AccountId: 011433970860
ContactId: 0cb70496-2dca-490b-8081-d4e2cb9e133e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 849570 ms
Total Talk Time (AGENT): 202326 ms
Total Talk Time (CUSTOMER): 260195 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/0cb70496-2dca-490b-8081-d4e2cb9e133e_20250528T12:37_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Ocean County Foot and Ankle Surgical Associates to take on a denial clarification for the medical claim.
[AGENT][NEUTRAL] Sure, I can assist you with that, [PII]. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Yeah, sure, the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII] with extension of [PII].
[AGENT][NEUTRAL] Extension of [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can I have the policy number of the member that you're calling in regards to the claim status?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure. I do see here the group number is 16257.
[AGENT][NEUTRAL] The policy number?
[AGENT][NEUTRAL] Just say policy or er number.
[CUSTOMER][NEUTRAL] Policy number, yeah, just.
[CUSTOMER][NEUTRAL] Yeah, sure. The policy number is 0199407H.
[CUSTOMER][NEUTRAL] M as in Mike, [PII]
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth and I'll be able to assist you.
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's name is [PII] and the date of birth of the patient is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] What is the patient's name?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[AGENT][NEUTRAL] So who's the policy holder of the policy?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The date of birth that you provided me is not matching the name with the name that we have in the system.
[CUSTOMER][NEUTRAL] OK. It's [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, just to give, give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Is there any possibility to pull the patient with the SSM of the member?
[AGENT][NEUTRAL] No, I, I found the name. However, the date of birth that you provided me is not correct, and due to HIPA, you have to verify that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The member's date of birth is not matching.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I can see.
[CUSTOMER][POSITIVE] OK, thank you so much. May I get your name, please?
[AGENT][NEUTRAL] Do you have an identification card on file? Because that's not the member's name.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] But it's not the member's date of birth.
[CUSTOMER][NEUTRAL] Sorry, I don't see.
[CUSTOMER][NEUTRAL] Mm, no.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, the date of birth is, yes.
[AGENT][NEUTRAL] Do you have a claim? Do you have a claim?
[CUSTOMER][NEUTRAL] Yes, they depend on, yeah, sorry.
[CUSTOMER][NEUTRAL] The dependent uh date of birth is [PII] and the subscriber date of birth. So [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] OK, so who's the claim for?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so, and could you, and [PII].
[CUSTOMER][NEUTRAL] Under the member ID?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And [PII]'s date of birth is because you gave me [PII] for [PII]. So what is [PII]'s date of birth that you're calling to check the status of the claim for?
[CUSTOMER][NEUTRAL] Yeah, but I'm checking here, I do found the [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] Thank you, and the claim is for [PII], correct?
[CUSTOMER][NEUTRAL] Yes, for [PII].
[AGENT][NEUTRAL] And what is the data service that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm not showing a claim on file for a day for [PII]. Do you have a claim number here from American Public Life or ELB?
[CUSTOMER][NEUTRAL] Yeah, we submitted the claim on [PII] and I do see here the claim number is 359.
[CUSTOMER][NEUTRAL] 9039.
[AGENT][NEUTRAL] So is this claim for [PII]? Again I ask you, you're saying that you're calling to check the status of a claim for [PII]. So are you sure that the claim is for [PII]? Because I'm not showing the claim on file for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's for [PII]. I do see here the [PII]'s name uh on AOB.
[AGENT][NEUTRAL] And what else does the EOB says say?
[CUSTOMER][NEUTRAL] Yeah. Here for the code of 73,610 and 73,620 got paid. And the pending for uh payment is pending for 99213 due to its a non-cover charges.
[AGENT][NEUTRAL] Give me one moment, let me pull this up because I'm not showing it for [PII]. Are you sure the claim was for [PII] and not a dependent?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, in remittance advice, I do see here, uh, the patient name is [PII].
[AGENT][NEUTRAL] OK, so who are you calling to check the status of a claim for [PII] or a dependent?
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Just give me one moment, mm.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah. So the 5's, uh, date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] May I place you on a brief hold because it look, may I place you on a brief hold because I'm not showing the claim on file for [PII] for that date of service. Let me pull up the claim itself. May I place you on a brief hold?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, sure. Before that, may I get your name, please?
[AGENT][NEUTRAL] My name is [PII], and today's day as a reference. May I place you on a brief hold, [PII], while I research this information.
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding. I apologize for the inconvenience. So [PII], so I pulled up the claim and it looked like the claim is actually for [PII]. however, it was processed under the incorrect insured, so I'm gonna send this back so that it can be reprocessed under the correct individual.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] Yeah, sure. Thank you so much. And could you please help me with um the client received it?
[CUSTOMER][NEUTRAL] And the present date, uh, [PII].
[AGENT][NEUTRAL] So the claim was received.
[AGENT][NEUTRAL] The Claim was received [PII]. It was processed [PII].
[CUSTOMER][POSITIVE] Yeah, thank you so much. [PII].
[CUSTOMER][POSITIVE] Thank you so much. Um, may I get the ticket number for the?
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, [PII], uh, may I get the ticket number too for the accepted the reprocess?
[AGENT][NEUTRAL] There is no number.
[CUSTOMER][NEUTRAL] OK. Shall I use the uh
[AGENT][NEUTRAL] They have not reprocessed the claim yet, so you could just use the original claim number that was provided.
[AGENT][NEUTRAL] And we don't provide reference numbers, but you can use my name in today's date as a reference.
[CUSTOMER][NEUTRAL] OK. Could you please
[CUSTOMER][NEUTRAL] OK. I actually, uh, it got denied incorrectly, right, [PII]?
[AGENT][NEUTRAL] It actually was processed under the wrong insured. The benefits will be the same, but it was processed under the wrong insured.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][POSITIVE] OK, thank you so much. May I take the ticket number as a call reference number as a ticket number?
[AGENT][NEUTRAL] We, we don't provide reference numbers.
[CUSTOMER][POSITIVE] OK. Thank you so much. May I know when I have to call you back?
[AGENT][NEUTRAL] You can use my name in today's date as a reference. I'm not sure how long this process will take, however, I'm gonna send this over to the adjuster for them to review and reprocess.
[CUSTOMER][NEUTRAL] Yeah, sure, sure.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] OK. May I know
[CUSTOMER][NEUTRAL] Yes, may I know the normal processing time?
[AGENT][NEUTRAL] Repeat yourself, [PII].
[CUSTOMER][NEUTRAL] The climb normal time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I know the client normal processing time for this?
[AGENT][NEUTRAL] 5 to 7 business days.
[CUSTOMER][POSITIVE] Thank you so much for your assistance today, [PII]. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well, [PII]. Goodbye.