AccountId: 011433970860
ContactId: 13d984da-6903-4de8-a930-7b86b3c67eac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 754099 ms
Total Talk Time (AGENT): 227204 ms
Total Talk Time (CUSTOMER): 371601 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/13d984da-6903-4de8-a930-7b86b3c67eac_20250210T18:33_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I'm calling because I need to speak with somebody in the claims department in regards to a couple patients.
[AGENT][NEUTRAL] In terms of like claim status?
[CUSTOMER][NEUTRAL] Yes, uh, well, claim status, but then also I had some questions on some claims that you guys were sending.
[AGENT][NEUTRAL] OK, well, I can help you with the claim, um, status. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] And then the phone number is [PII]. I'm sorry, I was gonna give you the other.
[AGENT][NEUTRAL] Oh, it's OK. And [PII], may I have the members, um, oh, you said it's multiple members, right?
[CUSTOMER][NEUTRAL] No, it's, well, I have 2, but one of the members has like quite a few claims.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It just wasn't making any sense because you guys are sending them back as if um you can't find the patient, but then I'm getting checks for the patient after the fact.
[AGENT][NEUTRAL] Alright, so you want to go over claim status and the denials and then the payments for the denials, sounds like?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so it's basically like let me tell you, um, one that I've gotten. So basically it's just saying, um, like you guys, you sending me this, um, like fax cover sheet or the cover sheet basically saying like if you can't find the patient, um, and I put you you want me to fill all her information and policy number, but then I'm receiving claims after the date of service that you're requesting that are getting paid.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's like you, some of the claims you're being able to find the patient and paying and then the other ones it's like you can't find the patient.
[AGENT][NEUTRAL] OK, let me take a look, um, but I'll be more than happy to help you. Um, what's the first member's policy number?
[CUSTOMER][NEUTRAL] Uh, let me tell you, hold on one moment.
[CUSTOMER][NEUTRAL] I, I have some questions. I hear you.
[CUSTOMER][NEUTRAL] OK, so her policy number is 02458537.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, so with you guys, um, let me tell you, so her first name is [PII], last name with you guys is [PII], I believe, um, actually.
[CUSTOMER][NEUTRAL] Yeah, last name with you guys the honest but with Aetna is um [PII]
[AGENT][NEUTRAL] OK, and her date of birth?
[CUSTOMER][NEUTRAL] Um, mm, [PII].
[AGENT][NEUTRAL] Thank you for that. And then may I have the date of service or or multiple if there's multiple?
[CUSTOMER][NEUTRAL] Yeah, there's multiple, but I can give you the very first one that I got sent, um, so I have one for 11-12-2024, and then the bill amount is 205.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] $205?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[AGENT][NEUTRAL] [PII], you said, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, OK, hold on one second. This is what's happening.
[CUSTOMER][NEUTRAL] Cause I don't know if there was like an Asian just because with you guys her last name is different or what, but I filled out a couple of them and send them to you guys like the forms that you guys send to me and I sent them back to you, but I don't know if those points.
[AGENT][NEUTRAL] So there
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] So it's 2 policies. So,
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] There's a policy that, well, no, still though, the data services.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, cause she has a couple from October and then mostly November. But then like some of the ones like, like a couple of October ones, it's saying like you guys can't find her, but then I received like a couple of October ones just recently and they paid them for her.
[AGENT][NEUTRAL] What's another um data service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let's see, let me give you one in October I just said, I have an [PII].
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEGATIVE] Yeah, it was weird because it's like you guys are paying so and they say you can't find the patient, but then there's a lot of them are getting paid and I'm still receiving claims, so.
[AGENT][NEUTRAL] I understand. So, the [PII], there's no claim on file for [PII]. We, there is a policy here for her, but there's no claim on file for her for [PII].
[CUSTOMER][NEGATIVE] And that's weird because I have to fix that back from you guys that's saying that you can't find the patient.
[CUSTOMER][NEUTRAL] And you gonna send it back to me as if you can't find her.
[AGENT][NEUTRAL] What does it say? Like, what are the words, what, what?
[CUSTOMER][NEUTRAL] It says, it says enclosing, it's basically like the enclosed informa well this cover sheet says the enclosed information was submitted to American public life. However, weren't able to locate the correct policy with the information provided.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I haven't changed any of like the policy numbers or anything like that when um submitting them um I just print out, you know, the EOB from Aetna and then I submit to you guys.
[AGENT][NEUTRAL] OK, and that's for the one for [PII], that's what you received that?
[CUSTOMER][NEUTRAL] Mhm, I received um all the other ones, all of them came with that cover sheet on the front, the ones that I got sent.
[AGENT][NEUTRAL] What's the other date of service?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, let's see. We have a
[CUSTOMER][NEUTRAL] Let's start with
[CUSTOMER][NEUTRAL] So I have 1002.
[CUSTOMER][NEUTRAL] I gave you the 22.
[CUSTOMER][NEUTRAL] Um, I have 1112. I gave you that one.
[CUSTOMER][NEUTRAL] Um, then it's all 2024 and then I have a 927 24.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 11 4 24.
[CUSTOMER][NEUTRAL] Let me see at 10:28.
[CUSTOMER][NEUTRAL] It's mostly uh 10:31.
[AGENT][NEUTRAL] OK. So the [PII] and [PII], we have those.
[CUSTOMER][NEUTRAL] That's so weird that you're not getting some, but you're getting the other one.
[AGENT][NEUTRAL] That claim was
[AGENT][NEUTRAL] I'm just going through them so I can see if there's a denial reason or so or so I can know what I see.
[CUSTOMER][NEUTRAL] OK, I have an 11 4, um.
[CUSTOMER][NEUTRAL] 117, I don't know if I gave you that one.
[AGENT][NEUTRAL] All right. 11
[CUSTOMER][NEUTRAL] And some of them, um, I know I do. I have to just upload the medical records to Aetna and send them back, and then I'll be sending again to you. I just spoke with Aetna about that, um, but yes, but most of these are just the it's like you're not, you're not finding the patient in your guys' system. It's pretty much what it looks like.
[AGENT][NEUTRAL] So for, are these the only dates of service for this member?
[CUSTOMER][NEUTRAL] Yeah, those are the only ones I received for her.
[AGENT][NEUTRAL] Alright, hold on one second, [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I would say to go just resubmit these. [PII].
[CUSTOMER][NEUTRAL] Just resend them all back.
[AGENT][NEUTRAL] I mean, I'm sorry, [PII], [PII], [PII], [PII], and [PII], just resubmit them because there's nothing we don't have, I'm not showing anything here on file. So just resubmit them so we can process it.
[CUSTOMER][NEUTRAL] OK, so do you want me to, uh, just resubmit them to you guys? OK, and then do you want me to just send them back with the cover sheet on the front with all her information?
[AGENT][NEUTRAL] When you say all her information, what do you mean like?
[CUSTOMER][NEUTRAL] Yeah, because it's asking for full name, policy number, date of birth, social security number, spouse's number, name, spouse's social security date of birth.
[AGENT][NEUTRAL] What does it say? Does it say APL on that form?
[CUSTOMER][POSITIVE] Mhm, yeah, it does. It is American Public Life expanding the benefits horizon and it has our address on it.
[AGENT][NEUTRAL] Wait, wait, wait, wait, wait, say that one more time.
[CUSTOMER][NEUTRAL] It says American Public Life on the top. It says you guys send it [PII].
[AGENT][NEUTRAL] It's like a claim form.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Yeah, you can, um, you can attach the claim form with it.
[CUSTOMER][NEUTRAL] OK, alright, yeah, that's what I did to the other ones, and I think those are the ones that got processed, so, um, I'll go ahead and send all these ones that you sent back to me, um, to get them processed again.
[AGENT][NEUTRAL] Alrighty. Well, was there anything else I could assist you with today?
[CUSTOMER][NEGATIVE] Uh yes, actually I have one other patient too, um, this one didn't make any sense either. No, you're fine.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] OK, I'm I'm finished with this one. I'm sorry I had to note that policy. What's the next member's policy number?
[CUSTOMER][NEUTRAL] OK, the next one is 01458876.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mm yes, give me one second see if I have it here now. I'm gonna have to look it up. Give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, her name is [PII], but let me tell you the date of birth. Give me one.
[CUSTOMER][NEUTRAL] OK, date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided again is a verification of benefits, not a guarantee of payment. And [PII], may I have the date of service for [PII]?
[CUSTOMER][NEUTRAL] OK, so I only have her, I have [PII].
[CUSTOMER][NEUTRAL] And then you guys sent that one twice.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the other one was [PII].
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] OK, no, you're good.
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, so for the [PII], um, that's claim number 355.
[AGENT][NEUTRAL] 243 7.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We received it on, on flipping screen, hold on one second. We received it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] And it was, it's in a holding status, they're waiting eligibility um from the employer for this data service.
[CUSTOMER][NEUTRAL] OK, OK, so I just have to get with the um patient and just see if that um if she can get that information to you guys.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then as soon as we receive that, we can continue processing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, because those are the last two that are only open for her, so I figured that you probably didn't, um, so I'll have her, I give her a call and let her know that she just needs if she still has that she needs to send you her information so we can, and then I can just resend them back to you, correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, let me check for the [PII]. 0, it's the same thing for the [PII] too.
[CUSTOMER][NEUTRAL] Yeah, I was, they say the same thing, so.
[CUSTOMER][POSITIVE] Alright, perfect. Can I get a reference number as well please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. So again, that's [PII], first initial and my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you very much.
[AGENT][POSITIVE] You're welcome, [PII], and thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye. Hello [PII].