AccountId: 011433970860
ContactId: 17de2374-6481-41aa-9207-5b57380da794
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 558080 ms
Total Talk Time (AGENT): 216760 ms
Total Talk Time (CUSTOMER): 194054 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/17de2374-6481-41aa-9207-5b57380da794_20250319T12:48_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], calling for provider office to check additional information of the claim that was denied. Please note this call will be monitored and recorded for the quality and the training purposes, and how are you doing today?
[AGENT][POSITIVE] I'm doing well how are you?
[CUSTOMER][POSITIVE] Yeah, I'm doing good. Thank you so much for asking me.
[AGENT][MIXED] Good. And in the beginning of the call, it was kind of staticky. Did you say your name was [PII]?
[CUSTOMER][NEUTRAL] No, no, it's [PII]. It's spells like [PII] Yeah, yes.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] OK, I just couldn't hear you. OK, thank you, [PII]. And may I have a good contact number in case we are disconnected?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line, no extension.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, that's uh.
[CUSTOMER][NEUTRAL] One moment. Yeah. 01288297.
[AGENT][NEUTRAL] OK, 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.
[CUSTOMER][NEUTRAL] The member's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service of the claim that the claim number that you'd like me to take a look at?
[CUSTOMER][NEUTRAL] The date of service I have here that is on [PII], billed amount of $3,818 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] For [PII] for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And this is for the medical policy?
[CUSTOMER][NEUTRAL] Yes, Ma.
[AGENT][NEUTRAL] The reason I'm asking is because it's not showing any claims on file, so I'm just trying to make sure we're in the right place.
[CUSTOMER][NEUTRAL] Actually,
[CUSTOMER][NEUTRAL] Yes. Actually, I need like, is this payer ID to submit a claim is 57,080?
[AGENT][NEUTRAL] No, that's not uh.
[CUSTOMER][NEUTRAL] Because we have submitted, uh, yeah, we have submitted with this payer ID and the mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, none of that information is correct. Are you trying to reach American Public Life?
[CUSTOMER][NEUTRAL] Actually, we did not receive any OB from you. Actually, the claim guard has been rejected as a duplicate. So, uh, this, mhm.
[AGENT][NEUTRAL] Ma'am, ma'am, what I'm saying to you is we have not received the claim. The claims mailing address that you just gave and the claim payer ID that you just gave is not for American public life. So I'm asking is that who you're trying to reach so that I can help you because we don't have that claim on file and the information you're giving is not for this company.
[CUSTOMER][POSITIVE] Yes, actually, it's American Public Life uh Multiplan indemnity.
[CUSTOMER][NEGATIVE] Indemnity, sorry.
[AGENT][NEUTRAL] The member has a policy. The member has a policy with us where you sent the claim is not for us. I can give you the mailing address and the payer ID, but there is no claim on file here with APL for your date of service for [PII].
[CUSTOMER][NEUTRAL] We have to
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No problem. I'm going to submit with the correct uh payer ID and the mailing address. Can you please help me with the correct payer ID to submit a claim and the mailing address also?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure, OK, so the, you're welcome. So it's going to IMA like igloo, Mary, Apple.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Payer ID is 64556.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] 04.
[AGENT][NEUTRAL] Egan
[AGENT][NEUTRAL] E A G as in girl, A N like Nancy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Minnesota
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. I just want to repeat. The payer ID is 64556 and the mailing address is [PII], right?
[AGENT][POSITIVE] Yes, that's correct. And there's no timely filing limit. So once you send it, we'll go ahead and process it for you.
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][POSITIVE] Thank you so much. And uh can you please help me with the effective date of this patient?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, um, the policy has been effective since [PII] and it's still active.
[CUSTOMER][NEUTRAL] Still active. No termination date.
[CUSTOMER][NEUTRAL] One moment, OK.
[AGENT][POSITIVE] Mhm. Take your time.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And can you please help me with the attention?
[AGENT][NEUTRAL] Sure, um, for the, for the fact, so it'll be attention.
[AGENT][NEUTRAL] Well, it goes to IMA, so it will be attention [PII].
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you need any specific forms or uh only we have to submit the claim?
[AGENT][NEUTRAL] Um, so from the providers, it's usually your health claim form, whatever claim forms you have, and then the documents that you're trying to file for the claim, the itemized billing, um, you know, and whatever documents you, you're wanting to submit.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And for the future reference, can you please help me with the
[CUSTOMER][NEUTRAL] Apple mailing address also?
[AGENT][NEUTRAL] Wait a minute, you said the attention, I'm sorry, you said the attention, um, when you say attention, you mean for the mail for the mailing address because IMA doesn't have a fax number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you're mailing it, it would just have IMA at the top, and then if you're sending it electronically, you just go straight to them. I just want to clarify that for you. I just thought about that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no problem. And what is the app mailing address for the future reference?
[AGENT][NEUTRAL] Um, it's the same mailing address.
[AGENT][NEUTRAL] As the claims.
[CUSTOMER][NEUTRAL] And is there any timely filing limit for the appeal?
[AGENT][NEUTRAL] For an appeal, it's 180 days from the denial date.
[CUSTOMER][NEUTRAL] Attention to
[AGENT][NEUTRAL] This goes to IMA.
[CUSTOMER][POSITIVE] Thank you so much. And can I have the call reference for this patient?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The call reference for this patient.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. So again, that's [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] And also I have the same patient with a different date of service. And can you check whether is there any claim on file for the [PII]?
[AGENT][NEUTRAL] Sure, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And there is no claim on file for [PII].
[CUSTOMER][NEUTRAL] Yes, actually, we have submitted with the same payer ID for that claim also. And uh we are going to submit with the correct payer ID again and same details, right?
[AGENT][NEUTRAL] Yes, everything is the same.
[CUSTOMER][NEUTRAL] Yes, that's the same reason.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][POSITIVE] And thank you so much for assisting me and have a wonderful day. Bye-bye.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Alright, well thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] You too. Take care. Bye-bye.
[AGENT][NEUTRAL] Bye bye.