AccountId: 011433970860
ContactId: 1b34d64f-2b1e-4142-8cf1-a767ba021e2f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 988010 ms
Total Talk Time (AGENT): 278004 ms
Total Talk Time (CUSTOMER): 346140 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/1b34d64f-2b1e-4142-8cf1-a767ba021e2f_20250122T19:48_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] Uh, hello, good afternoon, [PII]. This is [PII] calling from the provider, uh, regarding about general claims dish.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] Yeah, it's gonna be [PII]. And can you please spell your name for me?
[AGENT][NEUTRAL] It is spelled [PII] last initial of [PII] and today's date will be the call reference.
[CUSTOMER][NEUTRAL] OK, [PII], am I right, your name?
[AGENT][NEUTRAL] Say that again, please.
[CUSTOMER][NEUTRAL] [PII] can.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII], am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII] and [PII], thank you. I appreciate for your correction.
[AGENT][NEUTRAL] May I please have a policy number?
[CUSTOMER][POSITIVE] Sure, definitely.
[CUSTOMER][NEUTRAL] Uh, the policy number is 01448566M as in Mary, L as in Lima 5.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure, the first name is uh [PII] the last name is [PII] And the date of birth is gonna be.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK. The date of birth is [PII].
[AGENT][NEUTRAL] And you're calling in for status of claim. May I please have date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure, the date of service is uh [PII] and the bill amount is $354.72. 354.72.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I did pull that information up for you.
[AGENT][NEUTRAL] And it does show that we received that claim on [PII].
[AGENT][NEUTRAL] It was process
[CUSTOMER][NEUTRAL] Sorry, [PII]. Am I right?
[AGENT][NEUTRAL] Yes, it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That claim number is 354.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0576 that claim process and it denied that the policy was not active at the time of service. This policy term date.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Not just
[AGENT][NEUTRAL] Is showing 21 of 21.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 21 of 21, am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, OK, and before we move to the, the, the call reference number, please.
[AGENT][NEUTRAL] The call reference will be my first name, last initial of [PII] in today's date.
[CUSTOMER][POSITIVE] OK, I today is it. Thank you so much and we can move to the next again, am I right?
[AGENT][NEUTRAL] How many do you have for me to review?
[CUSTOMER][NEUTRAL] Uh, I still have 5 more claims. I would appreciate if you can finish up for me. OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. I only have a total of 4 that I can do for you since I did already do 1 May I have the next policy number?
[CUSTOMER][NEUTRAL] Yeah, 1475935. M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the first name is [PII] and the last name is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Sure. [PII] and the bill amount is $354.42.
[AGENT][NEUTRAL] And that's 1011 of 2024?
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] And for this member you can pull that claim up via our secured portal that is [PII].
[AGENT][NEUTRAL] And I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for this claim, it actually looks like we received it in twice.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The first time we received it in [PII].
[AGENT][NEUTRAL] We processed it [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 353.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] 322 8.
[AGENT][NEUTRAL] It looks like the claim processed and it made a payment in the amount of $50.
[CUSTOMER][NEUTRAL] 28, yeah.
[CUSTOMER][NEUTRAL] $50 and what is the allow more?
[AGENT][NEUTRAL] That is the maximum payment that we will pay out for this member.
[CUSTOMER][NEUTRAL] OK, um, is it paid through your check?
[AGENT][NEUTRAL] It is via check. Are you ready for the check number?
[CUSTOMER][POSITIVE] Yeah, I'm ready for the check number.
[AGENT][NEUTRAL] That check number is 267.
[AGENT][NEUTRAL] 97, I apologize, wrong number. That is 201.
[AGENT][NEUTRAL] 5179.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7 and is it both or single?
[AGENT][NEUTRAL] It's a single check.
[CUSTOMER][NEUTRAL] $50 am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, OK. And can you please verify me the check that issue that I mean?
[AGENT][NEUTRAL] That will be the processing date, which is listed as [PII].
[CUSTOMER][NEUTRAL] OK. So, and can you please uh fax to you before us because we still did not receive the EOB?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, may I have a fax number?
[CUSTOMER][NEUTRAL] Sure, definitely. The fax number is gonna be [PII].
[AGENT][NEUTRAL] Attention.
[CUSTOMER][NEUTRAL] Attention to [PII]'s pediatrics.
[AGENT][NEUTRAL] OK, and is there anything else that I can assist you with on that member?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] No problem and we can move to the next right.
[AGENT][NEUTRAL] May I have the next policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Next policy, uh, just one please, 60801.
[AGENT][NEUTRAL] That's not one of our policy numbers.
[CUSTOMER][NEUTRAL] Just, uh, let me just check it, OK? Because it's showing only.
[CUSTOMER][NEUTRAL] Mm, just one please. Can you hold for a moment? Let me just check it because yes, here it's only one.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] Uh, let me just pull another one, OK, just hold on please.
[CUSTOMER][POSITIVE] Yeah, thank you so much. And the policy number is gonna be 02224472 M as in Mary, L as in Lima 8.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the first name is [PII] and the last name is [PII]. And date of birth is gonna be [PII].
[CUSTOMER][NEUTRAL] I mean [PII].
[AGENT][NEUTRAL] May I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah, uh, the date of service is [PII] and the total bill amount is $683.76.
[AGENT][NEUTRAL] And that data service is 827 of 24 total bill is 683-76.
[CUSTOMER][POSITIVE] Yeah, correct.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So for that claim, it does show that we received it on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Claim number 3532.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 878, that claim shows that it did process and it made a payment in the amount of $60.
[CUSTOMER][NEUTRAL] $60 and a single amount, am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Can you please check number?
[AGENT][NEUTRAL] Check number is 201.
[AGENT][NEUTRAL] 5137.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, so can you please fax to you before us even this one?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, with the uh with the fax number which I provided you before.
[AGENT][NEUTRAL] Yes, I have that listed.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] May I have the next policy number?
[CUSTOMER][POSITIVE] Sure. Thank you so much. And uh 02501377.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII], [PII] And the date of birth is gonna be [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $245.28.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] So for that claim, it does show that we received it on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 352.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9652 that claim processed and it denied that office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of just one piece.
[CUSTOMER][NEUTRAL] So I can delete the account to the patient number right?
[AGENT][NEUTRAL] That is the provider's discretion.
[CUSTOMER][NEUTRAL] OK, no problem, uh.
[CUSTOMER][NEUTRAL] You're saying that office visits are not covered under the patient plan, am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, thank you so much and.
[CUSTOMER][NEUTRAL] For the last, I still have one more.
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Sure, yeah, definitely just one, please.
[CUSTOMER][NEUTRAL] And the policy number is 02465765.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, 7.
[AGENT][NEUTRAL] 002465765.
[CUSTOMER][NEUTRAL] Yeah. 02465765 ML 7.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the first name is [PII], and the first name is, I mean, date of birth is gonna be [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah, that is uh [PII] and the total bill amount is $245.28.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] For that claim, it does show that we received it on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number 3533233 claim process and it made a payment in the amount of $50.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] $50 and single amount, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the check number?
[AGENT][NEUTRAL] The check number is 2015178.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 7, so can you please fax the UB for us?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the check, uh, is check issue that is gonna be processed and am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Can you please fax that you'll be even for this one?
[AGENT][POSITIVE] Yes I will and is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No thanks, thanks for asking. I really appreciate, uh, [PII].
[CUSTOMER][POSITIVE] Once again I really appreciate. Have a wonderful rest of the day. Take care. God bless you, all right.
[AGENT][POSITIVE] Thank you and same to you and thank you so much for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You too, bye.