AccountId: 011433970860
ContactId: 17a5e578-6f50-41cd-9279-2f6651c84b58
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1155359 ms
Total Talk Time (AGENT): 470935 ms
Total Talk Time (CUSTOMER): 381563 ms
Interruptions: 6
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/17a5e578-6f50-41cd-9279-2f6651c84b58_20250214T19:25_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from product office checking on the claim status.
[AGENT][NEUTRAL] OK, I'm sorry, what was your name? Can you spell it for me?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] OK, it is. Thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] My callback number is [PII] with [PII] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yes. Thank you for confirming.
[AGENT][NEUTRAL] Thank you. And uh do you have one claim that you're needing status on, is that correct?
[CUSTOMER][NEUTRAL] Yeah, I'm having two claims for the same member.
[AGENT][NEUTRAL] OK, so you have 2 dates of service for the same patient, is that correct?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. I'm sorry.
[CUSTOMER][NEUTRAL] Overall, I'm having
[CUSTOMER][NEUTRAL] Just a moment. Overall, I'm having 4 claims. For uh each member, I have 222 claims.
[AGENT][NEUTRAL] So you have 4 different patients and each of them have 2 claims each.
[CUSTOMER][NEUTRAL] No, I have, I have overall 4 claims.
[AGENT][NEUTRAL] OK. Is it all for the same patient?
[CUSTOMER][NEUTRAL] No, it was a different patient. Two claims for the same patient and another 2 claims for the same patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you have 2 different patients with a total of 4 claims, 2 each. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, A. I can help you with that. And so first off, my, again, my name is [PII]
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] And you will use my name and today.
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Sorry, [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you're gonna use my name. You're welcome. My name in today's date, [PII] will be your call reference number for each.
[CUSTOMER][POSITIVE] OK. Thank you. [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Claim that I check. Also, any information that I provide for you today on any of the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] And then lastly, if we do have the claims on file and you need a copy of the explanation of benefits, you may print them by going to our portal and our website for the portal is secured.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Dot com.
[CUSTOMER][NEUTRAL] A M
[AGENT][NEUTRAL] Public
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Again, it is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Yeah, OK. Thank you for that.
[AGENT][NEUTRAL] You're welcome. And what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] Yes, member ID number is 20134905 M as in Mary, L as in Lima 8.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][POSITIVE] Yeah, OK. You're welcome.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] Actually, bear with me just one moment, please.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] OK. Jeez, I'm so sorry. Give me the policy number one more time, please.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] 2, sorry, it's uh 02134905 M as in Mary, L as in Lima 8.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] And, uh, your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes, member's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, I'm so sorry. I'm having some, uh, a technical issue with my screen, so please bear with me.
[CUSTOMER][NEGATIVE] a technical issue.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] OK, so let's try this again. OK, so first off, what is the um what is the first day of service and total bill amount for this number, please?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the bill amount is $515 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And the second one is also for [PII]. And the bill amount is $5,325 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, so that 5000.
[CUSTOMER][NEUTRAL] Total charge amount.
[CUSTOMER][NEUTRAL] Yes, $5,325 even.
[AGENT][NEUTRAL] OK, thank you. Now, uh, the claims, there are no claims on file on this policy for that data service, but this policy was not active for your data service. This policy was active from [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Sorry, the members active from?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Active from [PII] to [PII]. Let me see if the member has another policy that's active and they do.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, just a moment, just for confirm sorry for the interruption. Just a confirmation. The member is effective from [PII] and it was turned on.
[AGENT][NEUTRAL] So I'll need to give.
[AGENT][NEUTRAL] 91.
[CUSTOMER][NEUTRAL] May I have the date?
[AGENT][NEUTRAL] Uh-huh. [PII]
[CUSTOMER][NEUTRAL] 9120 24.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, OK. Just a moment.
[AGENT][NEUTRAL] So there is another policy though that is active, and I'm gonna give you the correct policy number that you should have for the data servicing question.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] So just one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so the policy that is active for your date of service is 237.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] But um
[AGENT][NEUTRAL] 0301.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It has an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there is no termination date, this policy is still active, so give me a moment to see if we received the claims and process, process them under the correct policy.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] And no sir we do not have any claims on file for this member for this data service.
[CUSTOMER][NEUTRAL] Yeah, OK. Uh,
[CUSTOMER][NEUTRAL] Oh, may I know
[CUSTOMER][NEUTRAL] During the date of service, which insurance is active for the member?
[AGENT][NEUTRAL] The last policy number that I just gave you was an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's the policy number is 237-0301. Am I right?
[AGENT][NEUTRAL] 237-0301.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK. May I have the insurance name?
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] APO
[AGENT][NEUTRAL] APL as in Lima.
[CUSTOMER][NEUTRAL] OK. A as in Alpha. O as in Oscar, L as in Lima.
[AGENT][NEUTRAL] A as in Alpha, P as in Peter.
[AGENT][NEUTRAL] L as in Lima.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's American Public Life.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah, OK. May I, is there any possible to have the contact number?
[AGENT][NEUTRAL] Uh, you're, I am with [PII]. You're speaking with [PII].
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] We just don't have the claim on file.
[CUSTOMER][NEUTRAL] Yeah, OK. There is no claim on file. Am I right?
[AGENT][NEUTRAL] That is correct for either of those amounts, no claim on file for [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now when you do submit the claim to [PII] A for our review, you must also send us the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I have the timely filing limit to submit the claim?
[AGENT][NEUTRAL] And then
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. May I have the mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] To submit the claim.
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, uh, may I know the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, can I go with uh another date of service?
[AGENT][NEUTRAL] For a different member, correct?
[CUSTOMER][NEUTRAL] No, for the same member, I have provided two data service. For 2 data service, there is no claim on file.
[AGENT][NEUTRAL] OK, you, you told me that for 627-2024, 1 billed amount was $515 and you also said that for data service $627 the billed amount, there was a separate billed amount of $5,325.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it is different day.
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] So how many more days of service do you have for this number?
[CUSTOMER][NEUTRAL] This number only I have these two data of service. For this two data of service, there is no claim on file. Am I right?
[AGENT][NEUTRAL] No, neither. OK, let me ask you this one more time, A, to make sure we're not having any miscommunication.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] You have 2 separate bills amounts.
[AGENT][NEUTRAL] For the same data service, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so we do not have any claims on file for data service 627-2024 in the amounts of $515 or $5,325.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][POSITIVE] OK, thank you for that and uh
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah, and the
[CUSTOMER][NEUTRAL] Can I go with another member?
[AGENT][NEUTRAL] Uh, just one moment and let me finish my note on this one first, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, [PII], what is the next patient's policy number?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] Sorry for that. And the member policy number is 2111171.
[AGENT][NEUTRAL] 2111171.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello my name is.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Member's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, what is the data service and total bill amount?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the total bill amount is
[CUSTOMER][NEUTRAL] $1,276.
[AGENT][NEUTRAL] OK, so just one moment for me to check that one first.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, so we do not have a claim on file for him for that date of service.
[CUSTOMER][NEUTRAL] OK, so we do not have a claim on file.
[AGENT][NEUTRAL] And total bill amount.
[CUSTOMER][NEUTRAL] Yeah, for this member also I have a same date of service and the bill amount is different. I have two claims.
[AGENT][NEUTRAL] OK, so for the $1,276 for 823 2024, that claim is not on file.
[CUSTOMER][NEUTRAL] Yeah, OK. May I know the member effective date of coverage?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Effective date is [PII], termination date [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is
[CUSTOMER][NEUTRAL] Um, may I know the timely filing limit to submit?
[AGENT][NEUTRAL] Uh-huh. The next bill amount.
[AGENT][NEGATIVE] No timely filing?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] Yeah, OK. And the mailing address and the payer ID is the same, am I right?
[AGENT][POSITIVE] It's the same. Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, OK. Thank you for that. And, and uh another bill amount is $1,037 even.
[AGENT][NEUTRAL] And that's also for 823, 2024?
[CUSTOMER][NEUTRAL] Yeah. Yes.
[AGENT][NEUTRAL] No, sir, we do not have a claim on file file for that amount either for this data service.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Hey you.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] For this also same, am I right? Mes same effective from [PII].
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] That is correct, yes, sir.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you for your patience and assistance, [PII]. Have a nice day.
[AGENT][NEUTRAL] Well, you're certainly very welcome. Yes. And again, um, make sure that when you do submit those claims to us for review A, that you do include the primary insurance company's explanation of benefits for each of the dates of service for both patients.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I explained to you that because this is a supplemental policy, when the claim is filed with APL, you must also send us a copy of the primary insurance company's explanation of benefits as well for each of both of these members. OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah, yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, OK. OK.
[AGENT][POSITIVE] Alright then, well if that's all I can help you with then thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] I didn't
[CUSTOMER][POSITIVE] You too have a great day. Thank you.
[AGENT][POSITIVE] Uh, thank you very much. Yes, sir.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, for just a confirmation.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] If, uh,
[CUSTOMER][NEUTRAL] We all need to submit a claim through electronically or paper?
[AGENT][NEUTRAL] It may be done either way, but you must also send us the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] OK. Well, you're welcome. And again, thank you for calling APL.
[CUSTOMER][POSITIVE] I know. Thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye. You too.
[CUSTOMER][POSITIVE] Have a nice day. Have a nice day. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Bye bye thank you.
[AGENT][POSITIVE] You're welcome.