AccountId: 011433970860
ContactId: 3c21e239-94da-462d-b240-c9c6bf71181a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 609090 ms
Total Talk Time (AGENT): 168029 ms
Total Talk Time (CUSTOMER): 166691 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/3c21e239-94da-462d-b240-c9c6bf71181a_20250611T18:50_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] That's the second.
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, this is [PII]. I wanted to know his name status.
[AGENT][NEUTRAL] Could you spell your name for me please?
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I please have a callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Sure, before I tell you that, just letting you know this call is being recorded for quality and training purpose, OK?
[AGENT][NEUTRAL] OK, may I have the policy number?
[CUSTOMER][NEUTRAL] And the poli
[CUSTOMER][NEUTRAL] Yes and the policy number is 024.
[CUSTOMER][NEUTRAL] 08915.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, and number 8.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII]. Last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Their service is [PII]. The amount is $515 even.
[AGENT][NEUTRAL] And you can also check claim status via our secured portal that is [PII] and that is for data service of 2525. I'm pulling that information up for you now.
[AGENT][NEUTRAL] It does show we received that claim 31925.
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 357.
[AGENT][NEUTRAL] 9533. It shows that the procedure code 99214 denied office visits are not covered. The procedure code 95251, it denied requesting the primary EOB.
[CUSTOMER][NEUTRAL] Um, actually previously on [PII] we had.
[CUSTOMER][NEUTRAL] Already sent the primary EOB, so would you please check?
[AGENT][NEUTRAL] We don't have a claim on file with the primary EOB.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] May I have the fax number?
[AGENT][NEUTRAL] Yes, the fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 94
[AGENT][NEUTRAL] 23 and that is attention claims department. Is there anything else that I can assist you with today, Naaj?
[CUSTOMER][NEUTRAL] Uh there's one more claim.
[CUSTOMER][NEUTRAL] Uh, one more member's claim.
[AGENT][NEUTRAL] Same member or different member?
[CUSTOMER][NEUTRAL] No it's actually a different number. Just give me a moment.
[AGENT][NEUTRAL] May I have that policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is.
[CUSTOMER][NEUTRAL] 02588
[CUSTOMER][NEUTRAL] 453.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patience's first name is [PII]. Last name is uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And you're calling for status for this member as well. May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the bill amount is $388 even.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that is for data service of 221 25 total bill 388. I'm pulling that information up for you now.
[AGENT][NEUTRAL] And for that claim, it does show that we received it on 4/21 or 25. It was processed on 4/22 or 25.
[AGENT][NEUTRAL] That claim number is 35.
[AGENT][NEUTRAL] 92238. It shows the claim processed and a payment was made to the insured, so you will have to contact the insured in regards to that claim.
[CUSTOMER][NEUTRAL] Um, you mean the payment was.
[CUSTOMER][NEUTRAL] Done to the member?
[AGENT][NEUTRAL] Yes, you would have to contact the insured in regards to that payment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Do you know how much was paid and when was it paid?
[AGENT][NEUTRAL] I can't disclose that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK just a moment.
[CUSTOMER][NEUTRAL] And may I know why was it paid to the insured and not the insurance because it was billed through us and uh.
[AGENT][NEUTRAL] For this
[AGENT][NEUTRAL] For this policy, we go off of who submits in the claim first.
[AGENT][NEUTRAL] So that documentation and information was received and it was submitted to the insured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, may I know the exact reason why I was paid to the insured, uh, what you said earlier, could you please repeat that again?
[AGENT][NEUTRAL] OK, this would be my last time repeating it. I advised you we make payments to whoever submits the documentation in first.
[CUSTOMER][NEUTRAL] Because, uh, I would have to.
[AGENT][NEUTRAL] So we received that information from the insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, and, um, before I end the call, may I have the call reference number?
[AGENT][NEUTRAL] The card reference is first name, last initial of H, and today's date.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] And may I know your name?
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Could you please spell it out for me?
[AGENT][NEUTRAL] It is spelled [PII]
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] And the initial last name?
[AGENT][NEUTRAL] It is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you. That will be all. I hope you have a great day ahead.
[AGENT][POSITIVE] You're welcome and thank you so much for calling American Public Life. Have a great day as well.