AccountId: 011433970860
ContactId: 3db005fa-8f42-4eb1-8f39-221024b769af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356299 ms
Total Talk Time (AGENT): 130208 ms
Total Talk Time (CUSTOMER): 185895 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/3db005fa-8f42-4eb1-8f39-221024b769af_20250605T17:08_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, yes, this is [PII] calling from Florida dermatology. I was calling to check on claim status for a member.
[AGENT][NEUTRAL] OK, may I please have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] OK, it's 01791856 M as in Mary, L as in Larry 7.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. You're calling in for status. You can also check claim status via our secured portal that is [PII]. And may I please have the date of service?
[CUSTOMER][NEUTRAL] The data service is 32825, um, I believe the claims split, so the amount of the charge is gonna be 32771.
[CUSTOMER][NEUTRAL] If not, I can give you the total amount.
[AGENT][NEUTRAL] OK. So, when you're saying it's split, what are you meaning?
[CUSTOMER][NEUTRAL] I think that the primary paid it separate.
[CUSTOMER][NEUTRAL] But the total charge is 93438.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is for data service of 32825. It's showing that we don't have a claim on file for that data service.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Awesome
[CUSTOMER][NEUTRAL] Alright, let me verify some information. Hey, where's my computer screen?
[CUSTOMER][NEUTRAL] OK, let's take a look at something here. um OK, offices is not covered.
[CUSTOMER][NEUTRAL] OK, so that one's not on file. What address should we be sending the claims to? I tried to go on the portal, but I don't have the last four of his social so I can't verify, um, claims, you know, I can't find a claim status.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] OK. So for the mailing address, it is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, let's take a look there let me see when we mailed this, um, yes, if you have a fax number I would definitely take that and then I could fax those in.
[AGENT][NEUTRAL] And would you like the fax number?
[AGENT][NEUTRAL] OK, the fax number is [PII].
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] And that is attention claims department, but if you have access to that portal, you also have the option to submit it via the portal as well.
[CUSTOMER][NEGATIVE] Yeah, I wish I had the last 4 of his social so I can pull it. I don't.
[CUSTOMER][NEUTRAL] Um, I'm also going to.
[AGENT][NEUTRAL] No, you don't need the social to to upload in the system.
[CUSTOMER][NEUTRAL] Oh, we don't. Let me see, so I checked for claim status. Maybe I it says oh file a claim resource center. Let's see what we got. Oh, it kicked me out. I gotta log back in. Ah, nope, there it goes claim support.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So I could search let's see what comes up.
[CUSTOMER][NEUTRAL] Meddling claim form loss of claims, blah blah blah is that there like oh this is just return home.
[AGENT][NEUTRAL] Did you, did you go on to file a claim?
[CUSTOMER][NEUTRAL] No, I didn't go there. Let me, let me return home.
[CUSTOMER][NEUTRAL] Alright, we'll go back to the dashboard that says file a claim, so the next step traditional claim.
[CUSTOMER][NEUTRAL] This is what you'll need next, OK, so I, it still says primary insured last four S.
[CUSTOMER][NEUTRAL] SSN so I don't have that.
[CUSTOMER][NEUTRAL] So I don't know if that's gonna come up automatically.
[CUSTOMER][NEUTRAL] I put it in let me see what it does.
[AGENT][NEUTRAL] Because normally for filing the claim, it doesn't.
[AGENT][NEUTRAL] So you need a social.
[CUSTOMER][NEUTRAL] I think it just abstracted out but let me see because I know when I was looking for claim status it said I needed it and I was like yeah we don't have that yep it says please provide the last four digits of the primary.
[AGENT][NEUTRAL] Now, I think you
[AGENT][NEUTRAL] I think when you're searching as well for the um it asks you for the patient control number as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm yeah I have everything but the last four of the social and it's still primary insured's last 4 SSN number. I do need that so.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yeah, it's not gonna work. I'll go ahead and fax in the form that I have right, and we do have the right address.
[AGENT][NEUTRAL] OK. And we'll need their primary EOB as well.
[CUSTOMER][NEUTRAL] Oh yes, I have that one I believe it primary insurance on file for him. I wanna say is Aetna.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, and I have that as well, and we should be billing under the outpatient number, the one that ends in 8, correct?
[AGENT][NEUTRAL] Yes, they, they actually the same number, it just ends in ML7 and ML8 so you wouldn't have to put that whole policy number on there. You could stop at the number before the letter M.
[CUSTOMER][NEUTRAL] Oh OK so it won't matter all right perfect I just wanted to make sure so OK I'll take a reference number for the call and then I'll go ahead and upload that.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, the reference number would be my first name, [PII]. That is spelled [PII] last initial of [PII] and today's date. And is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's it thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] You too alright bye bye.
[AGENT][POSITIVE] Thank you.