AccountId: 011433970860
ContactId: eb55e423-8610-4e12-b5b1-0f46f1af9f41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 506790 ms
Total Talk Time (AGENT): 202521 ms
Total Talk Time (CUSTOMER): 155000 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/eb55e423-8610-4e12-b5b1-0f46f1af9f41_20250424T13:11_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] Uh, yes, [PII]. My name is [PII] and my policy number is 204.
[CUSTOMER][NEUTRAL] 1957.
[AGENT][NEUTRAL] And may I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, [PII] [PII] and mm.
[CUSTOMER][NEUTRAL] Is it under [PII]?
[AGENT][POSITIVE] I do apologize, one second. That is correct and thank you for verifying that information. How may I assist you today?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Excuse me, I keep trying to put through two gap claims.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] It, you keep telling me I need this information. Last time I called, you told me what I needed, I wrote it down. I called the hospital and they sent me, I waited, they sent me what I told them I'm assuming cause I don't know what it is. And now you're saying you need something else.
[AGENT][NEUTRAL] I do apologize for that. Let me get your file pulled up. Is this for data service 552024?
[CUSTOMER][NEGATIVE] What is it? No, no, no, no.
[CUSTOMER][NEUTRAL] It's for, um, one was 1:15 and the other one was 120.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] The 115 and the 120, is that the date of service?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the rest of the files I've uploaded on there anymore.
[CUSTOMER][NEGATIVE] They're gone.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Because I'm not showing 115 or 120 in our system.
[AGENT][NEUTRAL] I'm showing we processed a data service 552024 for urgent care visit and we asked for the EOB on that one.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Let me get that piece pulled up.
[CUSTOMER][NEUTRAL] No, this is for this year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because this one was submitted.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] In 2024, so I don't see anything for this year.
[CUSTOMER][NEUTRAL] It's the, the.
[CUSTOMER][NEGATIVE] The newest things that I uploaded are in there, but anything previous that I sent is, is not there.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, so they're for your husband.
[CUSTOMER][POSITIVE] Yes, I'm sorry.
[AGENT][NEUTRAL] OK. I was looking for you. OK. So let's go over to him.
[AGENT][NEUTRAL] Let's see, so we do have claims for [PII] looks like they were submitted.
[AGENT][NEUTRAL] April, OK, so let's get over to those dates of service.
[AGENT][NEUTRAL] So there was a hospital stay, 115 to 125. Looks like they asked for the diagnosis code and then they asked for the primary insurance EOP. So let me see what we have.
[AGENT][NEUTRAL] One moment, let me get this pulled up and see what we have on file.
[AGENT][NEUTRAL] I do apologize. I was looking under your file.
[CUSTOMER][NEUTRAL] I'm sorry, I didn't even think.
[AGENT][POSITIVE] It's OK. We'll get it together.
[AGENT][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] Thought I had it all together, but I guess not.
[AGENT][POSITIVE] It's OK. We're gonna get it.
[AGENT][NEUTRAL] OK, I'm just looking through.
[AGENT][NEUTRAL] This is the data service.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] I'm just going through the pages that you previously submitted and see what we're missing.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] I don't know what else I could possibly.
[AGENT][NEUTRAL] Yeah, and I just want to see what.
[AGENT][NEUTRAL] OK, so this is the itemized bill for the provider.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] But there were two instances. One on the [PII], he went from the [PII].
[CUSTOMER][NEUTRAL] That was a Wednesday. Go out Friday, and then he had to go back in Monday for surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Was that surgery outpatient?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so he went back.
[CUSTOMER][NEUTRAL] He was in, he was admitted.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I have all this insurance and it's like jumping through hoops to.
[CUSTOMER][NEUTRAL] Claim any of it.
[AGENT][NEUTRAL] Yes, they are very particular on that.
[AGENT][NEUTRAL] And there is a UB here. It does have the diagnosis code on it. So,
[AGENT][NEUTRAL] We don't need a diagnosis code. We need
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] As of right now, the only thing that I am missing is.
[AGENT][NEUTRAL] The primary insurance EOB.
[AGENT][NEUTRAL] Cause I do see that, who is your primary insurance?
[CUSTOMER][NEUTRAL] What's that?
[AGENT][NEUTRAL] Is it United
[CUSTOMER][NEUTRAL] United Healthcare. Mhm.
[AGENT][NEUTRAL] OK. So United has an EOB which shows what was applied to your copays, your co-insurance, and our deductibles. That's what this policy will pick up, but we can't process the claims until we receive the EOB.
[CUSTOMER][NEUTRAL] EOB. Would that be like the bill?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, it'll be an explanation of benefits.
[CUSTOMER][NEGATIVE] Oh, I submitted that no.
[AGENT][NEUTRAL] It comes from um United.
[CUSTOMER][NEUTRAL] Explanation.
[CUSTOMER][POSITIVE] Of benefits, OK, I'll get on the website and see if I can, I can just probably pull it off of my profile, right?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it.
[AGENT][NEUTRAL] Yes, yes, and it shows what was applied on each data service that he was in the hospital because it looks like we have everything else we need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, I'll look for that and submit that.
[AGENT][POSITIVE] Yes ma'am, and once you get that over to us, we'll get these claims processed for you.
[CUSTOMER][NEUTRAL] OK, and you said your name was? I'm sorry?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you very much, [PII].
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life. Have a great day, [PII].
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.