AccountId: 011433970860
ContactId: 15a8775a-d9db-4f2c-ae1f-be1bbf3c30d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1430410 ms
Total Talk Time (AGENT): 326738 ms
Total Talk Time (CUSTOMER): 528527 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/15a8775a-d9db-4f2c-ae1f-be1bbf3c30d7_20250204T20:25_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]. I'm [PII]. I'm calling from provider's office to check on a claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][POSITIVE] I'm doing good, thank you so much for asking.
[AGENT][NEUTRAL] May I please have a callback number and then the policy number?
[CUSTOMER][NEUTRAL] Sure, the uh callback number is [PII].
[AGENT][NEUTRAL] Policy number please.
[CUSTOMER][NEUTRAL] Yes, the policy number is 02505740.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient's name here is uh
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII], sorry, [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yes, the date of service is uh [PII] and the bill amount is $10,742 even.
[AGENT][NEUTRAL] That's $10,742.
[CUSTOMER][NEUTRAL] Yes, $10,742 even.
[AGENT][NEUTRAL] I'm pulling that information up for you now. And that date of service was [PII].
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] That date of service was [PII].
[CUSTOMER][NEUTRAL] [PII], uh, yeah, yeah.
[AGENT][NEUTRAL] So for that member is showing that no claim is listed on found.
[CUSTOMER][NEUTRAL] Is that so? Actually, we have sent a claim on [PII].
[CUSTOMER][NEUTRAL] Uh, to the mailing address. Just a second.
[CUSTOMER][NEUTRAL] Yeah. Uh, mailing address, um, no, we have faxed it to the fax number [PII].
[AGENT][NEUTRAL] And you say that that was faxed yesterday?
[CUSTOMER][NEUTRAL] Yeah, yeah, that's right. And we have mailed it also to the [PII] [PII], OK, and zip code is [PII].
[AGENT][NEUTRAL] OK, so you say that you faxed the claim in yesterday. So as of right now, that claim has not been entered in our system. So as of right now, there's no claim listed on file for that date of service. You do have to allow a total of 7 to 10 business days once that claim is received. You just submitted it yesterday.
[CUSTOMER][NEUTRAL] And the payer ID is
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so you need to allow 7 to 15 days.
[AGENT][NEUTRAL] 7 to 10 business days.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Uh, OK, got that. Thank you so much. um.
[CUSTOMER][NEUTRAL] OK, got that. Um.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, yes, I have a few more claims. Could you check with that too? And may I know the call reference number for this claim?
[AGENT][NEUTRAL] The call reference for the whole call will be my first name, [PII], that is spelled [PII] last initial of [PII] and today's date. And also if you would like to check claim statuses, you do have the option to be viewed via our secured portal that is [PII]. And may I please have the next policy number, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure, just a second. Let me pull that up.
[CUSTOMER][NEUTRAL] It's loading on my system.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, the
[CUSTOMER][NEUTRAL] Policy number here is 02448967ML7.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII] and the date of birth is uh [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yes, it is [PII] and it ranges to [PII].
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $47,116.86.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And that is for data service of 8:29 to 8:30.
[CUSTOMER][NEUTRAL] Yes, uh 8:29 to 8:30.
[AGENT][NEUTRAL] And is this a facility bill or a physician bill?
[CUSTOMER][NEUTRAL] Yes, it
[CUSTOMER][POSITIVE] It is in facilitable.
[AGENT][NEUTRAL] OK, I'm not seeing a facility bill for that date span.
[CUSTOMER][NEUTRAL] And we have
[CUSTOMER][NEUTRAL] Uh, actually we have sent it yesterday to the fax number, uh, which I provided, uh, in the same call before.
[AGENT][NEUTRAL] OK. And as I provided in the
[AGENT][NEUTRAL] The same information, you do have to allow a total of 7 to 10 business days. If that fax was received yesterday, it is not in our system.
[CUSTOMER][POSITIVE] Yeah, I know. I understand that I have to again validate all the information just for that. I'm so sorry.
[CUSTOMER][NEUTRAL] Let me pull up the next account.
[CUSTOMER][NEUTRAL] I have just
[CUSTOMER][NEUTRAL] 2 more claim after this?
[CUSTOMER][NEUTRAL] And the policy number here is 02022379 ML7.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Is the patient's name here is um.
[CUSTOMER][NEUTRAL] Um, [PII], and the date of birth is uh [PII].
[AGENT][NEUTRAL] May I have the date of service and total bill.
[CUSTOMER][NEUTRAL] And the date of service is uh [PII] and it ranges to uh [PII] and the bill amount is $38,209 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And that was for $38,209?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I uh I checked in my system. It shows it has been also faxed yesterday.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Yes, uh, should we allow time for this too?
[AGENT][NEUTRAL] So for that claim, it does show that we had received that claim.
[AGENT][NEUTRAL] That claim was received.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 3521735. That claim shows that it.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Sorry to interrupt. Could you please repeat the claim number once again?
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 21
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 735.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And for that claim, it shows.
[AGENT][NEUTRAL] That the above reference claim, it is a duplicate.
[AGENT][NEUTRAL] Let me see what's the duplicate. And then there is expenses that is not covered, which we do not cover kinesiology, speech or occupational therapy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me see what did they deny a duplicate to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, with that claim, it is showing that it has previously been paid. You would have to contact the insured in regards to that claim.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] For that claim, it shows that it was previously paid. You would have to contact the insured in regards to that claim.
[CUSTOMER][NEUTRAL] Insured, uh, could you please provide me the, uh, information on that? Like, may I know how much has been paid and paid to the uh provider?
[CUSTOMER][NEUTRAL] Uh, the patient.
[AGENT][NEUTRAL] You would have to contact the patient in regards to that. I can't disclose that information.
[CUSTOMER][NEUTRAL] Actually, I can't, I, I can't contact the, uh, I need to get the information from the insurance about payment.
[AGENT][NEUTRAL] No, because I can't disclose that information if it was processed to the insured. The provider will have to contact the insured in regards to this claim.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] So, the claim has been paid to the insured, right?
[AGENT][NEUTRAL] The claim has been processed and paid. You would have to contact the insured in regards to that.
[CUSTOMER][NEUTRAL] Can I get this information from the portal?
[AGENT][NEUTRAL] You can get that and the only thing it's gonna state is that the claim had processed and paid. So I'm giving you the information of contacting the policyholder in regards to that claim.
[CUSTOMER][NEUTRAL] Uh, OK, I got that. May I know the, uh,
[CUSTOMER][NEUTRAL] Pay date
[AGENT][NEUTRAL] I can't disclose the information of when it was paid.
[CUSTOMER][NEUTRAL] When it was paid.
[CUSTOMER][NEUTRAL] OK. I understood. May I know the portal name so I could access information?
[AGENT][POSITIVE] As I stated at the beginning of the call, it is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Got that. Uh, I'll go and check on that.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] One second. Yeah, uh, I have just one last claim. Could you check on that too?
[AGENT][NEUTRAL] May I have that policy number, please?
[CUSTOMER][NEUTRAL] Yeah, once again, let me pull that up.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] I'm gonna
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's loading on my system just a second.
[CUSTOMER][NEUTRAL] 36.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] Sorry, I think my system got stuck. Just a second.
[CUSTOMER][NEUTRAL] Yeah. One second. It has opened here.
[CUSTOMER][NEUTRAL] Yes, the policy number here is 980753.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Is the patient's name here is [PII], sir. And the date of birth is [PII].
[AGENT][NEUTRAL] May I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Is the date of service as just a second, uh [PII] and the bill amount is $13,985.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that is [PII]?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] No claim is on file.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Once again, yeah, [PII]. Sorry, the system is acting up. No claim on file. OK. Uh, let me check.
[CUSTOMER][NEUTRAL] On my system if we have sent.
[CUSTOMER][NEUTRAL] No, we haven't. OK. Uh, as you stated, there is no claim on file. May I get the, uh,
[CUSTOMER][NEUTRAL] Mailing address or payer ID?
[AGENT][NEUTRAL] The electronic payer ID is 60.
[AGENT][NEUTRAL] 801.
[AGENT][NEUTRAL] And the mailing address is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 731.
[AGENT][NEUTRAL] 24
[AGENT][NEUTRAL] 8950.
[CUSTOMER][NEUTRAL] Ah,
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] That is [PII] [PII]. OK. [PII].
[AGENT][NEUTRAL] 8950. Yes.
[CUSTOMER][NEUTRAL] OK. Um, no claim on file. May I know the member ID which I provided is correct, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And may I know the um
[CUSTOMER][NEUTRAL] Uh, timely filing limit for this?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] May I know the uh.
[CUSTOMER][NEUTRAL] Plan type
[AGENT][NEUTRAL] This is supplemental.
[CUSTOMER][NEUTRAL] OK. May I know, uh, does this patient have any group number or group name?
[AGENT][NEUTRAL] Let me get that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The group number is 16312.
[AGENT][NEUTRAL] And the group name is showing Healthy mother's Healthy baby.
[CUSTOMER][POSITIVE] Thank you so much for that.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] That's all I required, I think. PD, yeah.
[CUSTOMER][NEUTRAL] And may I know the effective date and the termination date?
[AGENT][NEUTRAL] It is showing that the policy is currently active with the effective date of.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Ah,
[CUSTOMER][NEUTRAL] Actually, let me check. Uh, maybe I have just one claim.
[CUSTOMER][NEUTRAL] I'm not sure. Just let me uh double check with that.
[CUSTOMER][NEUTRAL] Yeah, I have one claim.
[CUSTOMER][NEUTRAL] Could you check with that too?
[AGENT][NEUTRAL] May I have the policy number please? And this will be the last claim. I can only do a total of 5.
[CUSTOMER][NEUTRAL] Yeah, this is the last, this is the last. 02506178. I was also shocked where did this uh account come from because this, there were just that claim.
[CUSTOMER][NEUTRAL] That's why I asked you to check.
[AGENT][NEUTRAL] May I please have the member's name and date of birth?
[CUSTOMER][NEUTRAL] Yes. Uh, the member's name here is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] And may I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] It is [PII] and the bill amount is
[CUSTOMER][NEUTRAL] It's $579 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] And I'm pulling that up for you now.
[AGENT][NEUTRAL] And for that claim, it does show that it was received today.
[AGENT][NEUTRAL] And it shows that you do have to allow a total of 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK, just a second. It has been received.
[CUSTOMER][NEUTRAL] Today
[CUSTOMER][NEUTRAL] And we have
[CUSTOMER][NEUTRAL] I to
[CUSTOMER][NEUTRAL] 7 to 14 business days.
[AGENT][NEUTRAL] 7 to 10.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got that. And as you stated, it's uh 7 to 10 business days. May I know the normal processing time of this claim?
[AGENT][NEUTRAL] As I stated, it's 7 to 10 business days before the claim is reviewed and or processed.
[CUSTOMER][NEUTRAL] I got that. I just have to double check, not double-check, uh it's like turnaround time and the business normal processing time we should ask for separately. That's why. Thank you so much. Uh, do you have any claim number for this claim, uh, all right?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim does not have a, the claim does not have a claim number. It has not been pulled to be processed.
[CUSTOMER][POSITIVE] OK. Thank you so much. Uh, that's all I required. Thank you so much for Tarika uh Tarika, for your patience and assistance. Have a great day. Thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day as well.