AccountId: 011433970860
ContactId: 00bab2d3-81eb-4fc9-9a1e-0285ae70d7e0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1015039 ms
Total Talk Time (AGENT): 303521 ms
Total Talk Time (CUSTOMER): 596538 ms
Interruptions: 9
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/00bab2d3-81eb-4fc9-9a1e-0285ae70d7e0_20250428T12:49_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provider to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So, may I know how can I help you with the patient's information or the provider's information?
[AGENT][POSITIVE] Yes [PII], I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. No extension, it's a direct line. And the policy number is 1,348,850 M as in Mike, L as in Lima 8.
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth and I'll be able to assist you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth of the member is [PII].
[AGENT][NEUTRAL] Thank you [PII] and what is the date of service that you're calling about today?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So let me give you the correct policy number that it would be under.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The policy number is 1896507. That's 1896507.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] However, the policy was terminated, so there was no payment made on this claim.
[AGENT][NEUTRAL] Would you like that claim number?
[CUSTOMER][NEUTRAL] OK, so the member was not act.
[CUSTOMER][NEUTRAL] OK, so the member was not active on the date of service?
[AGENT][NEUTRAL] Yes, that is correct. The member's policy terminated [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and what is the effective date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And when was the claim received?
[AGENT][NEUTRAL] The claim was received [PII]. It was processed [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Could you please tell me the uh received date and the denied date?
[AGENT][NEUTRAL] I just gave it to you. Would you like for me to repeat it again?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I gave you [PII] is when we received the claim. [PII] is when the claim was processed and denied.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and we have submitted the claim once again, so the recent claim is not on file, am I right? We have submitted the claim on [PII].
[AGENT][NEUTRAL] No, there isn't.
[AGENT][NEUTRAL] No, we don't have it on file.
[CUSTOMER][NEUTRAL] OK, bear with me just a minute. I have a few questions to ask. OK, could you please tell me when was the last coordination of benefits were updated?
[AGENT][NEGATIVE] There is no coordination of benefits. This is a gap insurance.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the policy terminated [PII] and your date of service was [PII], actually two years after the policy was terminated.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK. And do you see any other payer listed for this patient?
[AGENT][NEUTRAL] No, there is no policy active policy for this member here at American Public Life. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Yeah, the claim number.
[AGENT][NEUTRAL] The claim number is 3592553. That's 3592553.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] And could you please tell me uh what's the timely for him to submit the claim.
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] And mail uh mailing address to submit the.
[AGENT][NEGATIVE] We're still gonna be denied because the policy is terminated, was terminated the date of service so the claim is still gonna be denied. You can submit it. I'm not telling you not to resubmit it, however, it's definitely still gonna be denied because the policy was not active for the date of service.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, could you please tell me the, uh, what will be the mailing address to submit the correct claim.
[AGENT][NEUTRAL] The mailing address would be addressed to American Public Life Claims Department.
[AGENT][NEUTRAL] [PII]. That's [PII], [PII]. That's [PII]. Would you like that payer ID as well?
[CUSTOMER][NEUTRAL] Let's schedule.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I yeah.
[AGENT][NEUTRAL] 60801
[CUSTOMER][NEUTRAL] And could you please tell me, uh, finally I need to submit an appeal as well? What will be?
[AGENT][NEGATIVE] There is no timely filing.
[CUSTOMER][NEUTRAL] Uh, for an appeal.
[AGENT][NEGATIVE] Yes, there is no timely filing.
[CUSTOMER][NEUTRAL] And mailing address will be the same, which you gave me for the corrected claim.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And is there any specific form for an appeal? OK. And then you will be required by submitting an appeal or a claim?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] So you can, I mean, yes, that's what you want to do.
[CUSTOMER][POSITIVE] I like.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Repeat your question.
[CUSTOMER][NEUTRAL] If denied, you will be required while submitting an appeal or a claim.
[AGENT][NEUTRAL] No, just the claim number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, what will be the call reference number for our conversation?
[AGENT][NEUTRAL] We don't provide those, [PII], but you can use my name in today's date as a reference. Would you like for me to spell my name for you?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], and today's date, which is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and could you please give me two more claims I have on file.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] For the same member?
[CUSTOMER][NEUTRAL] I know for the different member.
[CUSTOMER][NEUTRAL] Yeah, sure. Yeah, bear with me. The member ID is loading. Just a minute.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, the next member ID is
[CUSTOMER][NEUTRAL] OK, I think so. I don't have a member ID for this one because the member ID is 60801 and I think so it's your PIID am I right?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yeah, uh, say, repeat the number again.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes, that is correct. Do you have the member's social?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm mm mm mm no, I don't have the member's social. I just have the member's name and the date of birth and
[AGENT][NEUTRAL] So what is the member's last name?
[CUSTOMER][NEUTRAL] Remember last name, I would like to spell it's [PII].
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] [PII], sorry, [PII]
[AGENT][NEUTRAL] What city and state does this member live in?
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Give me a minute. So, so just for like the, uh, like for like for just for member lives in [PII].
[AGENT][NEUTRAL] Could you verify his name and date of birth?
[CUSTOMER][NEUTRAL] So we
[CUSTOMER][NEUTRAL] Uh, member's name and the date of birth. And the member's first name is [PII] and the last name is [PII], and the date of birth will be
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that's kind of gonna be the.
[CUSTOMER][NEUTRAL] Yeah, the date of birth is [PII].
[CUSTOMER][NEUTRAL] Like I have, well, the first thing I think to I mean uh.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the data service that you're calling about?
[CUSTOMER][NEUTRAL] Yeah, bear with me. The date of service is [PII].
[AGENT][NEUTRAL] What is your procedure called?
[CUSTOMER][NEUTRAL] Yeah, sure. The procedure code is
[CUSTOMER][POSITIVE] I it's probably right.
[CUSTOMER][POSITIVE] She on the go because she's pretty very high car right.
[CUSTOMER][NEUTRAL] Yeah, the procedure code is 96372. Yeah, there is just one procedure code for the member.
[AGENT][NEUTRAL] So this claim was received [PII]. It was processed [PII]. There was no payment on this claim because the policy terminated [PII]. The policy became effective [PII] and terminated [PII]. The claim was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII], that's [PII].
[CUSTOMER][NEUTRAL] OK. And the effective date of the member is uh [PII]. Am I right?
[CUSTOMER][POSITIVE] [PII] have a great day.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, so for this one also the member is not active on the date of service.
[AGENT][NEUTRAL] Correct, the policy was terminated.
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, bear with me. OK. So do you have any recent claim on file because we have submitted the recent claim on [PII].
[AGENT][NEUTRAL] Yes, it was considered as a duplicate. It was received [PII], processed [PII], and it was considered as a duplicate because it was a duplicate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so could you please help me with the claim number of the duplicate claim?
[AGENT][NEUTRAL] The claim number for the duplicate claim is 3573985.
[CUSTOMER][NEUTRAL] 3985 and what's for the original one?
[CUSTOMER][NEUTRAL] The claim number?
[AGENT][NEUTRAL] 3547086
[CUSTOMER][NEUTRAL] 6.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what will any
[CUSTOMER][NEUTRAL] Uh, when was the last coordination of benefits updated?
[AGENT][NEGATIVE] There is no coordination of benefits. This is a gap insurance.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And do you see any other, any other pay listed for this member?
[AGENT][NEUTRAL] No, the policy, the member does not have an active policy.
[CUSTOMER][NEUTRAL] OK, now the further questions will be the same that I asked you before.
[CUSTOMER][NEUTRAL] And could you please help me with the last claim?
[AGENT][NEUTRAL] What is the date of the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure, it's loading. Give me a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, for this one.
[CUSTOMER][NEUTRAL] The member ID will be 024.
[CUSTOMER][NEUTRAL] 84562 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] That is for the same patient that we just looked at, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, that is for [PII]. The 202484562 is the policy number for my [PII] that we just recently reviewed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] M.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] It's for the same member which we looked for looked before.
[AGENT][NEUTRAL] Yes, that is correct. [PII], yes, what is, so you gave me the policy number 02484562. So what is that member's name and date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, give me a minute.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Alright so [PII]ow.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, the member's 1st 1st name is [PII]. And I would like to spell the last name. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So spell that last name again for me.
[CUSTOMER][NEUTRAL] Yeah. The last name is
[CUSTOMER][NEUTRAL] It's [PII]. It's spelled as [PII]. I would like to spell it out. It's [PII].
[AGENT][NEUTRAL] And what is the first name?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm not showing the member's name in that system.
[CUSTOMER][NEUTRAL] You're not able to find the member?
[AGENT][NEUTRAL] I'm not showing that member's name in the system, no, and the policy number that you provided me with is not the correct policy number. That is the correct policy number for [PII] for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a minute. Let me just check on the.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, so you were not able to find with the member's name also?
[AGENT][NEUTRAL] No, that's correct. I was not.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] And I don't have the social social for this member even.
[AGENT][NEUTRAL] So you may wanna reach out to the member to verify if American Public Life was the actual insurance company or verify if you gave me the correct spelling of the last name or reach out to the member to verify what their policy number was here at American Public Life.
[CUSTOMER][NEUTRAL] OK. OK. Gosh. Uh, could you please, uh, tell me the spell out the last name for the member? Let me just cross-check if the spelling is correct or not.
[AGENT][NEUTRAL] So you will have to provide me that again because I've left off that screen after I searched that their member was not in the system.
[CUSTOMER][POSITIVE] OK. OK, I will provide you once again.
[CUSTOMER][NEUTRAL] It says [PII]. And the first name I will like, you do want the first name once again?
[AGENT][NEGATIVE] [PII] and it's not in the system again after I've searched the second time.
[CUSTOMER][POSITIVE] OK, no worries. Thanks for your assistance, [PII].
[AGENT][POSITIVE] Thanks for calling APL. Have a great day, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, thanks for your assistance. Bye-bye.
[AGENT][NEUTRAL] Bye.