AccountId: 011433970860
ContactId: 3185d5fb-82b4-43a3-b435-f2978f43d141
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1499150 ms
Total Talk Time (AGENT): 358250 ms
Total Talk Time (CUSTOMER): 482600 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/3185d5fb-82b4-43a3-b435-f2978f43d141_20250415T18:55_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from Platinum billing office. How are you doing today?
[AGENT][POSITIVE] I'm great, [PII], how are you?
[CUSTOMER][POSITIVE] I'm doing great, thank you for asking. Before I proceed, this call is being recorded for quality and training purposes. Would you like us to continue the recording?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Yeah, I've called regarding to claim information. Can you help me out with that?
[AGENT][NEUTRAL] I can verify claim status. May I have a policy number, [PII]?
[CUSTOMER][NEUTRAL] 0245859 sorry it's 02458549 ML 8.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEGATIVE] Sorry, please off.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] Or and the date of birth [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have a date of service?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] A date of service.
[CUSTOMER][NEUTRAL] Yeah, your voice is cutting uh the date of service is going to be mm.
[CUSTOMER][NEUTRAL] [PII] and the bill amount $197 even.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well.
[AGENT][NEUTRAL] It processed under claim number 3549838.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] No benefits are payable. They do not have the office visit benefit.
[AGENT][NEUTRAL] This claim processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Uh, why it was denied.
[AGENT][NEUTRAL] No office visit benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No offers with the benefits are paid, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Can you help me out with the UB for this one?
[AGENT][NEUTRAL] May I have your fax number?
[CUSTOMER][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEUTRAL] Once again.
[CUSTOMER][NEUTRAL] Yeah, the fax number is going to [PII].
[AGENT][NEUTRAL] I have [PII]. I'll fax this right over. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I do have other claims as well.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I do have other member, oh sorry, other clients as well.
[AGENT][NEUTRAL] OK, I can only do 51 moment, let me complete this one.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] May I know your name?
[AGENT][NEUTRAL] It's [PII] Last initial is [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. One moment.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[CUSTOMER][NEUTRAL] It's not
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] May I have a policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's going to be um.
[CUSTOMER][NEUTRAL] 023694.
[CUSTOMER][NEUTRAL] 65 ML 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth, uh [PII].
[AGENT][NEUTRAL] Thank you. May I have a date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] Yeah, it's going to be $581 even.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] This processed under claim number 3548.
[AGENT][NEUTRAL] 966, no benefits are payable. They do not have the office visit or the office treatment benefit.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Office visits at?
[AGENT][NEGATIVE] Office visit is not covered, Office treatment is not covered.
[CUSTOMER][NEUTRAL] So for this pair only it is covered for uh mm like a surgery coach only?
[AGENT][NEUTRAL] Outpatient, outpatient and inpatient.
[CUSTOMER][NEGATIVE] Only for surgery quotes it covers not uh uh ENM visits it does not cover, right? Of visits in the sense.
[AGENT][NEUTRAL] If it's
[AGENT][NEGATIVE] If the services are rendered in an office visit, it will not be covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let's go with the next one.
[AGENT][NEUTRAL] Is it for the same person?
[CUSTOMER][NEUTRAL] No, a different person.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[AGENT][NEUTRAL] May I have a policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 256-9076.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, the patient name is going to be, yeah, [PII], and the date of birth [PII], sorry, [PII].
[AGENT][NEUTRAL] Thank you. May I have a date of service?
[CUSTOMER][NEUTRAL] Yeah it's uh.
[CUSTOMER][NEUTRAL] [PII] and the bill amount $628 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] So sorry for the previous one, can you help me out with the UB?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Sorry for that.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Is it the same fax number?
[CUSTOMER][NEUTRAL] Yeah, [PII], yes, the same one.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Like how much time it will take us to reach us.
[AGENT][NEUTRAL] As long as it takes to transmit over, you should receive those.
[AGENT][NEUTRAL] Eel beef.
[CUSTOMER][NEUTRAL] Mhm. Like within like within how many, like within 24 hours or more than that, just I need confirmation for that one.
[AGENT][POSITIVE] You should get them within 24 hours, yes.
[CUSTOMER][POSITIVE] OK, within 24 hours. Thank you for that.
[AGENT][NEUTRAL] You're welcome. One moment.
[CUSTOMER][NEUTRAL] You can send with the attention of [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] And so what was the total, total bill amount for 99 of 24?
[CUSTOMER][NEUTRAL] Mm, 99 it's $628. So previous one you have faxed, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, this one is $628 even.
[AGENT][NEUTRAL] So as of today, I'm not seeing we have received data service 99 2024 for [PII] for $628.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's not on file.
[CUSTOMER][NEUTRAL] So can you verify that the whether the patient is active or not?
[AGENT][NEUTRAL] The patient was active on data service 99-2024.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But we have billed it on [PII], uh, like two times we have billed it.
[AGENT][NEUTRAL] And what is the address?
[CUSTOMER][NEUTRAL] One moment, it's [PII] [PII], yeah [PII], OK, [PII], is it?
[AGENT][NEUTRAL] That is correct. Would you like to try and fax it?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, fax in the claim.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Oh, we need to fax only the only the claim form that's it to our attention which department?
[AGENT][NEUTRAL] You can fax
[AGENT][NEUTRAL] You will need to fax over the claim and the primary insurance explanation of benefits attention claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK attention team, uh, yeah, OK.
[AGENT][NEUTRAL] Let me check and verify there is no other policies. One moment.
[CUSTOMER][NEUTRAL] Uh, I do have primary payments, but we have billed to secondary but still no response so you people will accept electronic.
[AGENT][NEUTRAL] We are secondary.
[CUSTOMER][NEUTRAL] Yeah, yeah, we are secondary you people will accept electronic claims or paper claims.
[AGENT][NEUTRAL] Both the electronic payer ID is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me check if we have to see.
[CUSTOMER][NEUTRAL] Like previously in the call, I see that uh stated the no claimvi patient policies is inactive on from 61 to 6 has given updated member ID.
[CUSTOMER][NEUTRAL] And yeah.
[CUSTOMER][NEUTRAL] OK, the member is active for the date of service that's fine.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So there is no other policy out here. I checked to make sure we did not receive anything extra, and I'm not seeing data service 99 of 24.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK fine I'm gonna fax it to you so.
[CUSTOMER][NEUTRAL] Once again, what will be the call difference for these calls?
[AGENT][NEUTRAL] It will be the same my name along with today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Let's go with the next one.
[AGENT][NEUTRAL] OK. May I have a policy number?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Actually, the patient is the same one, but the date of service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In total bill amount?
[CUSTOMER][NEUTRAL] To $425 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I'm not showing we receive data service for 30 of 24.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me check something else. One moment.
[CUSTOMER][NEUTRAL] But we have it now.
[AGENT][NEUTRAL] You have a denial claim?
[CUSTOMER][NEUTRAL] Yeah, it's denied as C196 from our end.
[AGENT][NEUTRAL] Is there a claim number attached?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 4:30 of 2024.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I'm checking the past policies, one moment.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Television
[AGENT][NEUTRAL] This processed under policy number 01894936.
[AGENT][NEUTRAL] It processed under claim number 3571076.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Looks like the benefit amount of $15.92 processed to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this one processed on.
[AGENT][NEUTRAL] 34 of 25.
[CUSTOMER][NEUTRAL] Go
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For which one it was paid.
[AGENT][POSITIVE] It processed and paid.
[AGENT][NEUTRAL] 11,300. The office visit is not covered.
[CUSTOMER][NEUTRAL] So for this pay any like for any patient, it does not cover any office visits?
[AGENT][NEUTRAL] That is correct. This plan does not have office visit benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so this, this is the responsibility of patient.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, just one second, can you be on hold? 1 2nd, OK?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, let's go on with the last one, OK?
[AGENT][NEUTRAL] OK, one moment, just finishing this one up. Would you like a copy of this COD?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I have a policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] One moment, just a second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 15.
[CUSTOMER][NEUTRAL] One second, sorry for the inconvenience.
[CUSTOMER][NEUTRAL] 15.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, the next one is 024.
[CUSTOMER][NEUTRAL] 96464 ML 8.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name is called [PII].
[CUSTOMER][NEUTRAL] And uh the, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have a date of service?
[CUSTOMER][NEUTRAL] Uh, it's going to be [PII].
[AGENT][NEUTRAL] In total bill amount?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The bill amount is.
[CUSTOMER][NEUTRAL] $538 even.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] OK, looks like this plan was effective 113.
[AGENT][NEUTRAL] This plan was effective [PII] and the data service was prior to the effective date and we never received data service [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Is the member active for the data of service?
[AGENT][NEGATIVE] The policy was not effective at time of service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy was not effective until [PII].
[CUSTOMER][NEUTRAL] Can you send me the effective and term date for this one?
[AGENT][NEUTRAL] Oh, the policy was effective, [PII]. Policy terminated [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So at the time of uh uh [PII], November is active, right?
[AGENT][NEUTRAL] The date of service was [PII] or [PII].
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] [PII]. 1 moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This and the total bill amount was $538 or 536.
[CUSTOMER][NEUTRAL] 5:36.
[AGENT][NEUTRAL] This processed under claim number 356-5207.
[AGENT][NEUTRAL] It paid a benefit amount of $58.78 on line 17,110. Office visit is not covered.
[AGENT][NEUTRAL] This claim processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for that. So it is also going to be patient responsibility, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII] you. Have a great day. I have given the disclaimer I before I proceed. This call is being recorded. OK, thank you so much. Have a great day. Bye bye.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] [PII], you're so welcome and thank you for calling American Public Life. Have a great day, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.