AccountId: 011433970860
ContactId: 02080576-f8b9-47fb-b85b-13dbe2539983
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 901369 ms
Total Talk Time (AGENT): 269509 ms
Total Talk Time (CUSTOMER): 292141 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/02080576-f8b9-47fb-b85b-13dbe2539983_20250221T17:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] calling from provider's office to check on the claim status. Could you please assist me with that?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status. And um may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Sure, sure. The callback number is [PII] with the [PII] of [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one claim.
[AGENT][NEUTRAL] Alright, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh it's 01482184.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] For for this call I don't have.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, the member's name is [PII] with the date of birth of uh [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] For the
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, um, so that member is not on this policy.
[CUSTOMER][NEUTRAL] OK, sir, you are unable to find the patient or you're, uh, you, you can able to find the patient on this that's a different policy.
[AGENT][NEUTRAL] Right, so the policy number that you gave me does pull up a uh uh a policy with the [PII] family, but the number that you gave is not on this is not on this policy.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] OK. So could you able, uh, I will provide the uh patient uh name and date of birth and the address. Could you be able to check uh what is the right member ID or right policy for this patient along with this and if you need means.
[AGENT][NEUTRAL] So that's not really how it works. Um, you can give me the name and the date of birth again just for me to verify, but there's only 2 people on this policy and it's not who you gave, so there wouldn't be any, there's no policy for that member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] But what was the name again?
[CUSTOMER][NEUTRAL] Yeah, one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, yeah, the patient's first name is [PII]. It's [PII]. And the last name is [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, there's no one with that name or date of birth on this policy. So you would just have to reach out to the member and see who they had at the time for insurance.
[CUSTOMER][NEUTRAL] OK. OK, one moment. So, uh, under this policy, uh, you, under the given member ID is there any patients are listed without this patient, uh, uh, so I provided their number, member ID 01482184, right? Is there any other member on that policy other than [PII]?
[AGENT][NEUTRAL] Yes, there's 2.
[CUSTOMER][NEUTRAL] May I know the two patient names?
[AGENT][NEUTRAL] Uh, well, we didn't verify the policy because there's no member to verify, so I can't give the policy information. There are two [PII] members here, but they are not [PII].
[CUSTOMER][NEUTRAL] OK. So, OK, they are not [PII], but there, there are two other members on that policy without [PII], right?
[CUSTOMER][NEUTRAL] Not it was [PII], right?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, but I cannot provide you with their names because we have not verified this policy because your patient is not there. Do you have another member's name that you can verify and date of birth?
[CUSTOMER][NEUTRAL] Uh, no, I don't have that. One moment. Uh, let me check if there are any other information on file.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, the other two patients' name was ending with [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And for these patients, [PII] doesn't, does not have any policy, right?
[AGENT][NEUTRAL] Correct. I mean, if you want me to check for, if you have the full social, I can check and see if maybe she has her own policy, but under the policy number that you gave, she she's not on this policy.
[CUSTOMER][NEUTRAL] OK. Can I provide the assistance for you so if you can, you can able to check, right?
[AGENT][NEUTRAL] Yes, I will only need the social, the full social.
[CUSTOMER][NEUTRAL] OK, no problem. One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The last four social of the patient is [PII].
[AGENT][NEUTRAL] OK, I'll need the full social.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hold on one moment. The phone's breaking up. You said [PII]?
[CUSTOMER][NEUTRAL] Yeah, I'm repeating that it's [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, so I'm just waiting for the policies to come up here. Hold on one moment.
[CUSTOMER][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Does she have a middle initial?
[CUSTOMER][NEUTRAL] Yeah, Middle name is [PII]
[AGENT][NEUTRAL] OK, let me see if this is her. Hold on one moment.
[CUSTOMER][NEUTRAL] Do you, for reference, do we need the uh
[CUSTOMER][NEUTRAL] Uh, address?
[AGENT][NEUTRAL] No, I can't see any of that until I get into the policy, but I did find two [PII], so I'm gonna check and see if they have the same date of birth. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so both the, both of the policies that I saw for [PII] have a different date of birth. So we do not have a policy for [PII] for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. But also, uh, could you please check with the name of [PII]?
[AGENT][NEUTRAL] What's the last name?
[CUSTOMER][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] [PII] and [PII]
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][POSITIVE] Yeah we can do that.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Yeah that's.
[CUSTOMER][NEUTRAL] see how
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so I found 3 claims, I'm sorry, 3 policies. I'm looking through them now. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that policy was matching with the social?
[AGENT][NEUTRAL] There was no policy with the social.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so for [PII], yes, I do see a policy here. Um, what is the date of service for your claim?
[CUSTOMER][NEUTRAL] Yeah, before that, uh, could you please verify the address? I want to check is that the right patient. Can I, can I check with that, go ahead with the address? Could you please check that? Is that the right address for the patient. It's [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, that's the right address, right? $9.
[AGENT][NEUTRAL] That's the address on file, yes, sir.
[CUSTOMER][NEUTRAL] OK. And the patient name as per your records is [PII] A.
[CUSTOMER][NEUTRAL] Could you spell your, uh, could you spell the name for the patient as per your records?
[AGENT][NEUTRAL] Yes, her name is [PII], the name you provided. Once I see the claim number, I'm gonna let you know of the policy number, but there's 3 here, so I don't know which one the claim is under.
[CUSTOMER][NEUTRAL] OK. So could you please check for the date of service of [PII] with the bill amount of $218?
[AGENT][NEUTRAL] OK, and do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Well, first I need to figure out what that is and keep them connected just in case. OK, so what now?
[AGENT][NEGATIVE] Oh, this is a mess. OK, what, uh,
[AGENT][NEUTRAL] [PII] there is nothing that was active on [PII].
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. Um, so of the three policies for [PII], the last policy terminated on [PII]. Did you want me to see if there's a claim there? The policy wasn't active, but I can see if there's a claim there.
[CUSTOMER][NEUTRAL] No, the data services [PII], then how it's been in [PII], if the policy was terminated in [PII], then how we can submit for the [PII].
[AGENT][NEUTRAL] So what I'm explaining to you is the policy term in [PII]. You can file a claim as a provider at any time. So, because the data of service is 2024, there could still be a claim here. Would you like me to check and see what it would possibly be denied because the policy is terminated, but you can file a claim at any time. Would you like me to check for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Could you please check
[CUSTOMER][NEUTRAL] Yeah, could you please check?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so there's no claims on file.
[CUSTOMER][NEUTRAL] OK. I got that. So can I have the, can I get the uh at the time of period, the plan was submitted on uh sorry, [PII]. What is the member ID for the time period?
[AGENT][NEUTRAL] Um, on the most recent policy.
[AGENT][NEUTRAL] The policy number is 1,603,230.
[AGENT][NEUTRAL] And it was active from [PII].
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So after that, there's no other coverage for this patient with American Public Life, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, uh, patient as a policy under the member ID 1,603,230, which is effective from [PII]. After that, there is no other coverage for these patients, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it. Thank you. Uh, yeah, that's all for today. And can I have a call reference number for this patient?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you and uh have a great rest of the day. Thank you so much.
[AGENT][POSITIVE] You also, and thanks for calling APL.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yeah