AccountId: 011433970860
ContactId: 3520174f-c6f6-47cd-8451-09a8e019ea69
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 594969 ms
Total Talk Time (AGENT): 210443 ms
Total Talk Time (CUSTOMER): 263322 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/3520174f-c6f6-47cd-8451-09a8e019ea69_20250305T17:34_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi, [PII]. My name is [PII] calling on behalf of Cuesta Medical Group to check on the status of payment. Please be informed that this call is recorded and monitored for clarity and training purposes.
[AGENT][NEUTRAL] OK, can I get your name again, please?
[CUSTOMER][NEUTRAL] It's [PII] and the last name is [PII].
[AGENT][NEUTRAL] And [PII], if I could get a, could I get a callback number?
[CUSTOMER][NEUTRAL] Sure, callback number is going to be [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number you're calling on?
[CUSTOMER][NEUTRAL] Yeah, the policy number is going to be.
[CUSTOMER][NEUTRAL] 023
[CUSTOMER][NEUTRAL] 00416.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's [PII] it's [PII] and [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you so much for verifying the account and you said you're calling for status today. What is the data service?
[CUSTOMER][NEUTRAL] Yeah, that's for [PII]. I'm sorry, it's 24.
[CUSTOMER][NEGATIVE] And total charge is $138 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. I show we did receive that claim on [PII]. On [PII], the claim was processed. The claim did pay $75 which is the maximum amount allowed for this data service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so as per checking here, we are receiving two payments for this member. So initially we received the payment of $138 even and again we received $75 even.
[AGENT][NEUTRAL] OK. For what date of service, you ask for a particular data service?
[CUSTOMER][NEUTRAL] And the two different names.
[CUSTOMER][NEUTRAL] Yeah, same [PII].
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I show we only made one payment, so I'm not sure who the other payments are from. I don't show any other claims but one in which we pay $75.
[CUSTOMER][NEUTRAL] OK, uh, do you need the claim number?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, the claim number is going to be 352-5509.
[AGENT][NEUTRAL] OK, that's a different claim. Let me see what that data service is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You said 352-550-9?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] But that is quite.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, so let's see. So the claim in question first for 75 was for a, uh, for the physician. And let me look at the other one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So, uh, actually, I do show that that is a different policy number for the payment 138 even.
[AGENT][NEUTRAL] OK, let me check the, yeah, because I'm not pulling it on this policy.
[AGENT][NEUTRAL] Uh, uh, what is the policy number?
[CUSTOMER][NEUTRAL] Yeah, do you need that policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, that's for 02300305.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] shows.
[CUSTOMER][NEUTRAL] 8752.
[AGENT][NEUTRAL] OK, so this is an accidental policy. So, uh, the, if you need details on these payments, I would have to get you over to their department.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, but it, they have an accidental policy and it looks like, uh, because of the diagnosis, there are additional benefits allowed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] In which the 10 and $250 was paid towards the data service also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK, so that's under the different department, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK then.
[AGENT][NEUTRAL] Would you like to speak with someone in that department?
[CUSTOMER][NEUTRAL] Uh, yes, but before that, uh, can I ask some questions?
[AGENT][NEUTRAL] Regarding, it would have to be regarding the medical claim. Is it regarding the medical claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me go back.
[CUSTOMER][NEUTRAL] Yeah, medical card. Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, and how can I help you?
[CUSTOMER][NEUTRAL] Yeah, so here it's just like how the claim got processed it's primary and secondary.
[AGENT][NEUTRAL] Uh, this is a primary only policy. It does not pay secondary.
[CUSTOMER][NEUTRAL] OK, it's gonna be the primary. And is there other insurance listed as primary, secondary, or social new in.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Sir, our policies do not coordinate benefits. We would not have any additional policy information.
[CUSTOMER][NEUTRAL] No policy information. OK. So may I know the policy effective date? What's the original effective date?
[AGENT][NEUTRAL] Policy effective [PII].
[CUSTOMER][NEUTRAL] [PII] and still active, right? There's no terms?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, OK, uh, may I know is there any lapse in the policy?
[AGENT][NEUTRAL] I don't show a lapse in the policy, sir.
[CUSTOMER][NEUTRAL] OK. So may I know the, uh, is there any update in the coordination of benefits?
[AGENT][NEGATIVE] There is no coordination of benefits with this policy.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So there's no updates, right? OK. And also finally, may I know the refund mailing address just for the documentation purpose?
[AGENT][NEUTRAL] Mailing address for refunds would be [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. OK, can you just spell out your name for me?
[AGENT][NEUTRAL] [PII] H I A.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, can I get the call reference number?
[AGENT][NEUTRAL] To reference the call, you'll use my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] OK, can I get that direct phone number, please? Oh yeah, for the accidental policy, can I get the direct phone number?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The phone number is the same. It's a different department.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, uh, can you just transfer the call to them please?
[AGENT][NEUTRAL] Sure, hold on one moment.
[CUSTOMER][NEUTRAL] Sing.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], uh, you're in the hospital and the accidental care?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Oh, OK. OK. I have a provider, uh, calling in reference to a claim. I, I think I have the right department. Let me let you look at the policy.
[CUSTOMER][NEUTRAL] Alright, what's the policy?
[AGENT][NEUTRAL] 2300305
[CUSTOMER][NEUTRAL] And your name?
[AGENT][NEUTRAL] Uh, it's for [PII] is the provider calling.
[CUSTOMER][NEUTRAL] What is your name?
[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] [PII], I recognize your voice, but I didn't know.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right, so
[CUSTOMER][NEUTRAL] They're calling for claim status.
[AGENT][NEUTRAL] Yeah, he's, uh, calling on claim 352-5509.
[CUSTOMER][NEUTRAL] Let me get that pulled up, got you.
[CUSTOMER][NEUTRAL] And this is the provider.
[AGENT][NEUTRAL] It's the provider, yes, uh, callback number is the number coming up.
[CUSTOMER][POSITIVE] Cool beans. We got out, yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All righty. I will be happy to help, [PII]. Thank you, [PII]. You have a great day.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Oh, OK. You're welcome. Here he comes. Thank you.
[CUSTOMER][POSITIVE] Alright, thank you.