AccountId: 011433970860
ContactId: 2097a1a4-559a-43a7-9602-4cdb88872eca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1315479 ms
Total Talk Time (AGENT): 226136 ms
Total Talk Time (CUSTOMER): 463857 ms
Interruptions: 9
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/2097a1a4-559a-43a7-9602-4cdb88872eca_20250501T20:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider office. Can you please help me with the claim status?
[AGENT][NEUTRAL] Yes, I can help you with claims. Um, can I please get your call back number [PII] just in case the call is disconnected?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It is [PII].
[AGENT][NEUTRAL] Thank you, and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The policy number is RX.
[CUSTOMER][NEUTRAL] R as in rainbow, X as in Xerox, O as in onion, 2108285.
[CUSTOMER][NEUTRAL] And the patient's last name is [PII]. First name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK. And do you see a different policy number? That is not one of our policy numbers.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, with the policy number, can you uh pull the patient with patient details which I have provided you?
[AGENT][NEUTRAL] OK, can you spell the last name for me?
[CUSTOMER][NEUTRAL] Mhm. It is um [PII]. First name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, and spell the first name for me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, and spell the last name for me?
[CUSTOMER][NEUTRAL] Mhm. It is [PII].
[AGENT][NEUTRAL] OK, let me see if I can find it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that patient is not pulling up in my system.
[CUSTOMER][NEUTRAL] Mhm. So, as I said, it is uh invalid, uh, policy ID.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Or uh this patient is not enrolled with your policy.
[AGENT][NEUTRAL] No, we do not have a policy for this patient.
[CUSTOMER][NEUTRAL] Mhm. So where can I check whether, uh, he's, um, sorry, she's, um, enrolled with the American Public Life.
[CUSTOMER][NEUTRAL] Can you assist me?
[AGENT][NEUTRAL] No, the
[AGENT][NEUTRAL] The patient is not with American Public Life.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, can you please hold a moment? I will check with my supervisor.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, hi, um, let me have a moment so that I can check if we have any payments, uh, for this patient from APL.
[CUSTOMER][NEUTRAL] Just a moment, please. I'm checking.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] As I, uh, I have checked, we have received payment for this patient for different claims, so.
[AGENT][NEUTRAL] OK, what is the policy number for that claim? Or what is the claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one moment. I will provide you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] He's got.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Tax ID number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For this invoice, uh, the policy ID is the same as RX [PII].
[AGENT][NEUTRAL] No, that's not one of our policy numbers. What's the claim number that was paid?
[CUSTOMER][NEUTRAL] Mhm. OK. I will provide you.
[CUSTOMER][NEUTRAL] So the claim number is H as in horse 1 and 5 consecutive zeros.
[CUSTOMER][NEUTRAL] 9386021
[AGENT][NEUTRAL] That's not one of our claim numbers.
[CUSTOMER][NEUTRAL] That's not one of our.
[CUSTOMER][POSITIVE] Mm, wait a moment. OK, sorry, that was the wrong one. I'm so sorry.
[AGENT][NEUTRAL] Our claim numbers start with a 3.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So, rather than claim number, I can provide you the check number because uh I have check number, not the claim number for this one. So, can you check with the check number?
[AGENT][NEUTRAL] What is the number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is 223146-649.
[AGENT][NEUTRAL] OK, let me see if I can find that check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that's not our check number either.
[CUSTOMER][NEUTRAL] Mhm. But here it shows.
[CUSTOMER][NEUTRAL] That 1 331.
[AGENT][NEUTRAL] Yeah, this patient is not in our.
[CUSTOMER][NEUTRAL] Uh, OK. Uh, can I have a moment, please?
[AGENT][NEUTRAL] Yes, can you look at the check and see who the check is from?
[CUSTOMER][NEGATIVE] So you don't even have the check number which I have provided, right?
[CUSTOMER][NEGATIVE] That's the wrong one.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Right, that's not our check number it's too many digits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh hello. Thanks for being on hold. I'm transferring this call to my supervisor.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] I'm here. I'm listening.
[CUSTOMER][NEUTRAL] Hello. OK. Yeah, yeah.
[AGENT][NEUTRAL] Yes, ma'am. I'm here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, this is [PII] with APL.
[CUSTOMER][NEUTRAL] Hey, hi, [PII] from provider's office. So I do have an invoice which states like the primary already got paid and applies to the coinsurance. And it was already crossed over to your insurance, that is American Public Life.
[AGENT][NEUTRAL] OK. Can you give
[CUSTOMER][NEUTRAL] So I just want to ask you like, is there any, is there any possibility where I can check or find the patient using the last name and the first name?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I already did that and the patient wasn't in the system. Do you have the claim nu[PII] that's on the EOB?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, no, it has it is a crossover claim, so we don't have the UB or the claim number.
[CUSTOMER][NEUTRAL] Then to give me a time, I'll just check and update you for the same.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Do you have the patient's social security number?
[CUSTOMER][NEUTRAL] No, we do have the Social Security, but we do have only the last four digits of the Social Security number due to the confidential.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Yeah, I'll need all of it.
[CUSTOMER][NEUTRAL] HIPAA regulations.
[AGENT][NEUTRAL] Yeah, I did look up the name and I did um search by the check number she gave me and the check number has too many digits it's not ours. The uh policy number she gave me starts with an RX and none of our policy numbers start with an RX um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I asked her if she could see a claim number that started with a 3.
[CUSTOMER][NEUTRAL] I'll do one thing.
[CUSTOMER][NEUTRAL] Uh huh huh.
[AGENT][NEUTRAL] And she did not see one.
[AGENT][NEUTRAL] But looking.
[CUSTOMER][NEUTRAL] Just a minute. I'll just check the details and uh uh update you with the same. Just a minute. Just give me a minute.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, sure. Absolutely.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so I, so as I can see in the system, thank you so much for being online. So as I can see in the system, so we do have a clearing house from our end. It states already the claim was accepted by the payer.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK, what is the claim number?
[CUSTOMER][NEUTRAL] For the 2nd range, sir.
[CUSTOMER][NEUTRAL] But we don't have the claim number. We do have a claim number from the clearing house, not from the payer's end.
[CUSTOMER][NEUTRAL] So, what I'll do is I'll again reiterate you the information of the patient's first name and last name.
[CUSTOMER][NEUTRAL] Let's see, are you able to find it or not, OK?
[AGENT][NEUTRAL] I've already done that.
[CUSTOMER][NEUTRAL] Let me check, hold on.
[AGENT][NEUTRAL] I've already done that. Let me give you the spelling of the name that she gave me.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Is [PII] is [PII]
[AGENT][NEUTRAL] [PII] Last name is
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Exactly. So this is the patient's first name and last name and the date of birth would be.
[AGENT][NEUTRAL] And that patient is.
[AGENT][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] No, we didn't
[CUSTOMER][NEUTRAL] Exactly. So no patient is pulling with the name, right?
[AGENT][NEUTRAL] No, um, you'll have to contact the patient and get the correct policy number.
[CUSTOMER][NEUTRAL] OK. One more thing, like, could you please help me with the prefix of your insurance ID, the starting prefix?
[AGENT][NEUTRAL] The prefix
[CUSTOMER][NEUTRAL] Mhm. Is it Alpha alpha or what exactly?
[AGENT][NEUTRAL] It's APL, American Public Life.
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] Uh just a minute.
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Yeah, however, as I can see in the system, it says American Public Life.
[CUSTOMER][NEUTRAL] As a secondary insurance, the initial claim was paid by BCBS in the system.
[CUSTOMER][NEUTRAL] So with the help of the patient's first name and last name, we are unable to find the member, right?
[AGENT][NEUTRAL] That's correct with the information you've given me this member is not in our system.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, just a minute more.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Let me check the medical records. Hold on.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'll just check the information. However, uh, from the primary insurance I've checked, but however, we are unable to get the patient identified. So I'll do one thing. I'll just check the correct
[CUSTOMER][NEUTRAL] Insurance of the patient or we'll be doing one thing. We'll be sending an eligibility letter to the patient so that the correct insurance might get the claim, right? Just a minute, please. Let me check in the system again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, we can get a good policy number yes if we can get a good member ID number, we'll be able to pull it in. Looks like that that um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Member ID number she gave me looks like a prescription for a prescription. It starts with RX 021.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 08285.
[AGENT][NEUTRAL] That could possibly be that they got the wrong policy number.
[AGENT][NEGATIVE] I even tried it without the RX and it didn't pull up.
[CUSTOMER][NEUTRAL] What's the name you said?
[AGENT][NEUTRAL] I tried the policy number she gave me without putting the RX in the front.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] And it still did not pull up. I've tried every way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you please let me know what is your first, sir?
[AGENT][NEUTRAL] Sir?
[CUSTOMER][NEUTRAL] You said, what is your first name?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just tell me the call reference number.
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You in today's date that would be.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] [PII] right
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][POSITIVE] OK, great. And hold on just a minute.
[CUSTOMER][POSITIVE] OK, great, [PII]. Thank you so much for the assistance. Have a good day. Bye-bye.
[AGENT][POSITIVE] You too. Bye-bye, [PII]. Thanks for calling APL.