENT][NEUTRAL] Diagnosis code listed.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] I'm highlighting that information as well.
[CUSTOMER][NEUTRAL] Right, because the person originally when I spoke to the first time around.
[CUSTOMER][NEUTRAL] Told me that for, for example, for [PII], which is the doctor that's attending me, that even though I've had two claims in the, in the same month that I only needed to do one paper.
[CUSTOMER][NEUTRAL] So I originally went to see him for the pain, which was a [PII] visit. He sent me the MRI so I went to do the MRI and then I went to get the results on [PII].
[CUSTOMER][NEUTRAL] So it's obviously all with the same diagnosis code.
[CUSTOMER][NEUTRAL] So she told me, oh, you only need to do one claim for one for the same doctor, is that correct?
[AGENT][NEUTRAL] OK, now the only thing is in regards to that with this data service that was submitted in, it is just showing that for today, which is [PII], it is giving us the diagnosis code. Now for the other dates of service, it's not indicating that that is the reason for that visit, so that may not be sufficient enough. It has to indicate that date of service listed.
[CUSTOMER][NEUTRAL] OK, so my question is, what is it that I need to ask this doctor's office for? Because now this is the other, this is the main problem with these insurances that.
[CUSTOMER][NEGATIVE] The the doctor's office doesn't want to process the APL, so you as a customer, me as a customer, have to do all this paperwork and do all this to get my money back. But now when I go back to them and tell them, Hey, I need this for this visit, oh no, what I gave you should be sufficient. So what is, what type of paperwork or what is it that I need to tell the the office that they need to provide me with so I can get my money because I have.
[CUSTOMER][NEUTRAL] $120 just on office visits plus $75 in in um in the MRI so I'm out like $300 at this point.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So when you go to the doctor, if they're not submitting the claim over to us, they will give you documentation for the reason of that visit.
[AGENT][NEUTRAL] And that documentation does indicate why they saw you on that date.
[AGENT][NEUTRAL] And that will be the documentation that is needed.
[AGENT][NEUTRAL] Anything with their name, date of service, and the reason for that visit is what's sufficient for us to be able to review.
[CUSTOMER][NEUTRAL] OK, documentation for the visit with.
[CUSTOMER][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] And diagnosis code.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEGATIVE] There's gonna, there's gonna be a, a mission and a half to get this from all these doctors because no, the doctor's offices don't wanna work like they don't, well, they don't wanna go the extra stuff. They don't wanna even file the claim.
[CUSTOMER][NEUTRAL] So they're, they, you know, they tell you, no, no, no, we don't do that, we don't have that insurance, da da da da da. So now to get this from them is going to be like pulling teeth.
[CUSTOMER][NEUTRAL] But don't worry because I'm gonna call them now and I'm gonna tell them that they need to provide me this or not, I'm just gonna go in person.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Obviously I, I'm paying for an insurance that if you guys are not gonna accept it written by hand and I'm, I'm sending you the, the explanation of benefits and obviously I have a script saying I need to get an MRI for something. Obviously I'm not going to the doctor because I wanna go to the doctor. I'm going to the doctor to get my test results. I'm going to the doctor to get tested, so um.
[CUSTOMER][NEUTRAL] Let me start with the doctor's office now.
[AGENT][NEUTRAL] OK. So you do have to understand that even though it does come in writing, we only cover sickness or injury. So it's not a guarantee that that diagnosis is the correct diagnosis. So we just can't state that that is the correct one when it was submitted. So that's the reason why we're requesting the correct information from the provider.
[AGENT][NEUTRAL] That would be given to the insured on that date.
[CUSTOMER][NEUTRAL] OK, uh, I'll call them and find out what they tell me and then start with this. But I mean, like I said, you this, uh, it might, it might be something that you guys implemented it as a as of [PII], but I have not in the I've had this insurance for over eight years with my employer and I've never had an issue used to be able to write it down, send the, the, the, the explanation of benefits.
[CUSTOMER][NEUTRAL] Um, and that was it. And that we didn't get anything in writing. I didn't get anything in writing that the policies were changing. The rep when they came to do the open enrollment, didn't say anything either. So, I mean.
[CUSTOMER][NEGATIVE] It's bad in in the end of your company to not explain things to people correctly because at the end of the day we're paying for an insurance and we're, we are expecting, we're we're doing what was told for us to do and then now things have changed and.
[CUSTOMER][NEUTRAL] We're out the money and until.
[CUSTOMER][NEUTRAL] The doctor now decides to do what you guys want.
[CUSTOMER][NEUTRAL] Because, uh, like right now I'm not at the doctor's office, so it's very hard to get stuff when you call them, and it's different when I'm there and I, I won't leave the place until they give me the documentation, but I already went to the doctor on the [PII] and on the [PII], and I did this MRI a few, you know, 2 weeks ago or 3 weeks ago in the place. If I have to retrace all of that, how much time does that take me?
[CUSTOMER][NEGATIVE] Because doctor, because no one wants to work, because that's the other problem that you call the doctor's offices and you go even in person and everybody treats you bad, everybody gives you an attitude because you're putting them to work, which is, unfortunately,
[CUSTOMER][NEUTRAL] That's their job, but people don't like to hear that.
[CUSTOMER][NEUTRAL] OK, let me call, let me, let me start this process and and and call them.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, did you need for me to contact you with the person that called you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, no, I just, uh, what I, I, I, can you put in the notes what's going on with your website because again.
[AGENT][NEUTRAL] Or just, would you like for me to have her?
[CUSTOMER][NEGATIVE] That this website is not accurate. The claim says pending insured doesn't come out. It says undefined. There's no confirmation number. There's no status says uploaded it there you can't see, you can't see the paperwork you submitted that that that can't be correct.
[AGENT][POSITIVE] OK, I can reach back out to her and just let her know to give you a call back if you would like that as well.
[CUSTOMER][NEUTRAL] I mean, and this has been uh this.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] OK, and is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Thank you so much for calling American Public Life, have a great day.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] You too bye bye.