AccountId: 011433970860
ContactId: 2bf653f7-7064-4b4f-a80b-97184b120b43
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 480630 ms
Total Talk Time (AGENT): 196625 ms
Total Talk Time (CUSTOMER): 108413 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/2bf653f7-7064-4b4f-a80b-97184b120b43_20250501T18:34_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII]. I am calling from Trident Anesthesia, just calling to see if I can get some information on a claim, please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK [PII], you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Um, well, I have a, an, um.
[CUSTOMER][NEUTRAL] I have a correspondence.
[CUSTOMER][NEUTRAL] But it's saying that uh a duplicate of a previously submitted claim.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, but we haven't been paid for the claim, so.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Alright, just one moment. I'm gonna place you on just, can I place you on a quick hold for just one second?
[CUSTOMER][NEUTRAL] I was just calling to check on that.
[CUSTOMER][NEUTRAL] You sure can.
[AGENT][POSITIVE] Thank you so much. I will be right.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, I'm so sorry about that, [PII]. OK, I can help you with this and checking that status of the original claim. So what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Um, hold on, let me pull that back up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 025099909
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let's see. 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the data service [PII] in total bill amount?
[CUSTOMER][NEUTRAL] Data service is 1226 24, um, and the amount of.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 1590.
[AGENT][NEUTRAL] OK, and the claim number?
[AGENT][NEUTRAL] Did you receive showing as a duplicate?
[CUSTOMER][NEUTRAL] 357-400-007
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh my. Hold on. 3. Give me that again.
[CUSTOMER][NEUTRAL] Um, 357.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] 4007.
[AGENT][NEUTRAL] OK, and then what does it show? OK, so you're looking at the actual explanation of benefits for APL with that claim number on it?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so what's the policy number that's on that claim number?
[CUSTOMER][NEUTRAL] 025099909
[AGENT][NEUTRAL] Is that
[AGENT][NEUTRAL] OK, that claim number is not even on this policy. 357-400-007.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So the American Public Life Insurance Company.
[CUSTOMER][NEUTRAL] Explanation of benefits. This is not a bill.
[AGENT][NEUTRAL] OK, but that's not for the.
[CUSTOMER][NEUTRAL] insured or like
[AGENT][NEUTRAL] OK, so who's the patient that you're calling about?
[CUSTOMER][NEUTRAL] I'm sorry, say it again.
[AGENT][NEUTRAL] What is the patient's name? You gave me [PII], but what is your patient's name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] And the date of birth for the child? Mm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, so let me get his information pulled up just a moment.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] That's OK.
[AGENT][POSITIVE] No worries
[AGENT][NEUTRAL] OK, so the, let me get the original claims information pulled up.
[AGENT][NEUTRAL] OK, so the original claim was received.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] And that claim number.
[AGENT][NEUTRAL] [PII] is 356.
[AGENT][NEUTRAL] 462 6.
[AGENT][NEGATIVE] And that claim was also, that was denied.
[AGENT][NEUTRAL] And according to the remark on here, it states benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] OK, and I do have that. Is there a fax number I can send it to?
[AGENT][NEUTRAL] Yes ma'am, you can send that to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942-3 attention claims.
[AGENT][NEUTRAL] And you can reference that um it's not necessary but you can reference that claim number that I gave you on there and if you do need a copy of that explanation of benefits with that remark I just read you, you should be able to print that now that you have that claim number by going to our portal at secured.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Alright, and is there a reference for our call today?
[AGENT][POSITIVE] Yes ma'am, you're gonna use my name along with today's date.
[CUSTOMER][POSITIVE] All right, [PII] thank you so much for your help today.
[AGENT][POSITIVE] Well, you are very welcome. And is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] That is it.
[AGENT][POSITIVE] OK, well, thank you so much. Thank you for calling APL and I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too. Thank you so much.
[AGENT][POSITIVE] Thank you too.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] All right. Bye-bye.