AccountId: 011433970860
ContactId: 22f07dd0-27e6-408d-a625-26d171c74361
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 394299 ms
Total Talk Time (AGENT): 111463 ms
Total Talk Time (CUSTOMER): 153021 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/22f07dd0-27e6-408d-a625-26d171c74361_20250619T18:27_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I needed some information um on a claim and it's an old one.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] [PII], what is the policy number of the member that you're calling to check the status of a claim for and I'll be able to assist you.
[CUSTOMER][NEUTRAL] 001204852. 0 no, I'm sorry, it's 1204852 ML 8.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] 206.
[CUSTOMER][NEUTRAL] You did time want to send you next time.
[AGENT][NEUTRAL] Do [PII] have a something behind his last name like a sir or something?
[CUSTOMER][NEUTRAL] I just have [PII] and that's how you guys have it on the EOB.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What was your bill amount?
[CUSTOMER][NEUTRAL] 186 33.
[AGENT][NEUTRAL] And your procedure code?
[CUSTOMER][NEUTRAL] 99214.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed March, I'm sorry, it was received [PII]. It was processed [PII].
[AGENT][NEUTRAL] There was no payment made on this claim because
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was this for urgent care or office visit?
[CUSTOMER][NEUTRAL] Yes ma'am, uh, urgent care.
[AGENT][NEUTRAL] So there was no payment cause benefits are only payable if the major medical make a payment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They didn't make a payment because hold on I'll tell you right now.
[CUSTOMER][NEUTRAL] They, I mean before I stick my foot in my mouth.
[AGENT][NEUTRAL] So this, this gap insurance, they only make a payment if the primary put something towards deductible, co-pay and co-insurance.
[CUSTOMER][NEGATIVE] And they didn't make a payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Yeah, from the EOB that we have, it don't look like they did.
[CUSTOMER][NEUTRAL] Yeah, no, they didn't. I, I need to write this one off.
[AGENT][NEUTRAL] You said it was denied, claim was denied.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, because the pay the insurance didn't pay it.
[CUSTOMER][NEUTRAL] Um, and for some reason it went straight to the when it was, it went straight to you guys.
[CUSTOMER][NEUTRAL] Um, I have another patient if you can check it for me please.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Mhm, sure yeah.
[CUSTOMER][NEUTRAL] Um, this one.
[CUSTOMER][NEUTRAL] Never mind I already did that one. He was not active.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, wait, no, but I have a whole bunch of them.
[CUSTOMER][NEUTRAL] Alright, I should, um.
[CUSTOMER][NEUTRAL] Let me see, this is veto.
[CUSTOMER][NEUTRAL] Hold on, because for some reason we did like a big sweep with you guys.
[CUSTOMER][NEUTRAL] And for claims I guess that warrant is still outstanding.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] Let me see this one real quick if this one was.
[CUSTOMER][NEUTRAL] OK, this one, let me give you because this one I dealt with back in [PII].
[CUSTOMER][NEUTRAL] And you guys don't.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Um, the policy number is 01422516 ML8.
[AGENT][NEUTRAL] And [PII], what's this patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So it looks like we received the original claim [PII]. It was processed [PII]. There was no payment because the member's policy.
[AGENT][NEGATIVE] Doesn't cover outpatient service. The member's policy does not cover.
[AGENT][NEUTRAL] Patient is no longer eligible dependent. So it says the patient was no longer eligible dependent at the time of services. Let me see when the policy terminated.
[CUSTOMER][NEUTRAL] When do they terminate, please thank you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK right right page now.
[CUSTOMER][NEUTRAL] I guess, I guess they should start calling and and verifying with you guys with this American Public Life what benefits they do have correct?
[AGENT][NEUTRAL] Benefits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because they don't ever call they just put it in the system and do it like that.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, all right sweetheart, thank you so much.
[AGENT][POSITIVE] You're welcome, [PII]. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Not right now I might call back.
[AGENT][POSITIVE] Well, someone will be here for you. Thanks for calling APL and you have a great day.
[CUSTOMER][POSITIVE] Thank you have a great day bye bye.
[AGENT][POSITIVE] You're welcome. Goodbye.