AccountId: 011433970860
ContactId: 011c4a26-49dc-4201-b485-b3b6c94b6076
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 648900 ms
Total Talk Time (AGENT): 196160 ms
Total Talk Time (CUSTOMER): 261834 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/011c4a26-49dc-4201-b485-b3b6c94b6076_20250131T21:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on a claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to assist you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] Uh, uh, 2.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Um, so the members, the member ID would be.
[CUSTOMER][NEUTRAL] 975
[CUSTOMER][NEUTRAL] 707
[CUSTOMER][NEUTRAL] 089.
[CUSTOMER][NEUTRAL] It's United Healthcare.
[AGENT][NEUTRAL] OK, that's not an APL policy number. Do you um do you have the American Public Life policy number?
[CUSTOMER][NEUTRAL] Yeah, uh, one moment. Uh, yeah, I got it. Uh, it's 021.
[CUSTOMER][NEUTRAL] 2013.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] M as in mountain, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII] and uh date of birth would be [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yeah, sure. The date of service would be [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And the total bill amount is $1,968 even.
[AGENT][NEUTRAL] Thank you for that. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, it's, uh, do you want the facility name?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, it's uh JLR Medical Group, Anastasia, Florida.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So I'msh received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 353-032-0.
[CUSTOMER][NEUTRAL] Uh, could you please repeat that, uh, claim number, please? 0, I'm sorry.
[AGENT][NEUTRAL] 3353
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0320.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. Do you need 4?
[AGENT][NEUTRAL] The outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] So, the claim is received on [PII].
[CUSTOMER][NEUTRAL] And the claim number would be 353-0320.
[CUSTOMER][NEUTRAL] And the claim denied for
[CUSTOMER][NEUTRAL] Patient benefits calendar days has been met, right?
[AGENT][POSITIVE] Yes, the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK. Could you please tell me the process it?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, got it. And uh
[CUSTOMER][NEUTRAL] So in this case, what should I do?
[CUSTOMER][NEUTRAL] The need for patient benefits currently this is.
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility. Um, it would just be whatever your policies or procedures are on outstanding balances.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And did you want to move to the next member's policy number?
[CUSTOMER][NEUTRAL] Uh, could you please tell me the date?
[AGENT][NEUTRAL] I can't give you the date that it was that the um calendar year max was met. It's another claim.
[CUSTOMER][NEUTRAL] OK, it's another claim?
[AGENT][NEUTRAL] Right, I can only give you a claim status for your provider. So by the time your claim came in, they had used their full calendar year max.
[CUSTOMER][NEUTRAL] OK. Full calendar year, max.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, that's OK, but, uh, what is the benefits, uh, date actually? I just need to know when it was met. I want that exact date. OK.
[AGENT][NEGATIVE] I can't give that.
[CUSTOMER][NEUTRAL] Fine.
[AGENT][NEUTRAL] By the time your claim came in, it was met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for that. Could you please give me the reference number for this claim?
[AGENT][NEUTRAL] Sure, so the call reference number for the entire call will be my name and today's date. So again, that's [PII], and then today's date.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, got it. So shall we move on to the next claim?
[AGENT][POSITIVE] Yes, I'm ready when you are.
[CUSTOMER][NEUTRAL] Yeah. So the next member ID would be.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the next member ID would be uh 91 2nd is it uh
[CUSTOMER][NEUTRAL] Uh yeah. It's 194.
[CUSTOMER][NEUTRAL] 7648.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient name is [PII] and the date of birth would be [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, sure. The date of service would be um
[CUSTOMER][NEUTRAL] yeah
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][POSITIVE] One moment. I'm so sorry.
[CUSTOMER][NEGATIVE] Syste is really, really slow.
[AGENT][POSITIVE] It's OK, take your time.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, got it. So it's uh date of service would be [PII] and the total charge amount is $1,476 even.
[AGENT][NEUTRAL] Thank you and again just for the call, the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate that claim for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I'm showing received the claim on [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, last [PII], uh, [PII], right?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, received on [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 348.
[AGENT][NEUTRAL] 8343.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because the service is not
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, what was the date, [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, got it. The claim got denied for?
[AGENT][NEUTRAL] The service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] The service is not covered on doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Yeah, one moment. Uh let me just document this 11 moment.
[CUSTOMER][NEUTRAL] Is there a facility uh facility payment was done?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, is the facility facility payment was done or uh rejected?
[CUSTOMER][NEUTRAL] Could you please check that?
[AGENT][NEUTRAL] Wait, can you say that one more time slowly?
[CUSTOMER][NEUTRAL] Uh, could you please check the facility claim was paid or not?
[AGENT][NEGATIVE] It was denied because it's not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK. Could you please send me the process date please for this?
[AGENT][NEUTRAL] OK, again, it was processed on [PII].
[CUSTOMER][NEUTRAL] OK, got it. And um
[CUSTOMER][NEUTRAL] Could you please fax me to OB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] The fax number would be 407.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And would that be attention, [PII]?
[CUSTOMER][NEUTRAL] Oh, yeah.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK, so I'll go ahead and fax this over to you now. Is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, no, I, no, I've got enough information. Thank you so much for providing all the information. Hope you have a great day.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah bye bye.