AccountId: 011433970860
ContactId: f46b1c54-da6b-42c9-95e5-c6e98024e06d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 780640 ms
Total Talk Time (AGENT): 288595 ms
Total Talk Time (CUSTOMER): 379347 ms
Interruptions: 10
Overall Sentiment: AGENT=0.1, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/f46b1c54-da6b-42c9-95e5-c6e98024e06d_20250624T17:29_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, yes, I'm calling in reference to um some claims I've submitted online.
[AGENT][NEUTRAL] OK, I can take a look at that for you. Could I get a callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. If I could get your policy number, please.
[CUSTOMER][NEUTRAL] It's 02
[CUSTOMER][NEUTRAL] 5024444
[CUSTOMER][NEUTRAL] M L 8
[AGENT][NEUTRAL] OK, if you could verify.
[AGENT][NEUTRAL] Uh, your full name and date of birth.
[CUSTOMER][NEUTRAL] Uh [PII] [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying that information and you said you are calling in reference to.
[AGENT][NEUTRAL] Uh, some claims you submitted.
[CUSTOMER][NEUTRAL] Yeah, so I submitted, um, I've been doing this for a month already, um, I submitted some claims at the beginning of the month on the [PII]. Well, the first thing I'm having issues is with your website, um.
[CUSTOMER][NEGATIVE] I created the new website. I've spoken to a few people already, they told me that I had to clear the browser and all that, but it still doesn't work. Like all the claims come out as pending. They don't have my name, they don't have a status, they don't have anything. They just, it just comes out like that.
[CUSTOMER][NEGATIVE] I even received a text from you guys it's not even in this, it's not even on the website.
[AGENT][NEUTRAL] OK. OK, so it's not that it's not going through, you're just not being able to see updated information regarding your claims.
[CUSTOMER][NEUTRAL] And we had a
[CUSTOMER][NEGATIVE] Right, well, that's the first problem. I can't even see uh uh updated information, um, like you guys send me a check on Saturday and it doesn't even reflect in this website.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, we had like a, like, um, what do you call that, like a, a wellness fair here at, at, at, uh, at my employer, and there was a rep from APL and he took down my information and so supposedly someone was gonna call me and it's been a week and no one's called me yet. Um, but in the text that you guys sent me on, that I received in the mail on Saturday, um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I really don't understand the notes because it says like.
[CUSTOMER][NEUTRAL] You paid me, you paid me, I guess, for the MRI?
[CUSTOMER][NEUTRAL] Which I had done. But then, it's just something, I mean that.
[AGENT][NEUTRAL] OK, can you give me a claim number so because there's a few just so I'm looking at what you're looking at.
[CUSTOMER][NEUTRAL] Oh, I don't know because I can't see the claim.
[AGENT][NEUTRAL] OK, so this is not based on an explanation of benefits. OK, you said a text, you did. OK, let me.
[CUSTOMER][NEUTRAL] Because they all of them say pending.
[AGENT][NEUTRAL] Let me look what was recently process.
[CUSTOMER][NEUTRAL] So I started, I started this, I started this back on, on [PII] was the first claim I put in.
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What was the problem with that one? I don't, I don't, there was a problem with the claim. Oh, I didn't you, I couldn't write the diagnosis coded.
[CUSTOMER][NEUTRAL] OK, so then I got.
[CUSTOMER][NEUTRAL] The next one that I submitted, which was on the [PII], I submitted.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] The report
[CUSTOMER][NEUTRAL] And the, the script that they gave me for the MRI.
[CUSTOMER][NEUTRAL] With the, with for the doctor's visit.
[CUSTOMER][NEGATIVE] Apparently that wasn't good enough. So,
[CUSTOMER][NEUTRAL] When I called again, they told me, no, no, no, no, you have to go to the doctor and you have to get um notes, like the actual doctor's notes with the diagnosis code signed by the doctor, so on and so forth, what they put in your file. So I did that and I submitted it back on the [PII] then.
[CUSTOMER][NEGATIVE] But you see all of that that I've submitted online, I can't see anything. It just says pending, doesn't show my name, doesn't show that you've received it. It just says uploaded.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't know what the status is. I can't, I can't.
[CUSTOMER][NEUTRAL] So I don't know what you see on your end.
[AGENT][NEUTRAL] OK, so I, I can definitely see the claim. I just wanna make sure.
[CUSTOMER][NEUTRAL] Claims for.
[AGENT][NEUTRAL] As far as what is it, are you wanting to know as far as payment because as far as the system issue, that will be handled by a different department, but I want to make sure any other issues or questions regarding actual payment.
[CUSTOMER][NEUTRAL] Are
[AGENT][NEUTRAL] Uh, what those questions are because I can answer those questions.
[CUSTOMER][NEUTRAL] Well, yeah, because like I had, I've had.
[CUSTOMER][NEUTRAL] I've had 3 visits up to now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I only, like the, the text that I got in the mail was for, I think $125 is what I think they sent me. And I think it was for the MRI from what I understand, the MRI and then one visit of the doctor.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One of your offices, yes, so that payment was for [PII]. That was an office visit. The $50 was paid towards data service, [PII] with Doctor [PII]. The $75 was paid.
[CUSTOMER][NEUTRAL] Which I think is one of the office visits.
[CUSTOMER][NEUTRAL] Yes, but right, but then it says.
[CUSTOMER][NEUTRAL] For the MRI.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] For the MRI?
[AGENT][NEUTRAL] The $75 was for the MRI performed on [PII].
[CUSTOMER][NEUTRAL] OK, so then my question is because in that paperwork that where the check is attached, which I didn't bring it with me, it says that my max benefits have been exhausted like how can that be?
[AGENT][NEUTRAL] And let me check and see Max benefits exhausted.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Not diagnosed
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And so, on which date are you receiving or sending a message that your max benefits are exhausted?
[CUSTOMER][NEUTRAL] It was, it was in that check. It was in that, uh, again, I don't have to check with me, but it was in that check, the, you know, the thing in the back that explains the stuff because
[CUSTOMER][NEUTRAL] Uh, I've spoken to several different people, and several different people have told me to do it several different ways. So, when I asked, I go, because I've been to like 3 visits with [PII]. I, I've, I've been going every 2 weeks, and I know after a while I'm gonna get maxed out, but I've only gotten paid 1 visit. So how can I be exhausted?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You know, because I think it's like 4 visits a year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what I'm looking at, I do not show where you've received that message. So I would need maybe a particular date in which you received a message or in the statement, it said that you had maxed out the benefits. The only max that I see is for that data service. So for instance, an office visit of course pays only up to $50 for a specialist $25 for a general, so it will say.
[CUSTOMER][NEUTRAL] So, um.
[AGENT][NEUTRAL] You know, you receive the maximum benefits for that date of service, but you haven't maxed out any like calendar year benefits.
[CUSTOMER][NEUTRAL] OK, so now.
[CUSTOMER][NEUTRAL] Do you see the other claims that I've submitted because I submitted one for.
[CUSTOMER][NEUTRAL] Oh, I have them here. Hold on. I submitted one for the.
[CUSTOMER][NEUTRAL] Data service of 6121 for the date of service.
[AGENT][NEUTRAL] OK, so that's gonna help as far as can we do data service by data service and I can go through it for you.
[AGENT][NEUTRAL] And you said [PII] you submitted a claim for that data service? OK, so I'm not showing a.
[CUSTOMER][NEUTRAL] OK, so I'll stand up MRI one.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII]. When was that information submitted?
[CUSTOMER][NEUTRAL] I submitted that on the [PII].
[AGENT][NEUTRAL] [PII]. OK, so.
[CUSTOMER][NEGATIVE] Oh no, wait, this one I haven't submitted. Sorry, sorry, this one because I haven't gotten the the the explanation of benefits. I'm so confused. I'm, I'm confusing myself of how many times I've done this.
[AGENT][NEUTRAL] That's OK. Yeah, if we can just go day by day by day, it'll be easier. So what I see for [PII] that we received from you, it includes dates of service, [PII].
[CUSTOMER][NEUTRAL] OK, so,
[AGENT][NEUTRAL] Um, [PII] and [PII].
[CUSTOMER][POSITIVE] And then I should have another one for.
[AGENT][NEUTRAL] Those are the dates that I see that were received on May, I'm sorry, on [PII] of that claim, it looks like we made a $50 payment towards uh the office visit on [PII]. $50 was paid. Now that was just recently, let me see, that payment went out on the [PII]. So you may have not received that one yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so then I probably haven't.
[CUSTOMER][NEUTRAL] I haven't received that yet, OK.
[CUSTOMER][NEUTRAL] OK, so then I, I've been paid 2 visits, 2 doctor's visits.
[CUSTOMER][NEUTRAL] The thing is that this is an ongoing um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Issues so obviously the doctor doesn't want to process the payment. I mean the, the insurance, so I have to do it on my back end. So I just wanna make the thing is that the, the website doesn't show me anything so I can't even see if it everything still pending.
[CUSTOMER][NEGATIVE] So I can't even know what's going on. Before I used to be, it, it was said processing or in the process or checking, but now you can't see anything on the, on the website.
[AGENT][NEUTRAL] OK, OK, like I said that would be handled through customer service so I can go through the claims and we can um you know, make sure you.
[CUSTOMER][NEUTRAL] OK, so you paid visits.
[CUSTOMER][NEUTRAL] Right, so the 12 I haven't submitted because I haven't, I don't have that, um, that, um, I haven't gotten the explanation of benefits from the Aetna yet, so I haven't submitted that one. So as of now I should be OK if I, if that payment's coming in.
[AGENT][NEUTRAL] Yes, that is the most recent payment.
[CUSTOMER][NEUTRAL] Because it would be for the [PII] and the 520. OK, so that's, that's correct. So I'm pending the 10512 because obviously I haven't received the bene the explanation of benefits from Aetna.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] OK, so then how can I talk to someone about this website because it's driving me crazy.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK, hold one moment. I will, uh.
[AGENT][NEUTRAL] Get you over to someone that can, they may have to do a reset if you're not able to read um any kind of recent information, but hold one moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Hey [PII], real quick question if they are calling saying.
[AGENT][NEGATIVE] When they go on to this website, they can't see anything like for instance, the claims on our end show they've been paid, check's been sent out, but they're not able to see that. She's saying everything is just showing pending.
[AGENT][NEUTRAL] Have you had?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Customer care. OK, that's what I want to make sure. Is is it care team or customer service? Who is it?
[AGENT][NEUTRAL] All the time.
[AGENT][NEUTRAL] Nothing. OK.
[AGENT][NEUTRAL] OK, I'm just trying to figure out where they go. All right, that's.
[AGENT][NEUTRAL] This should drive, let me get out this file.
[AGENT][POSITIVE] Thank you.