AccountId: 011433970860
ContactId: 2e056fa0-bf7c-4a1f-adf8-07bacbff51ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514080 ms
Total Talk Time (AGENT): 157264 ms
Total Talk Time (CUSTOMER): 206942 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/2e056fa0-bf7c-4a1f-adf8-07bacbff51ea_20250617T13:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office that is orthopedic and neurosurgery specialist calling in regards for claim status.
[AGENT][NEUTRAL] I can verify claim status. May I have your first name and the policy number?
[CUSTOMER][NEUTRAL] Yeah, my first name, that is [PII], and the policy name is
[CUSTOMER][NEUTRAL] American Public Life Insurance Company.
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] And the policy number is 01660259 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Thank you. May I have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, before proceeding, could you spell your name for me again?
[AGENT][NEUTRAL] [PII] Last initial is [PII]
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And last name initial will be?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. Thank you so much. And the patient name is [PII].
[CUSTOMER][NEUTRAL] Bag check.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Date of birth will be [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have a date of service?
[CUSTOMER][NEUTRAL] Yeah, the service will be [PII].
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] Total bill amount will be $522 even.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well. One moment.
[CUSTOMER][POSITIVE] Yeah, yeah, take your time.
[AGENT][NEGATIVE] This processed under claim number 3579003. Looks like no benefits are payable. They do not have the office visit benefit.
[AGENT][NEUTRAL] And it looks like the primary paid in full on the 72,040 and 73,030.
[CUSTOMER][NEUTRAL] Uh, sorry, [PII], uh, your voice is firmer, so could you please repeat once because your voice is going in and out.
[AGENT][NEGATIVE] The there is no payable on this claim. There is no office visit benefits and the primary insurance did not. The primary insurance paid in full.
[CUSTOMER][NEUTRAL] OK. It means, uh, but I can see on my end there is no claim number, but I have the UOB which received on.
[CUSTOMER][NEUTRAL] [PII], the claim attachment are required. So which documentation I need to submit the for to process the claim?
[AGENT][NEUTRAL] The primary insurance explanation of benefit that shows patients responsibility.
[CUSTOMER][NEUTRAL] OK. It means the primary, we need to submit, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So, could you please provide me the claim number for this claim?
[AGENT][NEUTRAL] The claim number is 3579003.
[CUSTOMER][NEUTRAL] 357 9
[AGENT][NEUTRAL] 00.
[CUSTOMER][NEUTRAL] 003. Is this correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. Could you please provide me that uh who is the primary care for this patient?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The primary insurance?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] According to the ELB that was submitted, it looks like United Healthcare.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I can see here the United Healthcare of the states are primary. So I need to uh check once that, uh, is this the period is active for the patient on the date of service?
[AGENT][POSITIVE] That is correct. The policy is active.
[CUSTOMER][NEUTRAL] OK. So we need to submit the USC you be right for?
[AGENT][NEUTRAL] Correct. The EOB has to show any patient's responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah, I can see here the one you see UV.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And it uh it is on, yeah, and it is on the patient responsibility co-pay of $50.
[AGENT][NEGATIVE] The office visit is not covered. The office visit is not covered. This policy will not pay the copay for the $50.
[CUSTOMER][NEUTRAL] OK. So, could you please uh
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. The office visit will not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] So, is this the patient, uh, if the patient insurance will not cover this in office visits, so can we bill this claim to the patient?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] I have some more claims for this patient. So could you please verify once?
[AGENT][NEUTRAL] May I have a date of service?
[CUSTOMER][NEUTRAL] Yeah. Just a moment.
[CUSTOMER][NEUTRAL] Date of service will be that [PII].
[AGENT][NEUTRAL] I'm sorry, can you please repeat?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] Total amount is $400.
[AGENT][NEUTRAL] And I'm not showing that we have received 3 20 2025 for [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Would you like to fax it over?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The fax number is 877.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942-3 attention claims.
[CUSTOMER][NEUTRAL] OK. Attention to your name, right?
[AGENT][NEUTRAL] No, claims, C L A I M S.
[CUSTOMER][NEUTRAL] OK, claims.
[CUSTOMER][POSITIVE] OK. Thank you so much. One moment, please.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. I can see that all claims are the primary insurance with the GC, so I will connect with them. No issue for.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, thank you so much, [PII]
[AGENT][POSITIVE] [PII], you're so welcome and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, before that, could you please provide me with the call reference number?
[AGENT][NEUTRAL] Yes, it will be my name, which is [PII] along with today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. Have a great day ahead. Thank you so much for your help.
[AGENT][POSITIVE] You're so welcome.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Bye-bye, [PII].
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.