AccountId: 011433970860
ContactId: 37c74f24-2d2b-4bb7-bcd2-145771853f88
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1495959 ms
Total Talk Time (AGENT): 408623 ms
Total Talk Time (CUSTOMER): 711372 ms
Interruptions: 15
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/37c74f24-2d2b-4bb7-bcd2-145771853f88_20250509T19:30_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] calling for the provider to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] OK, [PII], you have one coin to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh yeah. I don't have the one claim. I have 4 claims.
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are they for 4 different patients, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I can help you. You will use my name that I've already given you along with today's date as your call reference number for each one. Also, any information that is provided on any of the claims will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And if we have the claims on file and you need a copy of any of the explanation of benefits, once you have the claim number, you can print those yourself by going to our portal at [PII].
[CUSTOMER][NEGATIVE] I don't have anything.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is your 1st, 1st off, [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII]. No extension, it's a direct line.
[AGENT][NEUTRAL] Oh God.
[AGENT][POSITIVE] Thank you. And the first policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's 1,000,554,559,300.
[AGENT][NEUTRAL] OK, that is not a policy number for our company. That is not a policy number for American Public Life Insurance.
[CUSTOMER][NEUTRAL] OK 100055.
[CUSTOMER][NEUTRAL] So can you find with the name and the date of birth?
[AGENT][NEUTRAL] No, so I can't search by the date of birth. What's the correct policy number or the number? Do you have this full social? And what does the ID card say?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, I don't have the ID card image with me, but I have the social.
[AGENT][NEUTRAL] What is the social?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You want the whole social number or the, just the last 4?
[AGENT][NEUTRAL] I do.
[AGENT][NEUTRAL] No, sir. I need the whole social if you don't have the correct policy number.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let's start over with that again. What is the social?
[CUSTOMER][NEUTRAL] And you are the secondary.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I a.
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes yes.
[AGENT][NEUTRAL] OK, there is no one in our system but with that social security number.
[CUSTOMER][POSITIVE] Hm, OK, no worries.
[AGENT][NEUTRAL] And the next number's policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, bear with me just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, you'll be
[CUSTOMER][NEUTRAL] OK, the next member ID is 02566221.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] How is that just the same.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So uh.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The patient's first name is [PII]. The patient's first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] identify the issues that they.
[AGENT][NEUTRAL] Mhm. Date of birth?
[CUSTOMER][NEUTRAL] The date of birth will be [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Hey the service and total bill amount for her, please.
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and the amount is $315.31.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK sorry the uh the.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] And same number I'm sorry.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] I uh I uh I just not a good, uh, no longer in this case.
[CUSTOMER][NEUTRAL] The member ID number is 98.
[AGENT][NEUTRAL] It's still searching, so bear with me, [PII].
[CUSTOMER][POSITIVE] Yeah, sure. No worries.
[AGENT][NEUTRAL] And you said the bill amount. OK, just a moment.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, 15 and date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, so the date of the deal is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this claim was received and the received date on it is going to be.
[AGENT][NEUTRAL] [PII], it was denied on [PII].
[AGENT][NEUTRAL] The claim number is 357-4415.
[AGENT][NEUTRAL] And the reason for the denial on this claim, [PII]?
[AGENT][NEUTRAL] Steaks
[AGENT][NEUTRAL] The maximum benefit payable.
[AGENT][POSITIVE] For this state of service has been met.
[CUSTOMER][NEUTRAL] OK, so the maximum payment of this for the date of service has been done. OK.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] And [PII], there will be no further payment?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Uh, the, yeah, the, yeah, there will be no further payment. OK, perfect. Give me a minute. Yeah. Could you please tell me what is the allowed dollar amount for the services?
[AGENT][POSITIVE] That is correct. No further payment.
[AGENT][NEUTRAL] No further payment.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] It's available.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The same on what?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] right and then.
[CUSTOMER][NEUTRAL] OK, I give you.
[CUSTOMER][NEUTRAL] Because that previously is not taking the correct be searching for this uh.
[AGENT][NEUTRAL] Let me look at something on this claim, bear with me just a second.
[CUSTOMER][POSITIVE] Yeah, [PII]. Take your time.
[AGENT][POSITIVE] Uh, thank you.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] OK, it is $100.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] And just a moment, give me a minute. OK, $100.
[CUSTOMER][NEUTRAL] OK. And could you please tell me when was the last, this type of services were billed?
[AGENT][NEUTRAL] Same date by a different provider and I can't provide that information.
[CUSTOMER][NEUTRAL] Uh, you can provide me the date.
[AGENT][NEUTRAL] Was a claim received prior to yours. The same date was a claim that was received prior to your claim being received.
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] Means [PII]. Sorry, [PII].
[AGENT][NEUTRAL] No, sir, you just gave me [PII].
[CUSTOMER][NEUTRAL] Oh sorry. Oh yeah. Oh, sorry, sir. Yeah, OK, you're right.
[AGENT][NEUTRAL] The date of service we're discussing is [PII].
[CUSTOMER][NEUTRAL] And what will be the time if I to submit the corrected claim?
[AGENT][NEUTRAL] An appeal must be filed within 180 days from the date of the decision.
[CUSTOMER][NEUTRAL] And for the correct claim?
[AGENT][NEGATIVE] There's no timeline filing.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And what will be the mailing address to submit the correctly?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]. Attention appeals department for an appeal.
[CUSTOMER][NEUTRAL] I'm up.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII] 1 24
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 8950. Am I right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, perfect. Is there any specific form for an appeal?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And could you please sir is denied you will be required while submitting the claim or an appeal?
[AGENT][NEGATIVE] It is not.
[AGENT][NEUTRAL] But it must be sent to attention appeals department.
[CUSTOMER][POSITIVE] Perfect and call the.
[CUSTOMER][NEUTRAL] Uh yeah, with the same mailing address you gave me for the corrected claim. Am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, call reference number will be your name in today's state. Shall we move to the next claim?
[AGENT][NEUTRAL] Yes. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, my system is thinking, give me a second.
[CUSTOMER][NEUTRAL] Yeah, the next member ID will be 1116824.
[AGENT][NEUTRAL] 1116824. Is that correct?
[CUSTOMER][NEUTRAL] Yeah yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] again.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII]. The date of birth will be
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh,
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have to get.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Oh yeah yeah sorry.
[AGENT][NEUTRAL] [PII], what is the data service and total bill amount?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the amount is $603 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so for data service, you said [PII]. Is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, there is no claim on file for her for that data service.
[AGENT][NEUTRAL] Now, with this particular
[CUSTOMER][NEUTRAL] So the claim is not done for for the date of service.
[CUSTOMER][NEUTRAL] And is it the?
[AGENT][NEUTRAL] That's correct, no claim on file for one.
[CUSTOMER][NEUTRAL] I have.
[AGENT][NEUTRAL] The date of service you gave me is [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah. Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No claim on file.
[AGENT][NEUTRAL] And with the type, this type of policy, you will also have to send us a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEGATIVE] I'm not interested in
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK. And do you have uh any claim on file for the $154 even for the same date of service?
[AGENT][NEUTRAL] No claim on file for data service 121.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] What was the other bill amount you just gave?
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] $154 even.
[AGENT][NEUTRAL] You gave me
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK, but just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Could you please tell me, is the patient active on the date of service?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and you have the.
[CUSTOMER][NEUTRAL] OK. So, what's the patient's effective and the term date?
[AGENT][NEUTRAL] [PII], no termination date. Policy is active. Effective date is [PII].
[CUSTOMER][NEUTRAL] OK, perfect. And what will be, uh, are you primary or secondary for the member?
[AGENT][NEUTRAL] As I explained to you, this is a secondary policy. I explained that you would need to send the primary insurance company's explanation of benefits with the claim for review.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] There.
[CUSTOMER][NEUTRAL] OK, and when was the last coordination of benefits updated?
[AGENT][NEUTRAL] We're not a major medical insurance. There's no coordination of benefits with APL.
[CUSTOMER][NEUTRAL] OK, claim submission time filing will be the same and mailing address will be the same.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, what will be the preferred mode of submission whether it will be both, uh, mail or electronic?
[AGENT][NEUTRAL] Again, either, but we do have to have a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] But let me just.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm not.
[CUSTOMER][NEUTRAL] OK, shall we move to the next one?
[AGENT][NEUTRAL] Which is your last one, correct?
[CUSTOMER][NEUTRAL] Uh, no, it's the 2nd last.
[AGENT][NEUTRAL] You said you had 4.
[CUSTOMER][NEUTRAL] Oh, it's OK. It's the last one.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And what is the patient's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] The patient's policy number is 02503327.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] [PII] is the date of service and the amount is 2, it's the amount is $202.04.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so there is no claim. You said the data service again is 224 [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, no claim on file.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK, and what will be the patient, uh, is the patient activity on date of service?
[AGENT][NEUTRAL] Policy has an effective date of excuse me, [PII].
[CUSTOMER][NEUTRAL] And he's still active.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and the further details will be the same.
[AGENT][NEUTRAL] Actually, for this policy, claims will be mailed to a different address.
[CUSTOMER][NEUTRAL] OK. What will be the mailing address?
[AGENT][NEUTRAL] The claim will go to IMA.
[AGENT][NEUTRAL] At [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] And the payer ID?
[AGENT][NEUTRAL] And their payer ID is 64556.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And what will be the claim submission timely filing limit?
[AGENT][NEGATIVE] No timely filing limit.
[CUSTOMER][NEUTRAL] OK, and, uh, the coordination of benefits, uh, when was the coordination of benefits updated whether it will be the same which you gave me for the previous claim?
[AGENT][NEUTRAL] It's like
[AGENT][NEUTRAL] Yeah, I explained this is we are not a major medical insurance company.
[AGENT][NEUTRAL] This plan that this member has is a hospital indemnity limited benefit plan.
[CUSTOMER][POSITIVE] OK, perfect. And you're the secondary for the member. OK, OK.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Uh, [PII], can you help me with the last number, please?
[AGENT][NEUTRAL] You have
[AGENT][NEUTRAL] Another policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah, just the last.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what is that policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 02206070.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII], last name is [PII]. Date of birth will be [PII].
[AGENT][NEUTRAL] OK, thank you. Now on this policy there is another company that you will need to speak to for claim status.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And that company is Web is called Web TPA.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And their phone number?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Uh, can you transfer my call to the web TPA?
[AGENT][NEUTRAL] I can. Is there anything else that I could help you with first, [PII]?
[CUSTOMER][POSITIVE] Uh, no, [PII], thanks for your assistance. It's a pleasure talking to you, [PII].
[AGENT][POSITIVE] Well, it was a pleasure speaking with you as well and thank you again for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] Yeah, you too, [PII]. Now you can transfer my call.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, I will. One moment, please.
[CUSTOMER][NEUTRAL] Welcome to WebTPA, the administrator for the Limited Benefit Health Insurance Program underwritten by American Public Life Insurance Company.
[CUSTOMER][NEUTRAL] If this is an emergency, please hang up and dial [PII].
[CUSTOMER][NEUTRAL] If you are a member calling about your premium billing or need to make changes to your account, such as an address change, add or drop a dependent, or you wish to modify your coverage in any way, please call American Public Life at [PII].
[CUSTOMER][NEUTRAL] For questions regarding pharmacy services, please contact Caremark at [PII].
[CUSTOMER][NEUTRAL] Please note, using a PPO provider can reduce the amount you pay out of pocket for services you receive.
[CUSTOMER][NEUTRAL] Network discounts continue after you have exceeded the maximum allowed visits, testing days, and hospital confinement days. Please call [PII] to locate a provider in the [PII] PPO network.
[CUSTOMER][NEUTRAL] This call may be recorded for quality assurance and training purposes.
[CUSTOMER][NEUTRAL] If you are calling on behalf of a hospital, physician, or other provider of services, please say.
[CUSTOMER][POSITIVE] I can help you with things like eligibility, benefits, claim status, and more.
[AGENT][NEUTRAL] Oh