AccountId: 011433970860
ContactId: 14649291-a3eb-46a6-94a6-e820e470710b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1120219 ms
Total Talk Time (AGENT): 275565 ms
Total Talk Time (CUSTOMER): 274393 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/14649291-a3eb-46a6-94a6-e820e470710b_20250620T15:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from the doctor's office to check on a claim status.
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] [PII]. And the extension is [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] The member ID is 1265656.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is
[CUSTOMER][NEUTRAL] [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] Data service and total bill charge?
[CUSTOMER][NEUTRAL] Oh, we are looking for the date of service is [PII].
[CUSTOMER][NEUTRAL] And the charge amount is $355 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you can also check claim status via our secured portal that is [PII] and that is for data service of 13 of 23 total bill 354.
[CUSTOMER][NEUTRAL] 355.
[AGENT][NEUTRAL] 355 and that is for 13 or 23, correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so for that data service no claim is on file.
[CUSTOMER][NEUTRAL] you want.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes [PII], actually, uh, this claim is sent through paper uh on [PII].
[AGENT][NEUTRAL] Would you like to verify the mailing address?
[CUSTOMER][NEUTRAL] No, no, no. Actually, I said uh this claim was submitted to paper on uh [PII].
[CUSTOMER][NEUTRAL] We, we did not submit through electronically.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK. Would you like to verify the mailing address?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK. Could you verify the mailing address that you said that it was submitted to?
[CUSTOMER][NEUTRAL] Uh, actually, uh, we previously, uh, submitted to [PII]. This is the mailing address we have to be submitted.
[AGENT][NEUTRAL] And that was submitted in [PII]?
[CUSTOMER][NEUTRAL] On uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, we don't have that claim on file. Would you like the fax number or you, you're more than welcome to resubmit it via mail?
[CUSTOMER][NEUTRAL] Uh, give me a minute.
[CUSTOMER][NEUTRAL] Can you please spell out your name?
[AGENT][NEUTRAL] Yes, it is spelled [PII] and today's date as the call reference. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Nothing. Uh, can you please provide the member with to date information date?
[AGENT][NEUTRAL] For this member, it is showing that they're currently active with the effective date of [PII].
[CUSTOMER][NEUTRAL] Can you please provide the payer ID?
[AGENT][NEUTRAL] The electronic payer ID is 60801.
[CUSTOMER][NEUTRAL] May I know the
[CUSTOMER][NEUTRAL] Claims time referral limit.
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] There is no time limit to submit this claim.
[AGENT][NEUTRAL] That's what I stated.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Uh, may I know the call reference number for this one?
[AGENT][NEUTRAL] I just gave the call reference it's my first name, last initial, and today's date.
[CUSTOMER][NEUTRAL] OK, can we move the next thing?
[AGENT][NEUTRAL] OK, so how many more claims do you have for me to review?
[CUSTOMER][NEGATIVE] I have 4 more claims are there.
[AGENT][NEUTRAL] OK, may I please have the next policy number?
[CUSTOMER][NEUTRAL] Next policy number is
[CUSTOMER][NEUTRAL] 02449994.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And you're calling for status for this member as well. May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Uh, we are looking for the date of service is [PII] and the charge amount is $3,087 even.
[AGENT][NEUTRAL] And for that claim that is data service 712 or 24 $3,0087. I did pull that claim up for you. I'm getting that information.
[AGENT][NEUTRAL] And for that claim, it does look like we received it on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 34.
[AGENT][NEUTRAL] 99
[AGENT][NEUTRAL] 114.
[AGENT][NEUTRAL] It processed and made a payment of $44.72.
[AGENT][NEUTRAL] Is there anything else that I can assist you on that claim with Nova?
[CUSTOMER][NEUTRAL] Yes. Uh, actually, uh, some amount is processed towards deductible, right?
[AGENT][NEUTRAL] I'm not understanding your question.
[CUSTOMER][NEUTRAL] Uh, is it, uh, some, some amount is processed towards deductible, right? for the CPT of 58661.
[AGENT][NEUTRAL] Yes, it shows that it's $100.
[CUSTOMER][NEUTRAL] Yeah. Uh, can you please provide the member individual annual deductible amount?
[AGENT][NEUTRAL] You're needing me to verify the member's outpatient benefits in regards to that verification of coverage does not guarantee the payment of the claim. This member does have up to $4800 for calendar year, but they also have a $100 deductible that had to be met.
[CUSTOMER][NEUTRAL] So for me $100.
[AGENT][NEUTRAL] They have a deductible of $100 that had to be met. So that is the reason why $100 was applied to the member's deductible on that claim.
[CUSTOMER][NEUTRAL] OK, but uh how much amount that so far?
[CUSTOMER][NEUTRAL] For this state of service.
[AGENT][NEUTRAL] I'm not understanding what your question is, what you mean, how much has it been made?
[CUSTOMER][NEUTRAL] In $4800 annual deductible amount, right? In that, how much amount made so far, is it 2000 $3000? Is it uh any figure on this? So for me, how much, how much met amount for this member?
[AGENT][NEUTRAL] You're trying to see how much has been accumulated as on that claim, it was $44.72.
[CUSTOMER][NEUTRAL] How much amount paid previously?
[AGENT][NEUTRAL] That's the amount that has been met.
[CUSTOMER][NEUTRAL] OK, there you go. Can we move to the next screen?
[AGENT][NEUTRAL] Yes, may I have the policy number?
[CUSTOMER][NEUTRAL] The policy number is 01912984.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Data service and total bill.
[CUSTOMER][NEUTRAL] Uh, we're looking for the date of services, [PII]. And the charge amount is $408 even.
[AGENT][NEUTRAL] And that is for data service of 821 or 24 total bill 408. I did pull that claim up for you. I'm getting that information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And for that claim, it shows we did receive it on 9-23-24.
[CUSTOMER][NEUTRAL] What is the status on?
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] That claim number is 3510075. It denied that office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] May I know the date?
[AGENT][NEUTRAL] It will be the process date, which is [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] So it is a patient responsibility?
[AGENT][NEUTRAL] That is the provider's discretion.
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] I'm ready with the next number ID.
[AGENT][NEUTRAL] May I have that policy number, please?
[CUSTOMER][NEUTRAL] 785116
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Day of service and total bill.
[CUSTOMER][NEUTRAL] We are looking for the services [PII].
[CUSTOMER][NEUTRAL] Bill amount is $408 even.
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It shows for that claim we did receive it on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] Claim number 351.
[AGENT][NEUTRAL] 0477. It shows that the claim processed and that it denied.
[AGENT][NEUTRAL] That the maximum amount of.
[AGENT][NEUTRAL] Visits has been met, so the member had no other available visits that could be paid for that year.
[CUSTOMER][NEUTRAL] Magazine benefits existed under visit wise.
[CUSTOMER][NEUTRAL] How many visits cover for policy here?
[AGENT][NEUTRAL] For this member verification coverage does not guarantee the payment of the claim. They do have a maximum of 4 visits per calendar year.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Can you please provide the visit dates for previous visits?
[AGENT][NEUTRAL] No, I cannot disclose that information.
[CUSTOMER][NEUTRAL] OK, I'm ready the next my ID.
[AGENT][NEUTRAL] May I have that, please?
[CUSTOMER][NEUTRAL] 021
[CUSTOMER][NEUTRAL] 10733.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] So [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Day of service and total bill.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] We are looking for the data services.
[CUSTOMER][NEUTRAL] [PII], the charge amount is $284 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[AGENT][NEUTRAL] It does show that we received it on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 35.
[AGENT][NEUTRAL] 493-69 that claim process and it denied that office visits are not covered under the patient's plan.
[CUSTOMER][POSITIVE] OK. Thank you. Thanks for the evening.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life Nova have a great rest of your day.
[CUSTOMER][POSITIVE] Yeah, thank you.