AccountId: 011433970860
ContactId: 12750ec2-13bf-4699-aa38-e142a6666329
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1156319 ms
Total Talk Time (AGENT): 266315 ms
Total Talk Time (CUSTOMER): 333499 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/12750ec2-13bf-4699-aa38-e142a6666329_20250212T17:25_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Hello. So my name is [PII] and I'm calling from Pros office and I want to check up on the claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Mr. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, sure. It is [PII] and extension would be [PII].
[AGENT][NEUTRAL] OK. And where are you calling from? What facility or provider?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, found the facility, old lady of the lake physician.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure it is 83401.
[AGENT][NEUTRAL] Is that all the poli the numbers you have for the policy number?
[CUSTOMER][NEUTRAL] Oh yeah, on the claim, uh, same as 1500 it is.
[CUSTOMER][NEUTRAL] Can I verify with the insurance card?
[AGENT][NEUTRAL] Yeah, if you have the card, yes. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Please give me a moment. Uh, how much do you is uh there in uh.
[AGENT][NEUTRAL] Sure. Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Insurance cards Medicare American Life. OK, so as per insurance card, the patient ID is
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I can't find the uh.
[CUSTOMER][NEUTRAL] OK. Uh, I think it is [PII].
[CUSTOMER][NEUTRAL] Is it correct?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, that's, uh, that's too many numbers as well.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK. Uh, do you have the copy of APL card or you don't?
[CUSTOMER][NEUTRAL] Uh, I, I have the insurance card, but, uh, only policy number is AC0527, is there?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is it an APL card?
[CUSTOMER][NEUTRAL] 86 0527.
[CUSTOMER][NEUTRAL] Uh, it is American Public Life Insurance Company Jackson MS, uh, I think it's insurance card.
[AGENT][NEUTRAL] OK, and you said, what is the number on that card?
[CUSTOMER][NEUTRAL] It is starting from AC and with the 0527 AC 0527.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yeah, that's yeah.
[CUSTOMER][NEUTRAL] Uh, it is policy number or certificate number?
[AGENT][NEUTRAL] Do you have a certificate number, a different number besides that AC 0527?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] No. OK, one moment.
[CUSTOMER][NEUTRAL] Uh, can you search with the patient, uh, name or the date of birth?
[AGENT][NEUTRAL] Mhm. Yes, I'm pulling that system. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the spelling of the last name?
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][NEUTRAL] OK, and what's the spelling of the first name?
[CUSTOMER][NEUTRAL] It is [PII], [PII]
[AGENT][NEUTRAL] All right. And may I have the date of birth for the member?
[CUSTOMER][NEUTRAL] Yeah, sure. It is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] Uh, [PII] for bill amount $484 even.
[AGENT][NEUTRAL] It was [PII].
[CUSTOMER][NEUTRAL] No, it is [PII].
[AGENT][NEUTRAL] [PII]. OK. OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Let me pull this EOB.
[AGENT][NEUTRAL] Do you mind holding for me?
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] Mhm.
[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] Mm
[AGENT][NEUTRAL] Thank you for holding and being patient for me. OK, I have um the, you'll be pulled up and it looks like the claim was denied. Um, it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the denial reason is that the policy provides benefits for treatment of cancer in a specified disease only. Therefore, benefits are not payable for any other disease.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it is denied for non-covered charges.
[AGENT][NEUTRAL] Correct, yes. This is a cancer policy.
[CUSTOMER][NEUTRAL] OK. And uh could you provide me the process date?
[AGENT][NEUTRAL] Again, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And what would be the claim number?
[AGENT][NEUTRAL] OK, the claim number is 3554765.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh sorry, what's that? 3554?
[AGENT][NEUTRAL] 765.
[CUSTOMER][NEUTRAL] OK, and it is uh denied for non-covered charges and uh it is not covered under patient's plan or provider's plan.
[AGENT][NEUTRAL] Patients plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what is exactly not covered, uh, CPT DX or uh place of service?
[AGENT][NEUTRAL] This is the cancer policy.
[CUSTOMER][NEUTRAL] OK, this is cancel policy. Patient have the cancer policy. And uh
[AGENT][NEUTRAL] Yeah, it's only for cancer.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this if it is rated too?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Non-cancer treatment.
[CUSTOMER][NEUTRAL] This if it is uh related to non-cancer treatment, right? Non-cancer.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh OK, no problem. So I have two more claims uh with the same patient. Can I, uh, could you please share the information about that?
[AGENT][NEUTRAL] OK, what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] I think it is.
[CUSTOMER][NEUTRAL] Please give me some seconds.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. Uh, the date of service would be, uh, [PII], uh, for bill amount 21.
[CUSTOMER][NEUTRAL] $[PII] even.
[AGENT][NEUTRAL] OK, that's [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh, yes, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] so uh.
[AGENT][NEUTRAL] I don't have a claim for [PII].
[CUSTOMER][NEUTRAL] OK, so that's when the claim not on file.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, patient was, uh, what's the patient's effective intermission date?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK. Um for the cancer policy, we have effective [PII] and it is active at the moment.
[AGENT][NEUTRAL] Again, this is only for cancer.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That mean patient was a data service and what would be the payer ID?
[AGENT][NEUTRAL] Payer ID is 60801.
[AGENT][NEUTRAL] And again, this is not a medical policy. This is a cancer policy, OK?
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] OK, so claim would be denied in future.
[AGENT][NEUTRAL] If it's not related to cancer, it will be denied, yes, because this is only a cancer policy.
[AGENT][NEUTRAL] This is not a medical policy, it's a cancer policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Sure, no problem.
[CUSTOMER][NEUTRAL] OK, and uh mailing address is [PII] [PII]. It is OK. It is different. Can you please share with me the correct one?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure, [PII], [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] So was [PII]?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] OK and what would the uh timely filing limit?
[AGENT][NEUTRAL] Um, we don't have timely filing limits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Not 365 days, 180 days like this is not a limit, right?
[AGENT][NEUTRAL] There's no limit on filing claims.
[CUSTOMER][NEUTRAL] We can submit claim at any time.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm moving to the last game.
[AGENT][NEUTRAL] But it's the data service.
[CUSTOMER][NEUTRAL] It is for uh [PII] and bill amount is.
[CUSTOMER][NEUTRAL] 4841.
[AGENT][NEUTRAL] What is the procedure called?
[CUSTOMER][NEUTRAL] Uh, it is 99291.
[AGENT][NEUTRAL] OK, yeah, we don't have that claim on file.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim is not on file.
[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let me check.
[CUSTOMER][NEUTRAL] Let me check it is for same to to different patient I confirming.
[AGENT][NEUTRAL] And you said it's, you have a different member that you need to check on?
[CUSTOMER][NEUTRAL] Greek.
[CUSTOMER][NEUTRAL] Uh, please give me a moment so I can verify.
[AGENT][NEUTRAL] OK, can you, uh, can you tell me if
[CUSTOMER][NEUTRAL] Because, uh, for American life, I have
[AGENT][NEUTRAL] Yeah, bear with me, Mr. [PII], can you tell me if I can make the note on this one and finalize this one?
[CUSTOMER][NEUTRAL] Uh, please add one more.
[AGENT][NEUTRAL] Are we done with this one, or you have one more day of service for this one?
[CUSTOMER][NEUTRAL] Oh, yeah, it is for claim not, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, just share me the effective interment date with the patient.
[AGENT][NEUTRAL] OK, now, um, I think I already gave you that information, but let me give it to you again. It's [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure, so that would be the all same.
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And uh can I go ahead and make a note on this one?
[CUSTOMER][NEUTRAL] Uh, please give me a moment so I can pull up the last claim.
[AGENT][NEUTRAL] Or OK.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Is it the same member or different member?
[CUSTOMER][NEUTRAL] Uh, let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 93 is done. 83 is also done.
[CUSTOMER][NEUTRAL] 931 83133 is also done.
[CUSTOMER][NEUTRAL] 936503. OK.
[CUSTOMER][NEUTRAL] Uh, I think it is for the same patient.
[AGENT][NEUTRAL] OK, what is the date of service?
[CUSTOMER][NEUTRAL] And the date of service would be?
[CUSTOMER][NEUTRAL] Uh, it is [PII] for $21 each.
[AGENT][NEUTRAL] I don't have that one on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is the same patient, right?
[AGENT][NEUTRAL] The same patient, correct, yes, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And uh how do I spell your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what would the call reference number?
[AGENT][NEUTRAL] My name in today's date. We don't have reference numbers.
[CUSTOMER][POSITIVE] OK, sure. OK. Uh thank you for helping me out and uh giving me the all the information and you have a good day.
[AGENT][POSITIVE] OK, you as well thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye for now.
[AGENT][NEUTRAL] Bye.