AccountId: 011433970860
ContactId: f678d5b0-a41d-426c-ae0b-40915701a02f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 508109 ms
Total Talk Time (AGENT): 204626 ms
Total Talk Time (CUSTOMER): 223129 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/f678d5b0-a41d-426c-ae0b-40915701a02f_20250620T16:13_UTC.wav
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[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for calling Life. This is. How may I assist you?
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that one more time? You were breaking up.
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. Um, my wife is with me on the phone. I'm just calling on behalf of her as well, um, so we got a letter in the mail from you guys and we're trying to figure out what exactly you guys need because I'm looking at the back of the page it currently states that, um, it says.
[CUSTOMER][NEUTRAL] We provide copies of your explanation of benefits from your summary insurance carrier. So I'm currently on my on the page for her insurance. Do you need just a coverage breakdown or what is it that you guys are currently needing or if you need to pull up her account, we can do that as well, whatever is easier for you.
[AGENT][NEUTRAL] May I have the policy number please?
[CUSTOMER][NEUTRAL] Of course, it's 025792662.
[AGENT][NEUTRAL] And you said your name is [PII]?
[CUSTOMER][NEUTRAL] My name is [PII], um, but my wife's name is [PII].
[AGENT][NEUTRAL] OK. And you said that she's on the phone?
[CUSTOMER][NEUTRAL] Yeah, she's on the phone she can hear you.
[AGENT][NEUTRAL] OK, [PII], how are you doing?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Good and you?
[AGENT][NEUTRAL] I'm doing good. How about, can you please verify your date of birth with me, please?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] And I do need to verify the mailing address that is listed on file.
[CUSTOMER][NEUTRAL] Here we go. Hey, give me one moment, because I changed my current address, but it is. [PII]. Sorry, [PII].
[AGENT][NEUTRAL] And could you verify the
[AGENT][NEUTRAL] Could you verify the email address listed on file?
[CUSTOMER][NEUTRAL] Yes, it is [PII], sorry.
[AGENT][NEUTRAL] OK, that's not the one that we have on file.
[CUSTOMER][NEUTRAL] Could it be? It's no, no, it is, uh, my work it's [PII].
[AGENT][NEUTRAL] OK, so with that being your business email address, may I have your personal? We use that for the OSC only.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can you repeat that one more time? She didn't understand you, sorry.
[AGENT][NEUTRAL] I'm needing the personal email instead of the business email.
[CUSTOMER][NEUTRAL] Your email, yes it is.
[CUSTOMER][NEUTRAL] Parties
[CUSTOMER][NEUTRAL] With [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, you will have to spell that out for me, please.
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I will get that updated in the system and may I please have a callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] And how may I assist you on this call?
[CUSTOMER][NEUTRAL] So, I received a letter from you guys that you need an explanation of benefits. It's just to confirm if I need to send only the overview uh benefits on my for my for my insurance or what you need exactly?
[AGENT][NEUTRAL] So what we're needing for.
[AGENT][NEUTRAL] The reason of that denial, it is stating that your primary EOB is requested and what the primary EOB is is from your primary insurance stating that you did have a patient's responsibility that was applied to your deductible, co-insurance, or co-pay.
[CUSTOMER][NEUTRAL] The what?
[CUSTOMER][NEUTRAL] So do you need a detailed PDF of what her coverage is or?
[AGENT][NEUTRAL] No, your primary insurance will process that claim when they, when the provider submits it to them, and then they will give you an EOB, which is an explanation of benefit or explanation of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when they submit that to you, go ahead.
[CUSTOMER][NEUTRAL] So this
[CUSTOMER][NEUTRAL] Go, go ahead, I'm sorry.
[AGENT][NEUTRAL] So when they submit it to you, it will, it will show the total bill charge with that date of service and then it will have a breakdown of if anything was applied to the deductible, co-insurance or co-pay. So the EOB is kind of like what you received from us, which is telling you that we either denied it or we either paid it. So that's what you will receive from the primary insurance as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so at the moment is there anything that she needs to do?
[AGENT][NEUTRAL] She can either contact the primary insurance to get that EOB or you if you all have access to it on the portal, they may be you may be able to download it from there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess um we're having a hard time because this we're not used to doing this all the time so we're having a hard time understanding what we need to do exactly and I do apologize for us not knowing but um we're just not clearly understanding what we need to do.
[AGENT][NEUTRAL] So, does, do you all have access to her primary insurance?
[AGENT][NEUTRAL] Website where she can go to see, OK, so you will pull you will go in and pull that date of service of when this claim from the date of service which is [PII] and you will see if the primary has processed that claim.
[CUSTOMER][NEUTRAL] Yeah, we're I'm logged in right now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] If they have, you would be able to download that EOB or explanation of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It doesn't seem like there's anything so far. Would it be better if we just called the, the provider? I mean, the, the, the coverage and just to see if they're in the process because I don't see anything right right at this moment from the [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, you will call them to see if they have received the claim and if they're in line of processing it. Then if not, you may have to contact the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And ask if they, they're going to submit the claim to the insurance.
[CUSTOMER][NEUTRAL] OK, looking right now um.
[CUSTOMER][NEUTRAL] Alright, sounds good we'll go ahead and do that, um, and then I am looking at 47, uh, where is it 418. I do see that, but it's only for [PII]. Oh yeah, Orlando Health Medical group that says it's been processed, but it's not for the same amount, so I guess they're still working on that.
[AGENT][NEUTRAL] Now, you may receive different claims for that date of service with it being inpatient, you will receive the facility, possibly some lab work, possibly um diagnostic. Anything that was rendered within that time of that service, you may receive a different bill.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] OK, so we'll go ahead and call the the company and see where we're at with it and I guess we would just have to follow up with you guys.
[AGENT][NEUTRAL] Yes, if once you receive that documentation, you can submit it in and once that examiner receives it, they will review it and if it's eligible to be processed then it will be processed at that time.
[CUSTOMER][POSITIVE] OK, well thank you so much I really appreciate your time.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today, [PII]?
[AGENT][NEUTRAL] And [PII]?
[CUSTOMER][POSITIVE] No, that'll be it. Have a great day. Thank you.
[AGENT][POSITIVE] You're welcome. You're welcome and thank you so much for calling American Public Life. Have a great day as well.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you, bye.