AccountId: 011433970860
ContactId: f77897f6-96ed-412d-aba1-d22ea6d911e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 336239 ms
Total Talk Time (AGENT): 164992 ms
Total Talk Time (CUSTOMER): 165392 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/f77897f6-96ed-412d-aba1-d22ea6d911e7_20250415T18:38_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]. Um, my name is [PII], and I'm calling because I have um some questions about a claim.
[AGENT][POSITIVE] OK, I can help you with that, [PII].
[AGENT][NEUTRAL] Can I get a callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is uh the policy number you're calling on?
[CUSTOMER][NEUTRAL] Um, 240-573-9.
[AGENT][NEUTRAL] OK. And, and [PII], if you could verify your date of birth and mailing address, please.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you so much for verifying your account and you said you're calling in reference to a claim?
[CUSTOMER][NEGATIVE] Yeah, and I think I just really might have screwed something up. So, um, I filed a claim.
[AGENT][NEUTRAL] Who's the claim for?
[CUSTOMER][NEUTRAL] It's for [PII], my son.
[AGENT][NEUTRAL] OK, I see it here. OK. And how can I help you?
[CUSTOMER][NEUTRAL] So I filed
[CUSTOMER][NEGATIVE] I filed a claim and I have a claim number and then I called this morning to ask about, like, what is going on, because I was expecting that, you know, it, it would be done and I can't, couldn't see anything on my online account. I kept getting a technical error. And she said that I needed to upload explanation of benefits. So that wasn't like.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] this morning so I just went to do that and when I uploaded the files it it looks like it didn't attach them to the claim number it looks like I've submitted a new claim and I didn't I did not want to do that so I can you guys still see those files?
[AGENT][NEUTRAL] And that is fine, yeah, that is, that is OK when you upload it will upload as a new claim every time, but we, we are able to see the claim before where we request the information and we check the information, the dates and all that to make sure they match so it is that is the way it will upload as a new claim.
[CUSTOMER][NEUTRAL] OK, perfect. So I just uploaded the um explanation of benefits. There's like 6 of them and unfortunately, the way my insurance makes the PDFs like my daughter is randomly in there, but it has all of [PII]'s stuff too. So all of the explanation of benefits that I was able to pull from the Aetna website, I've uploaded. But then she also said I need to get something from the hospital with itemized billing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, so what we actually need is the, let me see what so we requested the.
[CUSTOMER][NEUTRAL] Do you see that?
[AGENT][NEUTRAL] The explanation of benefits and we also requested the diagnosis code, which is the ICD 10 code. Um, let's see, so this is the emergency room visit. So when you, uh, when they, when [PII] had the services, you should have received a discharge summary. I'm not sure if you still have a copy of that.
[AGENT][NEUTRAL] So the discharge.
[CUSTOMER][NEUTRAL] Um, I can ask him.
[AGENT][NEUTRAL] OK, cause that will have what the information that we need, it would. So it'll have a description of why he was treated in the emergency room. So the admit and discharge sum summary basically.
[CUSTOMER][NEUTRAL] Would that have it on there?
[CUSTOMER][NEUTRAL] So his like appendix surgery will be on there.
[AGENT][NEUTRAL] Yes, the description of the, uh, why he was being treated in the emergency room on that date.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, so if he doesn't have his discharge summary, he can call and get hopefully the hospital to send that to him, um, and then I can just upload it separately like I just uploaded the explanation of benefits.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright perfect well I will work on that piece now then I just wanted to make sure when I saw that it like uploaded a a new claim that freaked me out a little bit.
[AGENT][NEUTRAL] Oh, OK, that's fine. Yeah, that is fine. We, we do know to, you know, put the information together and look at the dates. Uh, so that is fine, so.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] All right. Well, thank you so much for your help.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] No, I'll work on getting that over. I, I, I do have a question though, like, so once I upload the next file, what does that look like as far as time frame to like complete?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So claims are processed within 2 to 4 business days from the receipt of the information. So let's just say if you don't get this in before we process, um, the claim will probably deny again for the uh diagnosis code until we receive that information. So if you can get it in before the claim is um.
[CUSTOMER][NEUTRAL] Is it pretty quick?
[CUSTOMER][NEUTRAL] Or we
[AGENT][NEUTRAL] Processed the new information.
[AGENT][NEUTRAL] Um, we can go ahead and get it taken care of.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it is 2 to 2 to 4 business days from receipt of information.
[CUSTOMER][POSITIVE] OK perfect yeah well.
[CUSTOMER][NEUTRAL] Yeah, we'll see. I mean, my, my son is in college, so the fact that he probably doesn't still have that, and I'm 4.5 hours away, so we're, we're most likely gonna have to go to the hospital, but I'll work through it and get it uploaded. And as long as I, you know, like I said, if it closes and then I upload it again, as long as that works, I'm OK with it.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] OK, OK, yes ma'am. Well, you have a wonderful day. Thank you for calling APL.
[CUSTOMER][POSITIVE] Thanks for your help.