AccountId: 011433970860
ContactId: 27fb253d-2644-4869-ab9f-b9a811b1dcd7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 755080 ms
Total Talk Time (AGENT): 229897 ms
Total Talk Time (CUSTOMER): 201117 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/27fb253d-2644-4869-ab9f-b9a811b1dcd7_20250304T19:09_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from McCloud Health to check the claim status.
[AGENT][NEUTRAL] OK, I can help you with that. Could I get a callback number?
[CUSTOMER][NEUTRAL] [PII]. It was a direct line.
[AGENT][NEUTRAL] Thank you. OK. Can I get the policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 01802609
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much for verifying the policy and you did say claim status today. What is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I do not show we have a claim on file for [PII].
[CUSTOMER][NEUTRAL] You have the claim?
[AGENT][NEUTRAL] We do not have a claim on file for [PII].
[CUSTOMER][NEUTRAL] OK. Can I have member's eligibility?
[AGENT][NEUTRAL] I do show that this policy did cancel on [PII].
[CUSTOMER][NEUTRAL] So policy already termed, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is there any other active plan after the term period?
[AGENT][NEUTRAL] There is not. No, ma'am, there is not.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] And can I have the payer ID to resubmit the claim again?
[AGENT][NEUTRAL] Payer ID is 608.
[AGENT][NEUTRAL] I'm sorry, 60801.
[CUSTOMER][NEUTRAL] 60801. And can I have the timely filing limit?
[AGENT][NEGATIVE] There is no timely filing.
[CUSTOMER][NEUTRAL] OK. And I do have uh one more date. Could you please help me for that?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] For the same patient?
[AGENT][NEUTRAL] OK, what is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I do not show we have a claim on file for [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII], for that information. And I do have a few more patients. Could you please help me for that?
[AGENT][NEUTRAL] You're welcome, [PII].
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][NEUTRAL] Just second.
[CUSTOMER][NEUTRAL] It's loading just a minute please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next policy ID is 02469240.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you for verifying the policy and what is the date of service you're checking for this patient?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I do not show we have a claim on file for [PII].
[CUSTOMER][NEUTRAL] And remember
[CUSTOMER][NEUTRAL] Policy. Can I have the policy?
[AGENT][NEUTRAL] The policy
[AGENT][NEUTRAL] What type of information are you asking?
[CUSTOMER][NEUTRAL] I'm asking for member eligibility.
[AGENT][NEUTRAL] Oh, eligibility. I show the policy effective, uh, since [PII], it's still active.
[CUSTOMER][POSITIVE] Thank you so much. Shall we go for the next member?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] 02052175.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, and what is the data service?
[CUSTOMER][NEUTRAL] 627 2023 $120 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do show that that claim was received, received on [PII]. The claim denied on [PII]. The policy does not cover physician office visits.
[CUSTOMER][NEUTRAL] OK. Could you please send me the copy of EOB to my fax number? Is that possible?
[AGENT][NEUTRAL] What is the?
[AGENT][NEUTRAL] Sure, what is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold one moment.
[AGENT][POSITIVE] OK, it's on its way. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK. So when I'll receive the EOB?
[AGENT][NEUTRAL] It is on its way at this time.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] For the same member, uh, one sec.
[CUSTOMER][NEUTRAL] Yeah, for the same member, I do have some more dates. Could you please help me for that?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] What is the next date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Total charge.
[CUSTOMER][NEUTRAL] $200,260.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do show the claim received on [PII].
[AGENT][NEUTRAL] The claim was denied on [PII]. The policy does not cover services in the physician's office.
[CUSTOMER][NEUTRAL] OK. So can I have this EUB also?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, and I'll provide you the attention number.
[AGENT][NEUTRAL] OK, what is the attention number?
[CUSTOMER][NEUTRAL] It's X as in X-ray 1013207149.
[AGENT][NEUTRAL] OK, it has been sent. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah, I do have 3 more dates.
[AGENT][NEUTRAL] What is the next date of service?
[CUSTOMER][NEUTRAL] [PII] $268 even.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And what is the total bill one more time?
[CUSTOMER][NEUTRAL] $268.
[AGENT][NEUTRAL] OK, I do not show we have a claim on file for [PII] for $268.
[CUSTOMER][NEUTRAL] Uh, sorry, you have the claim?
[AGENT][NEUTRAL] We do not have a claim on file for that date and amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Shall we go for the next date?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I do not show we have a claim on file for [PII].
[CUSTOMER][NEUTRAL] OK. And the one more date. [PII].
[AGENT][NEUTRAL] I do not show we have a claim on file for [PII].
[CUSTOMER][NEUTRAL] Can I have the eligibility?
[AGENT][NEUTRAL] I show the policy effective since [PII] and still active.
[CUSTOMER][NEUTRAL] Shall we go for the next member?
[AGENT][NEUTRAL] OK, um, and this is the last member. What is the policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That's just like
[CUSTOMER][NEUTRAL] The policy number 02440625.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the data service you're checking?
[CUSTOMER][NEUTRAL] [PII] 2024.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the total bill?
[CUSTOMER][NEUTRAL] $384.
[AGENT][NEUTRAL] OK, I do not show we have a claim on file.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Member eligibility.
[AGENT][NEUTRAL] Let me check that.
[AGENT][NEUTRAL] I show the member's policy effective from [PII], the policy termed [PII].
[CUSTOMER][POSITIVE] Thank you so much. And for the same number, I just have 2 more dates. Could you please help me for the 2 dates? Only 2.
[AGENT][NEUTRAL] OK, what is the date of service?
[CUSTOMER][POSITIVE] Thank you so much. [PII].
[AGENT][NEUTRAL] OK, no claim on file for [PII].
[CUSTOMER][NEUTRAL] And the next [PII].
[AGENT][NEUTRAL] We do not have a claim on file for [PII].
[CUSTOMER][POSITIVE] Yeah. Thank you so much, [PII], and that's it for today. Can I have the call reference number?
[AGENT][NEUTRAL] You're welcome, [PII]. To reference our call, you'll use my name, [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much.
[AGENT][POSITIVE] You're welcome. You have a wonderful day. Thank you for calling APL.
[CUSTOMER][POSITIVE] Yes, you too. Bye bye.
[AGENT][NEUTRAL] Bye bye.