AccountId: 011433970860
ContactId: 0b73a3ff-704f-4a2e-a70f-1e767d60595b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 405339 ms
Total Talk Time (AGENT): 169123 ms
Total Talk Time (CUSTOMER): 119845 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/0b73a3ff-704f-4a2e-a70f-1e767d60595b_20250407T19:53_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. My last name initial is [PII] calling from the provider office, checking for the claim status.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, were you needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] I have only one.
[AGENT][NEUTRAL] OK. And what is that member's policy number, please?
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Is 02, yes, the, the policy number is 02557111. There is a three consecutive ones at the end.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Sorry, could you please repeat one more time?
[AGENT][NEUTRAL] Just one moment while I pull the member's policy information up.
[CUSTOMER][NEUTRAL] Sure, you can.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII]. The date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and this is for a dental policy that you're calling for claim status?
[CUSTOMER][NEUTRAL] No, for medical policy.
[AGENT][NEUTRAL] OK. The policy number you gave me is for a dental policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Could you please
[AGENT][NEUTRAL] Uh, let me see if I can locate the correct information.
[AGENT][NEUTRAL] Because there are no claims on file under his dental.
[CUSTOMER][NEUTRAL] If you need, I will provide you the claim number.
[AGENT][NEUTRAL] No, sir. Uh, not yet. I need to get the correct policy number first for you.
[AGENT][NEUTRAL] So you already, you don't need claim status you just need additional information on a claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] As we received the denial from you.
[AGENT][NEUTRAL] What is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] The date of service is [PII]. The bill amount $1,114.65.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you. And the claim number that you have.
[CUSTOMER][NEUTRAL] I have the claim number 356-076-7.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, yes, sir. How can I help you with that claim today?
[AGENT][NEUTRAL] Well, first off, let me give you the correct policy number. Let me give you the correct policy number, [PII].
[CUSTOMER][NEUTRAL] So could you please provide me that?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It is 02557107.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And so now, how can I help you with this claim?
[CUSTOMER][NEUTRAL] What is the denial reason?
[AGENT][NEUTRAL] The denial reason on this claim states ambulance benefits are payable only if an insured is admitted as an inpatient.
[CUSTOMER][NEUTRAL] OK. So, could you please check again let me know whether the member have uh ambulance services.
[CUSTOMER][NEUTRAL] Emergency ambulance services covered under this plan or not?
[AGENT][NEUTRAL] No, sir, as I just read, ambulance benefits are payable only.
[AGENT][NEUTRAL] If an insured is admitted as an inpatient.
[CUSTOMER][NEUTRAL] Yes, so you're just
[CUSTOMER][NEUTRAL] Speaking what's it showing and the uh explanation of benefit even which I have this information, but I want to know whether the mem whether the member have the
[CUSTOMER][NEUTRAL] Emergency ambulance benefits under his plan or not?
[AGENT][NEUTRAL] No, sir. That's why that is worded the way that it is.
[AGENT][NEUTRAL] Ambulance benefits are payable only if the insured is admitted as an inpatient.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] American Public Life, uh.
[AGENT][NEUTRAL] This is a
[AGENT][NEUTRAL] Uh-huh. Payable only.
[AGENT][NEUTRAL] If an insured is admitted as an inpatient. This is not major medical insurance.
[CUSTOMER][NEUTRAL] Sure. Could you please check?
[AGENT][NEUTRAL] This is a limited benefit plan.
[CUSTOMER][NEUTRAL] Sure. Could you please uh check and let me know whether the member have any other active insurance on the date of service?
[AGENT][NEUTRAL] I would not know that. You would not with us. You would have to contact the member to find out if they have any other coverage.
[CUSTOMER][NEUTRAL] Sure, we will do that. And could you please spell your name?
[AGENT][NEUTRAL] [PII], first initial to last name [PII], and you would use my name along with today's date as your call reference number and you.
[AGENT][NEUTRAL] You said that you already have the explanation of benefits. Is that correct?
[CUSTOMER][POSITIVE] No, that's it from my end. Thank you so much for your assistance. Have a great day. Bye-bye.
[AGENT][NEUTRAL] OK.