AccountId: 011433970860
ContactId: f34678f3-0979-4222-9368-75222e808fcc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 418170 ms
Total Talk Time (AGENT): 194075 ms
Total Talk Time (CUSTOMER): 219691 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/f34678f3-0979-4222-9368-75222e808fcc_20250114T20:50_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling because I had spoken to one of your reps about a month ago actually, and she was explaining to me that, you know, because what happened is I had um therapy on my knee, and when I was doing the therapy I completely forgot to do my APL card so she told me I could always send it in the um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Benefits as long as I got the, the explanation of benefits and what and I guess you would need to see, you know, I guess it'll show you in anything that I paid I need to attach that too right?
[AGENT][NEUTRAL] Uh, so let me get your policy pulled up really quick. Could I get a callback number for you?
[CUSTOMER][NEUTRAL] Yes, [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And do you have your policy number with us?
[CUSTOMER][NEUTRAL] Uh-huh, um, the outpatient is 014.
[CUSTOMER][NEUTRAL] 23,890.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, 8 number 8.
[AGENT][POSITIVE] Oh, thank you.
[AGENT][NEUTRAL] And if you could verify your date of birth, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much for uh verifying your account. Um, so,
[AGENT][NEUTRAL] Uh, you're calling to see what information would be needed to file a claim?
[CUSTOMER][POSITIVE] I had it all here. I got all my explanations, and I got like the, yeah, I got all of my receipts where I paid my deductibles ready to, to, to send to you and I.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] So I guess what I was gonna ask you because I think she said it'd be easier if I, I don't know if she said fax it or email it, um.
[AGENT][NEUTRAL] Uh, you can't, uh, email is not an option. You can fax or mail, but I do want to make sure you do, uh, have all information that's needed. Uh, we definitely do need the explanation of benefits, uh, and we need the ICD 10 code, which is the diagnosis code.
[CUSTOMER][NEUTRAL] OK, but the diagnosis codes are on your explanation of benefits, right?
[AGENT][NEUTRAL] Um, there are a few, um, insurance companies that provide that, uh, but a lot most do not due to privacy, but I'm not sure about your, um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It say
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the one looking at it says EX code and it has codes underneath like numbers. Is that what you're looking for?
[AGENT][NEUTRAL] It's usually a mix of letters and numbers. So if you can give me one, I can let you know for sure if that's the diagnosis code.
[CUSTOMER][NEUTRAL] OK, oh, this is an old one, so it says ADM 1684.
[AGENT][NEUTRAL] No, that would not be a diagnosis code.
[CUSTOMER][NEUTRAL] OK, that EX codes 147 and 25 because when I talked to the lady before that was one of the reasons I was holding off. She was telling me about the codes and I thought she said they would be under your on your explanation of benefit if you get that and I told her I don't have all of them, and that's why I waited so long to.
[AGENT][NEUTRAL] Sometimes the procedure codes are there, but the, the diagnosis which uh tells what the injury or sickness is, is normally not put on documents, like I said, due to privacy.
[CUSTOMER][NEUTRAL] So what do, how do I know?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] What you can do is uh contact the physical therapist that did your physical therapy. You can ask them over the phone, what is your ICD pin code for your services.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And now um.
[CUSTOMER][NEUTRAL] ICD.
[AGENT][NEUTRAL] And then the number 10.
[CUSTOMER][NEUTRAL] Pin
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And what you can do is just write that code on your explanation of benefits, uh, and just say this is the ICD 10 code for all services because I would imagine they're all related for the physical therapy. It's for the same condition. So you'll just say this is my diagnosis code for my, my physical therapy services and just write that code on your explanation of benefits and then you can submit that information to us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and your, your fax number is?
[AGENT][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, and on the fax that just write my name and birth date?
[AGENT][NEUTRAL] Uh, yes. Uh, not your birthday, just your name, and you wanna make sure you have the policy number on there that you provided.
[CUSTOMER][NEUTRAL] On the fact that
[AGENT][NEUTRAL] And that would be, yeah, that would be the information we need.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] That would be that would be enough.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, I have one just so you know that I just just received in the mail from North Shore and it shows that I, on the on the explanation of benefits it showed $1100.88 that supposedly I owe right? but I got the I got the letter and it's a difference of $65 the letter, the bill.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, we go by the explanation of benefits. So if it shows, we go by the patient responsibility showing on the explanation of benefits.
[CUSTOMER][NEUTRAL] OK, but I'm gonna, OK, so you don't overpay in case you, uh, in case I qualify for you to help me with this. I'm just saying to you because I even talked to AdMed before I called you, and they said, yeah, they shows the difference of $65. So in other words, it's not $1100 it's 10 1000 something, and that's what their bill says as well $1,0035 instead of $1100 they deducted $65 I guess when they went back, so they sent me a letter.
[CUSTOMER][NEUTRAL] Stating that that's what I owe now, so I'm, if you want I can send that to you and you, you know, you could do whatever. I know you guys know what to do, but I just wanted to share that with you because I mean that if you were to pay something that you're paying over, that's all I'm saying.
[AGENT][NEUTRAL] The only, the, um, I would, I would personally say not to send uh information that's
[AGENT][NEUTRAL] You know, going against the explanation of it because it could make it confusing. We are going regardless to pay by the explanation of benefits, the only way there will be any difference, like if your AMed came back and said, but you would have to submit those, that information, you know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] OK, I've no problem, OK, not a problem.
[CUSTOMER][POSITIVE] OK dear thank you.
[AGENT][NEUTRAL] You're welcome, [PII]. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much.
[AGENT][POSITIVE] OK. You have a wonderful day. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Oh, you, bye bye.