AccountId: 011433970860
ContactId: 1836c74b-0c85-4a42-a5bf-85b7b6e49fe3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 709650 ms
Total Talk Time (AGENT): 242777 ms
Total Talk Time (CUSTOMER): 343183 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/1836c74b-0c85-4a42-a5bf-85b7b6e49fe3_20250130T19:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello um my name's [PII] and um I need to check on this one patient because I was told that she has a new member ID, but now I'm not really sure what's going on.
[AGENT][NEUTRAL] OK. Do you have an ID number, [PII]?
[CUSTOMER][NEUTRAL] I have 02566928.
[AGENT][POSITIVE] Thank you and may I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Her date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for verifying that information. It looks like this plan is effective [PII] and it is active.
[AGENT][NEUTRAL] So that is her correct policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Well, there's a, there's a data service here before that. I have to, I have a data service here [PII] that was denied, and I'm not really sure why it was denied. um, uh, saying benefit name not found. I don't know why that would be. We've been going we working with you guys for years. So I'm questioning today, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] And I had spoken to
[CUSTOMER][NEUTRAL] Let me finish. I spoke with [PII] on [PII], and she said that she was going to reprocess it. The claim number I have is 353-575-4.
[AGENT][POSITIVE] Thank you, let me get that pulled up.
[AGENT][NEUTRAL] I do apologize.
[CUSTOMER][POSITIVE] It's all right, it's what we do.
[AGENT][NEUTRAL] OK, so it looks like data service 1162024.
[AGENT][NEUTRAL] Looks like.
[AGENT][NEGATIVE] They denied it as primary did not pay and
[AGENT][NEUTRAL] Let me get it pulled up and look at the EOB.
[AGENT][NEUTRAL] And it looks like this one did process under.
[AGENT][NEUTRAL] 256-6928 as well.
[AGENT][NEUTRAL] Let me get it pulled up.
[CUSTOMER][NEUTRAL] Alright, let me go back now and try to find my facts that I sent you on this because um uh if you're gonna tell me that I didn't have the, the, the primary you'll be in there, I wanna take a look at that because I don't know about that. I'm pretty good with this kind of stuff, so.
[CUSTOMER][NEUTRAL] That's where I feel like it's going, you know.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] And this would have been.
[CUSTOMER][NEUTRAL] Well, let me just keep looking. Let me go back to November and look for APL. Hold on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's when you got my ELB. That's when you got my my claim.
[AGENT][NEUTRAL] Your fax, yes.
[CUSTOMER][NEUTRAL] OK, let me take a look and see if I can find it.
[CUSTOMER][NEUTRAL] I see it. I see it. Alright, let me view it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See if I had that EOB in there.
[AGENT][NEUTRAL] Looks like there's a $30 co-pay.
[AGENT][NEUTRAL] On 989 41.
[AGENT][NEUTRAL] 4 116 data service.
[CUSTOMER][NEUTRAL] Right, which is what you guys usually pay. That's what, whatever you, so you do have the EOB from them. So I don't know what they're saying. It's the same thing that we always do. We've been doing this for years, same routine. That's the, that's the, the, the way they always the EOBs always are, they always pay that $30.
[AGENT][NEUTRAL] OK. Let me view this policy benefits real quick. One moment.
[CUSTOMER][NEUTRAL] I mean, I can, if you want, um, I can give you a couple of dates of service where it was exactly the same when they paid the $30. And also, if you look back to [PII], I spoke to [PII], and she was gonna reprocess it and I don't know what's going on.
[AGENT][POSITIVE] And I do apologize.
[CUSTOMER][NEUTRAL] But then the other thing I wanna say, the other thing I wanna say to you is that, if that new policy number that you gave me wasn't effective till [PII], then why was this November claim filed against that policy number? Could that be it?
[AGENT][NEGATIVE] And let me look cause it seemed like that one should have been processed.
[AGENT][NEUTRAL] Under 01640646.
[AGENT][NEUTRAL] Because that is the policy number prior to this one.
[CUSTOMER][NEUTRAL] Yep, I see that on the 01640646.
[AGENT][NEUTRAL] Yes, 646.
[CUSTOMER][NEUTRAL] Let me go look at that. Let me go look at that that fact. What's on the facts that we we looked at?
[AGENT][NEUTRAL] Let me get that pulled up.
[CUSTOMER][NEUTRAL] Could that be it? It sounds like it might be.
[AGENT][NEUTRAL] 1106 2024.
[AGENT][NEUTRAL] So it looks like under this policy.
[CUSTOMER][POSITIVE] You know, it's very light copy. It's a very light.
[AGENT][NEUTRAL] We processed and paid it under this one.
[AGENT][NEUTRAL] We paid the $30.
[AGENT][NEUTRAL] For
[CUSTOMER][NEUTRAL] I don't have that. Did you pay with the pay? I know you guys usually pay paper checks.
[AGENT][NEUTRAL] And it processed.
[CUSTOMER][NEUTRAL] Do you have a paper chip?
[CUSTOMER][NEUTRAL] Price is what?
[AGENT][NEUTRAL] Yeah, under uh claim number 354-0964. Let me see when this processed.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, check number 2018642.
[CUSTOMER][NEUTRAL] Do you, are you able to tell if the check cleared?
[AGENT][NEUTRAL] Now this one I would have to send over to finance to verify, but what I could do.
[CUSTOMER][NEUTRAL] Alright, hold on one second. All right, keep talking. I'm gonna look at my postings and see if I can see it. So that you're saying that check was on [PII] and you show with the 201864-2.
[AGENT][NEUTRAL] It was
[AGENT][NEUTRAL] 8642, yes. And that one processed.
[AGENT][NEUTRAL] 12, come on, [PII].
[CUSTOMER][NEUTRAL] And this is the date of service [PII], right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Co chiropractor and wellness.
[CUSTOMER][NEGATIVE] I don't even have that.
[CUSTOMER][NEGATIVE] Why would it show me that? Why would I, why can't I get that APL as a drop down within my.
[CUSTOMER][NEUTRAL] In my postings, why is it not showing me that drop down? What's the check number? Let me see. 201.
[AGENT][NEUTRAL] 8642.
[CUSTOMER][NEUTRAL] Alright, that's not helping. I'm gonna have to, I, we're gonna have to talk to a department that can tell me. I don't know why I'm, oh there it is. It's, I'm looking for APL. It's American. All right, let me see. 2018642, 201. I have a, I don't show 2018642.
[AGENT][NEUTRAL] So, I will send this over to finance. Once they tell me whether or not it was cash, I can give you a call back and fax you over the canceled check if it has posted.
[AGENT][POSITIVE] And clear
[CUSTOMER][NEUTRAL] OK, good. Let me, um, let, let me be very thorough with my note. OK. What's your name to start?
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Last initial is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, today's [PII]. All right, so.
[CUSTOMER][NEUTRAL] She says paid.
[CUSTOMER][NEUTRAL] Is checking.
[CUSTOMER][NEUTRAL] To see if check cleared right for the same patient, the data service [PII], do you show anything because I also have that open for for you guys.
[AGENT][NEUTRAL] OK, let's see for the [PII] would be under this one.
[AGENT][NEUTRAL] 1218 processed under claim number 3551082.
[AGENT][NEUTRAL] This one process the benefit amount of $30 to the provider on.
[AGENT][NEUTRAL] 1 13 2025.
[CUSTOMER][NEUTRAL] Well, that was fairly recent. Well.
[CUSTOMER][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] And this one is under.
[CUSTOMER][NEUTRAL] What's that check number? What was that check number?
[AGENT][NEUTRAL] Check
[AGENT][NEUTRAL] 202-268-1
[CUSTOMER][NEUTRAL] 202-268-1 and this is the claim number alright hold on.
[CUSTOMER][NEUTRAL] Let me see, this is data service 116, and this is data service 7 28th. Well this is really a pickle that we have ourselves in here, huh?
[AGENT][POSITIVE] We're gonna get it together.
[CUSTOMER][NEUTRAL] Alright, hold on a second.
[CUSTOMER][NEGATIVE] Oh, this is not good. Hold on a second, let me just go back to looking into my postings list.
[CUSTOMER][NEUTRAL] I'm gonna go with 3 months.
[CUSTOMER][NEUTRAL] I'm looking at the APL, but it's under American Public Life. It's no wonder I can't find it. Um, [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I don't have those [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I don't have them.
[AGENT][NEUTRAL] And so they're going to [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so that's great. So I'll put this one along with the first one, verify whether or not if it has posted and call you back on either one.
[CUSTOMER][POSITIVE] Now, I will, OK, good. I will add something that could have, that might have something to do with it. I have started working remotely more, so the girls are faxing me the EOBs. So, you know, I'm at the mercy of that. You know what I mean, of making sure that these girls are doing what they're supposed to do in the right way. Um, all right, so this is OK, [PII]. We're gonna just have to find it. I'm gonna put this at the top of my pending pile now, but this is a big one. This is going at the top now, um, to watch this. Um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And yeah, I'm gonna actually look through some of my old paperwork too and see if I can find something. All right, so good. Uh so how long do you think this will take?
[AGENT][NEUTRAL] Normal turnaround on the checks are 24 to 48. It doesn't necessarily take as long, but as soon as she sends it back, I'll call you back.
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][POSITIVE] All right, and let me give you my direct number because I'm, like I say, I'm working remotely. I'm at the office today, but I, I'll give you my best number when you're ready.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. I got that.
[CUSTOMER][NEUTRAL] And you're saying it should take 24 to 48 hours?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] All right. Let me, let's see what happens with that. And I'm gonna go look through some of my old DOBs and maybe they're there and I missed them, but I don't know, there's two of them here. Um, all right, if they clear then, OK, that's all we need to know, [PII]. All right, thank you so much. This was a good call. At least I got something done. All right. Thank you.
[AGENT][POSITIVE] [PII], I'm so happy. Thanks for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] OK, I'm glad I can make you laugh. We need to laugh, right? OK. All right, bye-bye now. Bye.
[AGENT][POSITIVE] Yes, ma'am. Yes, we do.
[AGENT][POSITIVE] Thank you. Bye-bye.