AccountId: 011433970860
ContactId: ece94b27-c0aa-476f-b5e3-e0ae366a157d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 542559 ms
Total Talk Time (AGENT): 237184 ms
Total Talk Time (CUSTOMER): 269255 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/ece94b27-c0aa-476f-b5e3-e0ae366a157d_20250516T22:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, sorry, um, I have a claim, uh, I had a sleep study, uh, test done, and I was under the impression that it was covered 100%, um, through American Public Life, and I'm calling to find out if that's true or not because I received a bill and I'm trying to figure that whole thing out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can um check your claim status for you sir. Can I please get your name and your call back number?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK and [PII], what is your callback number just in case the call drops I'll be able to call you back.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then what is your policy number, sir?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, it's 02572509.
[AGENT][NEUTRAL] OK, let me look up your policy real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright [PII], I'll need for you to please verify your date of birth for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Uh, my address is [PII]. Um, and my email address, you said it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then I see that the phone number that you gave me to call you back on, is that your cell?
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] OK, let me look at your policy real quick so I can find your claims.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] All right, I do show that we did receive a claim on [PII], which is still in process and there's no information on that one. on [PII], we received a claim.
[CUSTOMER][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Uh, for
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, so there's a, there was a couple, right? So that I just did two of those, right? So the first one I did, um, the first claim, let me get to it right here. I'm online, I'm online also, um, I, if I look at the first claim there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now the one that we received.
[AGENT][NEUTRAL] On [PII], the claim number is 3600506. It does have some remarks on there.
[CUSTOMER][NEUTRAL] Right, yeah, so, so it did say, mhm.
[AGENT][NEUTRAL] Um, the first one being.
[AGENT][NEUTRAL] Yeah, the first one is that office visits are not covered by the policy and then.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] We have received your claim, but in order to provide further consideration of this loss under this policy, we will need supporting documentation to evidence the accident sick of accident or sickness. Documentation may include but not limited to did you get that remark?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I see, I see, yeah, I, I do that, but I don't know what that means. I don't, I don't know what you're asking what what you're asking for there, um, I, what I did is I did.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I did see that it said uh any kind of supporting documentation uh itemized bill so I that's what the second claim is I just uploaded the bill that I'm receiving from the uh sleep study uh company that did it. I, I don't know if that's what you're looking for or, or really I'm asking you tell me what what documentation do you need?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] They're looking for documentation to support that this claim is for an accident or sickness.
[CUSTOMER][NEUTRAL] Uh well, it's not an accident. It's, it's, it's a sleep study, right? It's a, it's, I have sleep apnea. I was diagnosed with sleep apnea. Uh, I went to the doctor. The doctor diagnosed it. He said, hey, you need to get a, a sleep study done. Um, I had the sleep study done. The doctor said, uh, yes, in fact, you do have sleep apnea. They prescribed to me a CPAP machine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] I've been using for 2 months now. Um, and it's suggest that these are the pills that are coming now from the, the sleep study that, uh, my doctor did, [PII], I think is the sleep study doctor who ordered the test, you know, so, um,
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] I, I, I'm, I'm happy to provide you with whatever information I, I mean, documentation. I just don't know what I would be able to provide you what what is it that you need exactly.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So, um, any documentation that you can get, um, the itemized statement with the diagnosis codes and procedure codes, um, the explanation of benefits from your primary insurance, and then if you can get the documentation from the doctor about the sleep study and send it in.
[AGENT][NEUTRAL] Um, that's what they're asking for is documentation to show that it is an accident or sickness because these, this policy covers for accident or sickness.
[CUSTOMER][NEUTRAL] OK, is that something that you guys work with a doctor on, or do I get that I'll have to get all that information from the doctor and get him to upload it, you know, give it you're gonna have to go to the doctor now and say, hey, I need this documentation. Can you print this out for me so that I can upload it into your system, um.
[AGENT][NEUTRAL] Correct. Yes, sir. You'll have to send it in if they don't send it in for you.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hm, OK, um, I guess if I, if I gave them your, you know, the my card, I mean they already have a copy of it, but if I gave them the card and said, hey, you know, um, you know they need this information, you know, can you guys, you know, contact them and if is that something they can contact you directly and give that information to you over the phone or or I'm just trying to figure out like I don't wanna be in the middle of it, you know.
[AGENT][NEUTRAL] No, sir, um, we'll actually have to have
[AGENT][NEUTRAL] Right, I understand we'll actually have to have the documentation.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uploaded from the online service center so that the claims specialist has it to review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, and this policy, then, uh, I mean this you said this is is accident or sickness when you say sickness, this is like a policy that goes along with my insurance, correct? Like, like what I understood from our company is that we have a, we have a, we have a policy that, that has a deductible, you know, whatever the insurance company is, you know, we have United Healthcare.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And there's a like a $2000 or 5000 whatever it is, uh, deductible and then we have a gap plan for that exact amount so that we whenever there's an, you know, a situation we can just go to the gap plan and say, OK, well, you know, that's, that's why we have the gap plan is that my understanding correct because you're saying it's for sickness I'm assuming that that we're talking about the same thing there.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes sir, uh, and this policy does help with deductible co-pay or co-insurance only.
[AGENT][NEUTRAL] So if you're, if you had a deductible co-pay or co-insurance, of course, you know, you would want to file. And it does have um outpatient benefits for sickness or illness. Um, it does show that you can have a sleep study in a hospital facility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or home, but all the documentation needs to be sent to.
[AGENT][NEUTRAL] And from the study itself to show that it was done.
[AGENT][NEUTRAL] In order for them to be able to complete the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I got you. OK, so I'll, I guess what I'll do is I'll, I'll contact my doctor and, and based on that because I have that same sheet that you're reading to me, obviously, so I'll, I'll provide that to them and see if they can give me copies of whatever this, you know, uh, any kind of a documentation that would, uh, support that with the with the diagnostic codes and and all of that, OK.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, sir. Anything, anything that you feel
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] So like we'll help your claim go ahead and gather it up and send it in.
[CUSTOMER][POSITIVE] OK, all right, will do then. OK, well thank you so much. I appreciate your help thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome, [PII]. Is that everything I can help you with today?
[CUSTOMER][POSITIVE] Yes, yeah, yep, yep, that's it.
[AGENT][POSITIVE] OK, well you have a good weekend and thank you for calling APL sir.
[CUSTOMER][POSITIVE] You too thank you very much bye bye.
[AGENT][NEUTRAL] Bye-bye, sir.