AccountId: 011433970860
ContactId: 2398c9c0-8dc0-4a6b-87ba-1aad6a8eb2be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1116530 ms
Total Talk Time (AGENT): 203705 ms
Total Talk Time (CUSTOMER): 650570 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/2398c9c0-8dc0-4a6b-87ba-1aad6a8eb2be_20250312T20:20_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, I was, um, calling because about like 3 weeks ago I called because I didn't have my new ID card.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so they gave me the new ID card number and I gave it to, I had um.
[CUSTOMER][NEGATIVE] Two dermatologist appointments and they were supposed to file a claim with you guys with the new number but when I log in I don't see any new claims. I don't know if it just takes a while, but they said that you guys haven't answered them.
[CUSTOMER][NEUTRAL] I don't know if something's in in your system.
[AGENT][NEUTRAL] When you say they are you referring to the provider's office?
[CUSTOMER][NEUTRAL] Yes, the doctor's office.
[AGENT][NEUTRAL] Uh, OK. And what's your name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Give me the last name spelling again.
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] OK, and did you say you do or do not have your policy number?
[CUSTOMER][NEUTRAL] No, I do now. Now I have the new 1 248.
[AGENT][NEUTRAL] OK, let me get your policy number, uh huh.
[CUSTOMER][NEUTRAL] 15
[CUSTOMER][NEUTRAL] 53
[AGENT][NEUTRAL] OK, and a good phone number?
[CUSTOMER][NEUTRAL] So what happened was when they were filing a claim they were using the old one.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] I didn't realize it was a new number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then they said they reapplied. There's one from November and then there's one from February. There's only 2.
[AGENT][NEUTRAL] OK, um, what's a good phone?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, go ahead, I'm sorry.
[AGENT][NEUTRAL] What's that's OK. What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, I'll give you my cell [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and so you're checking to see if we've received a claim from your providers?
[CUSTOMER][NEGATIVE] Yeah, they said they filed it, but you guys haven't responded.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] So there should be one, there should be 21 from November and then one in February. When I log in, it, it only the last one it shows is [PII].
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Uh, verify your date of birth and your mailing address for me.
[CUSTOMER][NEUTRAL] [PII] mailing address [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The city, state, and zip code?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm showing in [PII] is that.
[CUSTOMER][NEUTRAL] [PII], yeah, sometimes it comes up as [PII], sometimes [PII], yeah.
[AGENT][NEUTRAL] [PII], right, OK, and what's your email address?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, OK. And do you pronounce your name, [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII], OK, that's different. I like that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so let's see if we've received any claims for you and thanks for verifying that information.
[AGENT][NEUTRAL] Do you know what the date of service is on the claim?
[CUSTOMER][NEUTRAL] OK, so the one it should be Menard Dermatology. I think it's from November, but I don't know the exact date of November.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know it's November and then the second one should be February, but again, I don't know the exact date either.
[CUSTOMER][NEUTRAL] In November and February.
[AGENT][NEUTRAL] February of this year, [PII] and then [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So everyone's like more recent, but.
[AGENT][NEUTRAL] OK, so I looked under under your policy number that was prior to this one and I don't see any under that policy. And so the policy number that you gave me is the one that they should be submitting the claim under.
[CUSTOMER][NEUTRAL] Yeah, they said they resubmitted it.
[CUSTOMER][NEUTRAL] Under the new number.
[CUSTOMER][NEUTRAL] So I don't know where the, you know, where the disconnect is.
[AGENT][NEUTRAL] Yeah, I'm not showing any claims uh under your new policy under the one that you just gave me that which has which was effective [PII] and then this one is currently active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEGATIVE] Where to go now because they're saying that you guys aren't answering them that they did file it.
[CUSTOMER][NEUTRAL] The new claim.
[AGENT][NEUTRAL] Who, who, who are you speaking with in the doctor's office?
[CUSTOMER][NEUTRAL] Uh, I don't have a name. Yeah, honestly I don't have a name. I called them like I followed up a few times because they.
[CUSTOMER][NEGATIVE] They said they were unsuccessful, you know, getting in touch.
[AGENT][NEUTRAL] Mm, we show a couple of calls made. We spoke with someone on [PII].
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And we verified your eligibility and and uh benefit information so they're they're connecting with us.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, so well then what's the issue if they're connecting?
[AGENT][NEUTRAL] And we advised the person of the new policy number provided that and then provided them with the outpatient benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have their
[CUSTOMER][NEUTRAL] OK, so why didn't it get?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, so why didn't it get done, the claim.
[CUSTOMER][NEUTRAL] From that time.
[AGENT][NEUTRAL] Yeah, I mea[PII], I can't answer that question. Um, do you have their phone number?
[CUSTOMER][NEUTRAL] Why wasn't it completed?
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Because yeah there was one that like I said it was in November and then there was one that was in February.
[CUSTOMER][NEUTRAL] Um, let me see the number here, hold on.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. And what office is this?
[CUSTOMER][NEUTRAL] Minar
[CUSTOMER][NEUTRAL] Minars dermatology.
[AGENT][NEUTRAL] Spell that
[AGENT][NEUTRAL] Spell it?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Dermatology, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] Uh, OK, so the first one, let's see, it shows [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the one in February that I did, I don't know because.
[CUSTOMER][NEUTRAL] Because they haven't sent me like a bill yet, but it was probably.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean I could let me see if I could find it like on a text on the appointment or something.
[AGENT][NEUTRAL] Yeah, I'm gonna dial him real quick while you look for that. Hold the line just a second, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] My dermatology this is [PII].
[AGENT][NEUTRAL] [PII], hi, this is [PII] with American Public Life Insurance Company. How are you?
[CUSTOMER][POSITIVE] I'm doing well. What can I help you with?
[AGENT][NEUTRAL] I have a patient of uh this office on the phone. His name is [PII]
[CUSTOMER][NEUTRAL] What's his date of birth?
[AGENT][NEUTRAL] And I show his date of birth as [PII]. There appears to be a problem with us receiving claims from this office, so I just wanna verify that you all have the correct information.
[AGENT][NEUTRAL] Do you show any outstanding balances for him? He gave me a [PII] data service and a date of service in February of this year. He wasn't for sure of the date.
[CUSTOMER][NEUTRAL] I don't have any pending balances with this patient. Um, he was just here last in [PII] and everything is still, um.
[CUSTOMER][NEUTRAL] Pending from the insurance.
[AGENT][NEUTRAL] From the primary?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what about [PII]?
[CUSTOMER][NEUTRAL] I have a balance of $122.03.
[AGENT][NEUTRAL] OK, and how was that applied by the primary? Is it deductible, co-insurance, or co-pay?
[CUSTOMER][NEUTRAL] It was applied from the deductible's primary insurance.
[AGENT][NEUTRAL] OK, and so was the claim submitted to APL, which is a secondary payer?
[CUSTOMER][NEUTRAL] No, it was submitted to United Healthcare and then it was resubmitted again. I tell you right now hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, yeah, then it was resubmitted to APL.
[AGENT][NEUTRAL] Can you verify how it was submitted electronically by mail, fax?
[CUSTOMER][NEUTRAL] And then there's
[CUSTOMER][NEUTRAL] No, it was electronically um billed.
[AGENT][NEUTRAL] And what payer ID number was used?
[CUSTOMER][NEUTRAL] Um, let me go ahead and see, give me one second.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Board certified dermatologist, Doctor [PII] completed medical school at the University of Miami and received multiple accolades, including the Alpha Omega Alpha Honors and Best Student in Dermatology Award. She
[CUSTOMER][NEUTRAL] her specialization in Moe surgery in [PII] and is a fellow of the American Society for Moe Surgery. She teaches and lectures to residents at the University of Miami Department of Dermatology. Thank you for holding. We'll be with you in just a moment.
[AGENT][NEUTRAL] A job.
[CUSTOMER][NEUTRAL] Board certified dermatologist, Doctor [PII] completed medical school at the University of Miami and received multiple accolades, including the Alpha Omega Alpha Honors, and Best Student in Dermatology Award. She
[CUSTOMER][NEUTRAL] her specialization in Moe surgery in [PII] and is a fellow of the American Society for Moe Surgery. She teaches and lectures to residents at the University of Miami Department of Dermatology. Thank you for holding. We'll be with you in just a moment.
[CUSTOMER][NEUTRAL] Dermatology certified nurse practitioner [PII] comes to us from [PII] where she was the only dermatology provider for the 25,000 patients under this health plan. She brings 10 years of experience in dermatology along with.
[CUSTOMER][POSITIVE] Love for opera and hails from [PII]. Dr. [PII] trained in dermatology residency at the University of Miami, and his interests include medical and cosmetic dermatology. He has received research awards from several medical societies.
[AGENT][NEUTRAL] Mr. [PII], are you there?
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] OK, I am speaking with someone on the other line they're checking something for me and I'll be right back with you, OK?
[CUSTOMER][NEUTRAL] OK, I found the date too if you, if you need it on the second one, OK, oh I just lost, hold on one sec, it's around that date, uh, yeah, [PII], yes, yeah, mhm.
[AGENT][NEUTRAL] What is it?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Was it the [PII]?
[AGENT][NEUTRAL] OK, that's, that's what they gave me. OK. Let me, let me reconnect with the doctor's office. I'll be right back, OK?
[CUSTOMER][POSITIVE] OK, thank you. For opera and hails from [PII], Dr. [PII] trained in dermatology residency at the University of Miami, and his interests include medical and cosmetic dermatology. He has received research awards from several medical societies and has over a dozen medical articles published in peer reviewed journals. Thank you for holding. We'll be on the line to help you shortly.
[CUSTOMER][POSITIVE] True experts, miner's dermatology has a tradition of excellence since [PII]. Our combination of experience and cutting edge care is unique. We are an established practice with experienced doctors as well as younger doctors, with both male and female physicians having specific areas of interest and expertise. We have more lasers.
[CUSTOMER][NEUTRAL] Than most universities on site, which are used for a wide variety of treatments. If you have an interesting or difficult case, you may be seen by several of our doctors during your visit, and you'll receive the advantage of an immediate second opinion from a potentially different point of view. Learn more about us than the service we provide at [PII].
[CUSTOMER][NEUTRAL] Dermatology certified nurse practitioner [PII] comes to us from [PII], where she was the only dermatology provider for the 25,000 patients under this health plan. She brings 10 years of experience in dermatology along with a love for opera and hails from [PII]. Dr. [PII].
[CUSTOMER][NEUTRAL] Trained in dermatology residency at the University of Miami, and his interests include medical and cosmetic dermatology. He has received research awards from several medical societies and has over a dozen medical articles published in peer reviewed journals. Thank you for holding. We'll be on the line to help you shortly.
[CUSTOMER][NEUTRAL] At Minor's dermatology, we can detect and treat almost every type of skin cancer in our office under a simple local anesthesia. We have both an experienced mo surgeon and a plastic surgeon on staff to meticulously remove and repair any surgical wounds with techniques designed to minimize scarring. Mo surgery produces a higher cure rate and the smallest scar.
[CUSTOMER][POSITIVE] As the procedure removes the smallest amount of tissue possible with our state of the art facility, on-site lab, and Mo's waiting room. In most cases, everything is done in the office on the same day with only local anesthesia needed. Our friendly staff is always here to help you and answer any questions. Thank you for choosing Minor's Dermatology. We look forward to assisting you in just a few moments.
[CUSTOMER][NEUTRAL] Father and son board certified dermatologist Doctor [PII] and Doctor [PII] are assistant professors in dermatology at the University of Miami School of Medicine, where they teach dermatology residents each month. Dr. [PII] has been in practice since [PII] and is a former president of Miami.
[CUSTOMER][NEUTRAL] Dermatologic Society. Dr. [PII] was [PII] and graduated summa cum Laude at the University of Michigan, was a member of the Alpha Omega Alpha Honor Society at NYU School of Medicine, and is a former chief resident of dermatology at Albert Einstein College of Medicine. We'll be with you shortly.
[CUSTOMER][POSITIVE] Thank you for calling Minor's Dermatology, where we have been treating Hollywood since [PII]. We provide advanced laser dermatology backed by an old fashioned caring attitude with the same day service and personalized approach you want and deserve. Our goal is to make your visit effortless, and our patients often remark that was the easiest doctor's visit I.
[CUSTOMER][POSITIVE] Ever had. We have a nice staff, nice doctors, and we will see you on time. We treat adults and children for medical, surgical, cosmetic, and laser dermatology. We're located at [PII] and on the web at [PII]. We're glad you called. We look forward to helping you in just a few moments.
[CUSTOMER][POSITIVE] Thank you for calling Minor's Dermatology, where we have been treating Hollywood since [PII]. We provide advanced laser dermatology backed by an old fashioned caring attitude with the same day service and personalized approach you want and deserve. Our goal is to make your visit effortless, and our patients often remark that was the easiest doctor's visit I.
[CUSTOMER][POSITIVE] We had, we have a nice staff, nice doctors, and we will see you on time. We treat adults and children for medical, surgical, cosmetic, and laser dermatology. We're located at [PII] and on the web at [PII]. We're glad you called. We look forward to helping you in just a few moments.
[CUSTOMER][NEUTRAL] Board certified dermatologist, Doctor [PII] completed medical school at the University of Miami and received multiple accolades, including the Alpha Omega, Alpha Honors, and Best Student in Dermatology Award. She
[CUSTOMER][NEUTRAL] her specialization in Moe surgery in [PII] and is a fellow of the American Society for Moe Surgery. She teaches and lectures to residents at the University of Miami Department of Dermatology. Thank you for holding. We'll be with you in just a moment.
[AGENT][NEUTRAL] [PII], are you there?