AccountId: 011433970860
ContactId: 05cb80fc-2931-46a3-856c-1b4fe6e00409
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 634809 ms
Total Talk Time (AGENT): 272561 ms
Total Talk Time (CUSTOMER): 235538 ms
Interruptions: 11
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/05cb80fc-2931-46a3-856c-1b4fe6e00409_20250421T19:07_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I have, um, this is [PII] calling from Day and Night Pediatrics, and I have 3 of your, um,
[CUSTOMER][NEUTRAL] Members that are patients of ours that have um your insurance and I need to check over their claims to see what's going uh what's the status on their claims.
[AGENT][NEUTRAL] OK, I'm so sorry. What was your name again? What was your name?
[CUSTOMER][NEUTRAL] Can you help me with that?
[CUSTOMER][NEUTRAL] [PII] from Dan [PII] from Day and Night Pediatrics.
[AGENT][NEUTRAL] OK, [PII], and you're needing to check claim status for 3 different patients?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Yes, I can help you with that and what is your call back number?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][NEUTRAL] OK, thank you. And are these um 3 different policies or are they all on the same policy?
[CUSTOMER][NEUTRAL] They're all different policies. I was just doing my research so I make one call because I already called in for another thing.
[AGENT][NEUTRAL] OK, so you
[AGENT][NEUTRAL] OK. All right, that's fine. So yeah, I can help you with them and then you will use my name, [PII], and today's date is your call reference number for each one.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Also, any information that I provide for you on any of the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then lastly, if we do have the claims on file, [PII], and you need a copy of the explanation of benefits, once you have the claim number, you should be able to print that EOB by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I can get the EOBs printed through there.
[AGENT][NEUTRAL] Correct. If you need a copy through that portal. Mhm.
[CUSTOMER][NEUTRAL] Through that that uh to that through that website.
[CUSTOMER][NEUTRAL] OK, OK, um.
[AGENT][NEUTRAL] Once I provide you the claim number, yes.
[CUSTOMER][NEUTRAL] Right, but we would have to register into in um sign in, get a get an account and everything like that, OK.
[AGENT][NEUTRAL] Yes, it's a self-register. It's a self-registering portal. Yes, that is correct.
[CUSTOMER][POSITIVE] OK, OK, alright, perfect, alright so first person.
[AGENT][NEUTRAL] Right. So, what is the first patient's policy number?
[CUSTOMER][NEUTRAL] Policy number is 02.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 212-383.
[CUSTOMER][NEUTRAL] M as in Michael. L as in Larry, 8.
[AGENT][NEUTRAL] OK, thank you one moment while I get the policy information pulled up.
[AGENT][NEUTRAL] And the the, the child's name and date of birth?
[CUSTOMER][NEUTRAL] The date of the service or the birthday? I'm sorry.
[AGENT][NEUTRAL] Patient name and date of birth.
[CUSTOMER][NEUTRAL] OK, [PII], and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service, the total bill amount for her, please?
[CUSTOMER][NEUTRAL] Total date of service is [PII].
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And the total amount is 300.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and you said the data service again is 2-10-2025.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, there is no claim on file.
[CUSTOMER][NEUTRAL] Oh no, 2:10.
[AGENT][POSITIVE] Oh, I'm right.
[CUSTOMER][NEUTRAL] You know what? it's
[AGENT][NEUTRAL] Wait, hold on, just, yeah, no gift. I was gonna say.
[CUSTOMER][NEUTRAL] Wait, give me a second because one says 2025 and the other one says 225 uh 24, yeah.
[AGENT][NEUTRAL] Well, give me just a second because I needed to refresh one of my screens, so let me check that again for her. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we did receive the claim for her for the [PII] excuse me, 210, yes, for 210-2025.
[CUSTOMER][NEUTRAL] OK, you did.
[AGENT][NEUTRAL] OK, so the claim was
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3575206.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And the claim was denied and the reason for the denial is that office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Offices it's not covered.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next, um, because, uh, another, uh, yeah.
[AGENT][NEUTRAL] Mm just a moment. Yeah, but give me just a moment because I have to get out of this record first.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, so do I.
[CUSTOMER][NEUTRAL] OK, 2025.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah, I believe this is what's happening with the same all the different, the same numbers, um.
[AGENT][NEUTRAL] Some of the supplemental policies [PII] do cover office visits, but some do not.
[CUSTOMER][NEUTRAL] The other numbers.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, uh, what is the next policy number?
[CUSTOMER][NEUTRAL] The next policy number is 00070968004.
[AGENT][NEUTRAL] Hm, that's not an American public life policy number.
[CUSTOMER][NEUTRAL] That's what I, that's what I thought because yours was 02.
[AGENT][NEUTRAL] I don't know what that's.
[AGENT][NEUTRAL] Yeah, I don't know what that's for, but that's definitely not ours.
[CUSTOMER][NEUTRAL] Give me a second.
[CUSTOMER][NEUTRAL] Hm. It's, it says American public. Let me see, let me click into it and see what's going on. Oh, it says that.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] No, I, that's the name that it says. So let me verify that one. Let's try another. Oh, the, the other one is a 016. Would that be yours also or no?
[AGENT][NEUTRAL] That could possibly be 016.
[CUSTOMER][NEUTRAL] 016349
[CUSTOMER][NEUTRAL] [PII]ael I 7.
[AGENT][NEUTRAL] OK, thank you. Well, it wouldn't be an I at the end. OK, so, but your patient's name and date of, uh, actually, the policy, the only part really that I need is the very beginning up to the number 2, ending with that 2 before the email. So 01634912 is actually the policy number. And what's your patient's name and date of birth for this one?
[CUSTOMER][NEUTRAL] An L.
[CUSTOMER][NEUTRAL] to the
[CUSTOMER][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The data of service and total bill amount, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And total bill amount was 423.
[AGENT][NEUTRAL] OK, so this claim was received, uh, this claim was received 325, processed on 327. The claim number is 3581851.
[AGENT][NEUTRAL] And this claim
[CUSTOMER][NEUTRAL] 3581851. I'm sorry?
[AGENT][POSITIVE] Uh-huh. 51, yes, ma'am. That is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this claim was also denied and this claim was denied to services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] And 32 uh-huh.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, so policy was terminated before time.
[AGENT][NEUTRAL] Uh-huh. The policy effect, that is correct. The policy had an effective date of [PII] and it turned [PII].
[CUSTOMER][NEUTRAL] On [PII]
[AGENT][NEUTRAL] Yes, there was no active policy for this data service.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Terminated [PII] and uh it started in um November. What what was the date on the the mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, the effective date has been [PII], and it turned 10-12019.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, your name was [PII], right?
[AGENT][NEUTRAL] My name was [PII].
[CUSTOMER][NEUTRAL] OK sorry.
[AGENT][NEUTRAL] First initial to my last name, [PII].
[CUSTOMER][NEUTRAL] Uh huh, and then the reference number would be your name.
[CUSTOMER][NEUTRAL] And the date of the right.
[AGENT][NEUTRAL] And today's date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] [PII], thank you so very much. You've been a great help. I'm, I'm sorry, I have 10 things going on at the same time it's hard to hear sometimes.
[AGENT][NEUTRAL] Oh, well, you're very welcome. Uh, you're fine. No, ma'am, you're fine.
[AGENT][POSITIVE] No, I totally understand. All good. Is there anything else, [PII], I can help you with today?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] No, that's it, um, thank you very much and you have a wonderful day.
[AGENT][POSITIVE] Well, thank you so much. I hope you have a wonderful day too if that's all I can help you with, and thank you again for calling APL.
[CUSTOMER][POSITIVE] OK perfect you bye bye.
[AGENT][NEUTRAL] Bye-bye.