AccountId: 011433970860
ContactId: 316eb94e-d960-4d28-963e-5168a0a718ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 732989 ms
Total Talk Time (AGENT): 255584 ms
Total Talk Time (CUSTOMER): 230413 ms
Interruptions: 7
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/316eb94e-d960-4d28-963e-5168a0a718ba_20250408T16:33_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning. Thank you for calling.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office. How are you?
[AGENT][POSITIVE] I'm good, [PII]. How are you today?
[CUSTOMER][POSITIVE] Yes, my name is [PII]. Yes, I'm good. And can I get your name once more? How do you spell it?
[AGENT][POSITIVE] Oh, [PII], I'm so sorry.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. And [PII], uh, what is your callback number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's [PII]. And your last initial, please?
[AGENT][NEUTRAL] [PII], and yours?
[CUSTOMER][NEUTRAL] It's like [PII], and you said this is for American public insurance, right?
[AGENT][NEUTRAL] American Public Life, yes, sir.
[CUSTOMER][NEUTRAL] OK, sir. I do have uh 2 member ID. I just need to help with that one, OK?
[AGENT][POSITIVE] I'm sorry, how can I help you today?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I just need to have the claim number.
[AGENT][NEUTRAL] OK, so you have 2 patients for 1 day of service each that you're needing claim status on, is that correct?
[CUSTOMER][NEUTRAL] you have
[CUSTOMER][NEUTRAL] Yes. Actually, I have to tell a free data service like, uh, with one member ID, the right to data service and the last one is single.
[AGENT][NEUTRAL] OK, so 2 dates of service for 1 member and 1 day of service for the other one, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with those, and [PII], you will use my name along with today's date if you need a call reference number. Also, any information that I provide for you on the claims will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of any of the explanation of benefits, you may print them by going to our portal, which is located at [PII].
[CUSTOMER][NEUTRAL] Yes, I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Thank you. And your invoice is breaking actually.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] We don't have a good connection. There's an echo. Yes. What is the first policy number?
[CUSTOMER][NEUTRAL] And uh OK, so can we go ahead with the member ID?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 016.
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] 652
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] [PII] like M. like Mary, [PII] like Larry, number [PII].
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] And [PII], what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the first date of service?
[CUSTOMER][NEUTRAL] For this for data service.
[AGENT][NEUTRAL] And total bill amount?
[CUSTOMER][NEUTRAL] And this is for 11.
[CUSTOMER][NEUTRAL] Yes, [PII] of 24 and the amount is $455 each.
[AGENT][NEUTRAL] 455. Is that correct?
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so for [PII], for [PII] 2024, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, there is no claim on file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] File
[AGENT][NEUTRAL] For that data service.
[CUSTOMER][NEUTRAL] And could you please provide me the, could you please provide me the eligibility like patients active.
[AGENT][NEUTRAL] Policy is active, effective [PII].
[CUSTOMER][NEUTRAL] And the 10.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And there is no timely filing limit with APL it is?
[CUSTOMER][NEUTRAL] Select
[CUSTOMER][NEUTRAL] Mhm. The I follow you.
[AGENT][NEUTRAL] And when the claim is submitted, there is no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you will need to send a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Yes. And what is that?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Uh, could you please provide me the payment mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] your
[AGENT][NEUTRAL] Oh, excuse me, [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah [PII].
[CUSTOMER][POSITIVE] Thank you, just a moment.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] OK, I'm ready with the.
[CUSTOMER][NEUTRAL] And next data service is uh [PII].
[AGENT][NEUTRAL] Total bill amount.
[CUSTOMER][NEUTRAL] Yes, [PII] month the same amount.
[AGENT][NEUTRAL] 4:55. OK, one moment.
[CUSTOMER][NEUTRAL] M
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And for this one I see here we send the claim on [PII].
[AGENT][NEUTRAL] OK, so I do not have a claim on file for this number either for that data service and that billed amount.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready with the last one.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And this is for another member, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Uh, the memory ready only, uh, ends in, uh, number 8 and everything is the same as before.
[AGENT][NEUTRAL] So it is the same policy number.
[CUSTOMER][NEUTRAL] Oh it is
[CUSTOMER][NEUTRAL] Yes, just uh last number is 8.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[AGENT][NEUTRAL] [PII], what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, this is for [PII].
[AGENT][NEUTRAL] OK, date of birth?
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] For [PII] and the amount.
[CUSTOMER][NEUTRAL] Yes, uh, [PII].
[CUSTOMER][NEUTRAL] And the amount is $530 even.
[AGENT][NEUTRAL] I'm sorry, 528.
[CUSTOMER][NEUTRAL] I'm sorry, 5
[CUSTOMER][NEUTRAL] 530.
[AGENT][NEUTRAL] 530. OK, one moment.
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Yes, uh,
[AGENT][NEUTRAL] OK, so this claim was received on 86 2024?
[AGENT][NEUTRAL] It was processed
[CUSTOMER][NEUTRAL] Wait, wait, uh, you said the 18624.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, process ma'am.
[AGENT][NEUTRAL] 812
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number 349.
[AGENT][NEUTRAL] 1195.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 1155. Wait, wait, wait.
[CUSTOMER][NEUTRAL] Uh, number 34911.
[AGENT][NEUTRAL] 95.
[CUSTOMER][NEUTRAL] 95.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $39.63.
[CUSTOMER][NEUTRAL] Uh, that's a paid amount?
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] $39.53 yes.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So for code.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 99215 that was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] 99
[CUSTOMER][NEUTRAL] Oh, that was all.
[AGENT][NEUTRAL] The patient's plan does not cover office visits, Hunter?
[CUSTOMER][NEUTRAL] OK, for the [PII] and 25 it's fastly paid, right?
[AGENT][NEUTRAL] I'm sorry, what did you say?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You said the same is partially paid $39.63 and uh so 399215 is not paid. Got it.
[AGENT][NEUTRAL] Yes, and I read you the denial for the office. Correct. 99215 was denied as office visits are not covered.
[CUSTOMER][NEUTRAL] OK, and uh
[CUSTOMER][NEUTRAL] And that's, there's no other information.
[AGENT][NEUTRAL] Uh, what other information do you need?
[CUSTOMER][NEUTRAL] Receipt 868 OK.
[CUSTOMER][NEUTRAL] So, uh, this, uh, you said got denied for office visits.
[AGENT][NEUTRAL] And what is the mailing address?
[AGENT][NEGATIVE] Yes, the 475 charge was denied because office visits are not covered.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So for this can you send a bill?
[AGENT][NEUTRAL] An appeal must be filed within 180 days from the date of the decision. It must be submitted in writing and sent to attention appeals department.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To the same address as the claims, but again attention appeals to Portman.
[CUSTOMER][NEUTRAL] The same address and the coin.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, and uh your reference number is suggested, right?
[AGENT][NEUTRAL] I'm sorry, what was, what did you say?
[CUSTOMER][NEUTRAL] The reference number is this date.
[AGENT][NEUTRAL] And my name, yes, sir.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] OK, well then, thank you again, [PII], for calling APL and I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][POSITIVE] Uh, thank you. Bye-bye.