AccountId: 011433970860
ContactId: 311085a2-a288-4346-a407-6665a05ac17f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1024348 ms
Total Talk Time (AGENT): 336868 ms
Total Talk Time (CUSTOMER): 458436 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/311085a2-a288-4346-a407-6665a05ac17f_20250102T16:41_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over in the broker resource area. I have got, uh, [PII] who's with Core Insurance calling on some claims for this customer [PII]. He has some questions. I guess he's got the claim information and has some questions on how it was processed.
[AGENT][NEUTRAL] OK. Do you have a policy number?
[CUSTOMER][NEUTRAL] I do, I do it's 240-790-9.
[AGENT][NEUTRAL] And do you have a good call back number for [PII]?
[CUSTOMER][NEUTRAL] I do, I do. It's [PII].
[AGENT][NEUTRAL] And is he an agent, a broker?
[CUSTOMER][NEUTRAL] Yes, he's broker agent with Core Insurance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess that's what he told me. I was trying to, I had a flip screen, so I'm trying to get back the other way so I can look to see. Hang on just a second. Let me look at group 20671. Hang on one second. Let me just look at this.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 260.
[CUSTOMER][NEUTRAL] Yes, um, so this is where the, the guy that owns [PII] built, his name is [PII], which is actually who they're calling on, I guess is [PII], and we've been going back and forth because they're trying to get some claims information, so I believe he went out on the portal and downloaded his claim information and this person's calling to get some clarification.
[AGENT][POSITIVE] OK. I am ready.
[CUSTOMER][NEUTRAL] OK. Alright, I'll bring him in just a second.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] Yes. Hi, I have got [PII] on the phone in our claims department. She's gonna help you with the questions you have on [PII], OK?
[CUSTOMER][POSITIVE] I'm [PII]? OK, thank you. All right, have a good day thanks for calling PL. You too thank you [PII] for all the help. Mhm bye bye.
[AGENT][POSITIVE] Good morning, [PII]. How are you today?
[CUSTOMER][NEUTRAL] Hi [PII], how are you?
[AGENT][POSITIVE] I'm wonderful, thanks for asking, and I'll be happy to assist you with the claim status. How can I help you today?
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][POSITIVE] Happy happy [PII] to you first so that there we go.
[AGENT][POSITIVE] And [PII] to you.
[CUSTOMER][NEUTRAL] OK, so, um, I'm looking at some of these claims that were processed for [PII], and I have a few questions if if you can help me with that, um, and I told [PII], uh, you know, let's start with [PII] claim for data service of 110 2024.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like this is a facility claim in which we asked for the diagnosis code.
[CUSTOMER][NEUTRAL] Um, it just said it was processed and it was like an office visit. Well, that's not the diagnosis code. That's what I was calling about. What where would you, so you're looking for the diagnostic code on this?
[AGENT][NEUTRAL] Yes, so it looks like under claim number 3485682.
[CUSTOMER][NEUTRAL] Wait a minute, let me write that down.
[CUSTOMER][NEUTRAL] 348-568-2.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] That's the claim number? OK.
[AGENT][NEUTRAL] That's the claim number and it looks like it's a facility claim.
[AGENT][NEUTRAL] And we ask for the diagnosis code.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Which is the reason for the treatment.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, um, and where would I get that from?
[AGENT][NEUTRAL] That would come from the insured.
[AGENT][NEUTRAL] Which you can let me.
[CUSTOMER][NEUTRAL] From the
[AGENT][NEUTRAL] I'm gonna pull up the claim image so I can look it.
[AGENT][NEUTRAL] What you're looking at
[AGENT][NEUTRAL] Cause the diagnosis code is just the reason for your doctor's visit, whether it be headache, backache.
[AGENT][NEGATIVE] Toe pain.
[AGENT][NEUTRAL] Let's see, because it looks like there's some other claims that were processed here as well.
[CUSTOMER][NEUTRAL] Yeah, that one
[CUSTOMER][NEUTRAL] Yeah, this was for in June for [PII] at the same Broward Health, which is, you know, a hospital.
[AGENT][NEUTRAL] Yeah. So it looks like on [PII], we would need the diagnosis code and on 110. And the diagnosis code is just the reason that they went to Broadwood have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what about 6:19 and 626?
[AGENT][NEUTRAL] OK let's see.
[CUSTOMER][NEUTRAL] I think that was all at that hospital too as maybe an outpatient I don't know.
[AGENT][NEUTRAL] 619. OK, so.
[AGENT][NEUTRAL] Everything that I'm seeing for 6:19.
[AGENT][NEUTRAL] Looks like there's a charge for $205 which the primary paid in full.
[AGENT][NEGATIVE] So no benefits was paid on that one.
[CUSTOMER][NEUTRAL] OK, so the primary paid as plata in full.
[AGENT][POSITIVE] It paid in full.
[CUSTOMER][POSITIVE] OK good alright.
[AGENT][NEUTRAL] And what was your other date?
[CUSTOMER][NEUTRAL] And then Labor [PII] Labor.
[AGENT][NEUTRAL] 626.
[AGENT][NEUTRAL] OK, so looks like 4 labs.
[AGENT][NEUTRAL] Looks like um the primary paid in full.
[AGENT][NEGATIVE] It looks like there was no responsibility for the labs. Looks like they paid in full on those.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So for 61 and 110 we need a diagnosis code and you're gonna say you get that from the the doctor.
[AGENT][NEUTRAL] Yes. Normally, they get it from the doctor. If the patient can tell you why they went, you can write that and submit that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK, so I call the patient and tell them why they went OK.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] All right, good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and then what about if you can, since I'm on the phone maybe you could help me. I have a [PII] claim.
[CUSTOMER][NEUTRAL] Um, from 85-2024.
[AGENT][NEUTRAL] OK, let me get over there.
[AGENT][NEUTRAL] 85 of 24 for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm not seeing 85. Let me go back. I have a 95.
[AGENT][NEUTRAL] But I don't show at 85 for [PII].
[CUSTOMER][NEUTRAL] Do you see one that's uh the Garcia Fusco?
[AGENT][NEUTRAL] Would that be the
[CUSTOMER][NEUTRAL] Hospital for specialists.
[CUSTOMER][NEUTRAL] It was how about hospital for special surgery for [PII]?
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Data service 85 2024.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, let me go through this because it's not pulling up.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Going through this history, one moment.
[CUSTOMER][NEUTRAL] No problem and [PII], when I get the, you know, I'm gonna call the the patient here and get the reason why they went who do I send that? Do I call you back and give it to you or?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Unfortunately, we cannot accept them over the phone anymore, so I'll give you the fax number and you.
[CUSTOMER][NEUTRAL] Oh, can I email it to you? Oh, OK.
[AGENT][NEUTRAL] You can, yeah, you can fax it over.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so the fax number will be 877.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] And I just put the uh data service, the group number, the person's name, and then the reason why they were at Broward Health, let's say, right?
[AGENT][NEUTRAL] Correct. And the date, don't forget the date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Data service to data service.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That sounds like I'll get this done, try to get this done today, but do you, do you see anything for [PII] at the hospital for special surgery?
[AGENT][NEUTRAL] I'm not seeing anything in August. I'm seeing looks like an inpatient 723, 7:25.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For that, OK.
[CUSTOMER][NEUTRAL] And do you see any claims for that that are.
[AGENT][NEUTRAL] Not seeing anything for 85. It would pull up.
[CUSTOMER][NEUTRAL] Gonna be paid?
[AGENT][NEUTRAL] I'm not seeing anything.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I see a 61, but nothing in August.
[AGENT][NEUTRAL] Do you know when it was submitted for me?
[CUSTOMER][NEUTRAL] For [PII] for [PII] is this [PII]? Um, I just see date of service.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] It was 85 and.
[CUSTOMER][NEUTRAL] It was saying it was processed and it's pending. If it's pending, do you not see it?
[AGENT][NEUTRAL] It would show up if it's pending. Let me make sure there's nothing.
[AGENT][NEUTRAL] I don't see anything pending for [PII].
[AGENT][NEUTRAL] There's a [PII] and there's a Max.
[AGENT][NEUTRAL] And there's no 85 under either chart.
[AGENT][NEUTRAL] 485. I don't see. Do you have a claim number?
[CUSTOMER][NEUTRAL] OK, do you see on.
[CUSTOMER][NEUTRAL] I don't see it. I'll have to find it.
[CUSTOMER][NEUTRAL] Uh, have so many much paper here.
[AGENT][NEUTRAL] I don't see anything pending.
[CUSTOMER][NEUTRAL] Hold on a second, let me see if I have.
[CUSTOMER][NEUTRAL] Claim number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Bear with me one second.
[AGENT][NEUTRAL] I'm not seeing. No, no, take your time.
[CUSTOMER][NEUTRAL] I got Max I got Max Levinson here.
[CUSTOMER][NEUTRAL] Here's one let's see if this.
[CUSTOMER][NEUTRAL] Inpatient expense I see 7:20.
[CUSTOMER][NEGATIVE] Charges paid to provider 0.
[CUSTOMER][NEUTRAL] What about um.
[CUSTOMER][NEUTRAL] Let's see if I can find a claim.
[CUSTOMER][NEUTRAL] This was 773.
[CUSTOMER][NEUTRAL] Service 722.
[CUSTOMER][NEUTRAL] Policy number check number, reference number do you want a reference number?
[AGENT][NEUTRAL] No, but we wouldn't give a reference number.
[CUSTOMER][NEGATIVE] That's that's not the right date.
[CUSTOMER][NEUTRAL] It comes from APL explanation of benefits.
[AGENT][NEUTRAL] OK, does it have a claim number anywhere on that EOB?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] No I'm trying to find it.
[AGENT][NEUTRAL] Or a date, you see a date on there?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Data services all 85, that's what I get, uh.
[AGENT][NEUTRAL] Is there a date on the EOB?
[AGENT][NEUTRAL] Usually when there's a check number, there's usually a date.
[CUSTOMER][NEUTRAL] Yeah, hold on.
[CUSTOMER][NEUTRAL] Benefits.
[CUSTOMER][NEUTRAL] 14
[CUSTOMER][NEUTRAL] Um, I cannot find that one, but [PII], if I can start with, if you can, uh, uh, I'm gonna try to get the stuff for [PII], and then I'll go back to this maybe on another call, um.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][POSITIVE] I'm gonna try to get that. Let's do one more if I can.
[AGENT][NEUTRAL] In the meantime,
[AGENT][NEUTRAL] Sure, but in the meantime, [PII], I'll go back through what we have in-house for him and see if I find the 85.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome awesome um and then the last one is the 5-13-2024 for [PII] at the Boca Raton Regional.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, that's good.
[CUSTOMER][NEUTRAL] Hospital.
[AGENT][NEUTRAL] Get back pulled up.
[AGENT][NEUTRAL] Looks like an ER visit.
[CUSTOMER][POSITIVE] I think that probably is it yes.
[AGENT][NEUTRAL] OK, so it looks like.
[AGENT][NEUTRAL] The primary paid in full on this one. Let me get the EOB pulled up.
[CUSTOMER][NEUTRAL] It did.
[AGENT][NEUTRAL] And just verify because we have it processed under claim number 3542133.
[CUSTOMER][NEUTRAL] 354-213-3 OK.
[AGENT][NEUTRAL] Yes, and let me get it pulled up just to verify that because it looks like.
[AGENT][NEUTRAL] It was billed 1023.17 and let me see what it says.
[CUSTOMER][NEUTRAL] I just have this one is.
[CUSTOMER][NEUTRAL] Build amount 2567 subscriber amount 350.
[AGENT][NEUTRAL] Let me see, cause I'm seeing another claim 3542133 for 2567 and we asked for the diagnosis code.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You didn't get you need the diagnosis code on that too, huh?
[AGENT][NEUTRAL] So it looks like that there's a co-pay of 350 on this one.
[AGENT][NEUTRAL] So, let me see. So under claim number 3542133, we did ask for the diagnosis code.
[CUSTOMER][NEUTRAL] So we need that too, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, alright, and I could just call the member, ask what what they were in there for, and, uh, put it to an to the fax, and you should get it in your department there.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] [PII], you have been really a big help. What is there a way I can get directly in contact with you?
[AGENT][NEUTRAL] We don't have a direct line, but what you can do is when you get through, just ask them to transfer you over.
[CUSTOMER][NEUTRAL] If I need any more.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what's the number that I could call just so they can transfer me over to you.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 256.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][POSITIVE] Really appreciate it. Thank you, [PII] for everything. I really it was helpful.
[AGENT][POSITIVE] [PII], you're so welcome. And I'll check on [PII] and see if we have anything in-house. Maybe we overlooked that.
[CUSTOMER][POSITIVE] I appreciate it.
[AGENT][POSITIVE] Alrighty. So when you get that information, we'll get it processed for you, [PII].
[CUSTOMER][POSITIVE] OK, that would be great.
[CUSTOMER][POSITIVE] Alrighty thank you.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye now.