AccountId: 011433970860
ContactId: 3f7185f0-0e2d-447d-b375-ad50ae2000d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1514469 ms
Total Talk Time (AGENT): 426078 ms
Total Talk Time (CUSTOMER): 522364 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/3f7185f0-0e2d-447d-b375-ad50ae2000d3_20250408T15:31_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provider of Florida Women Care LLC 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 if I can help you with the patient's information or the provider's information?
[AGENT][POSITIVE] Um, yes, I'll be more than happy to help you with the claim status, and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have 2 claims in total.
[AGENT][NEUTRAL] All right. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. The callback number will be [PII] and no extension direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure. The member's ID is 21,780.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that the policy number or the group number?
[CUSTOMER][NEUTRAL] Um, it's listed, uh, as member ID in our system.
[AGENT][NEUTRAL] OK, what's the member's first and last name?
[CUSTOMER][NEUTRAL] Sure. The member's first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] Is the what's the full first name?
[CUSTOMER][NEUTRAL] Uh, so the full first name, uh that will be [PII]
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] Sure. Me's date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number is 245.
[AGENT][NEUTRAL] 854 8.
[AGENT][NEUTRAL] And the policy has been active since [PII]. May I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Sure. The date of service will be [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] And the total bill amount is $948 even.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] That will be
[CUSTOMER][NEUTRAL] Florida Women K LLC.
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] OK, so we have a claim here for that data service, but it's a different total bill. It is the same provider, um, but it's a different total bill. Actually, let me make sure, what's your tax ID?
[CUSTOMER][NEUTRAL] Sure, the tax ID is [PII].
[AGENT][NEUTRAL] OK, so yes, this is the same provider, but it's a different um total bill. There's no claim on file that totals the $948.
[AGENT][NEUTRAL] So did you want me to provide you with this claim status or there is actually another claim that you're looking for?
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Be.
[CUSTOMER][NEUTRAL] Oh, so, could, could you help me with the, uh, total bill amount that you have?
[AGENT][NEUTRAL] Hm, hold on one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The total bill of the claim we have is $60.
[CUSTOMER][NEUTRAL] OK. So you, uh.
[CUSTOMER][NEUTRAL] Just uh give me a moment.
[CUSTOMER][POSITIVE] Thank you so much for your patience, [PII]. So, could you provide me the status of the $60 claim? We do submit that claim uh to you uh with the $60.
[AGENT][NEUTRAL] Welcome.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, but I provided you the total bill amount.
[AGENT][NEUTRAL] OK, we received it on.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 355.
[AGENT][NEUTRAL] 654 2.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim.
[AGENT][NEUTRAL] A total of $14.79.
[CUSTOMER][POSITIVE] Thank you so much for the information. So this claim is paid, right? And could you please help me with the uh uh allowed amount?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] So, I mean, there's no a lot. The benefit is for outpatient $5000 per calendar year.
[CUSTOMER][NEUTRAL] Mm, OK. So the, uh, there is no allowed amount because the benefit is for outpatient, right?
[AGENT][NEUTRAL] Um, so I guess that usually is for primary, but for this policy, secondary, the allowed amount, I guess we could say is 5000 because that's the benefit maximum.
[AGENT][NEUTRAL] But allowed and out out of pocket and coinsurance, that's all from primary.
[CUSTOMER][POSITIVE] Thank you so much for the information, [PII]. So, um,
[CUSTOMER][NEUTRAL] I just, uh, we bill the claim for $60. So how come there, there is uh $5000 allowed amount?
[CUSTOMER][NEUTRAL] Do you have any information on the allowed amount on this. No, uh, I, I need the allowed amount for this claim.
[AGENT][NEUTRAL] You're trying to see why we paid the $14?
[AGENT][NEUTRAL] OK, so there's a primary insurance and a secondary insurance, allowed amount out of pocket, co-insurance, deductible, that's all usually from primary. For the secondary insurance, which is who APL is, we don't have like allowed amount, but we do have
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Maximums for the benefits because we're secondary. So to answer your question, the allowed amount would be the $5000. That's how much we can pay up to.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information, [PII].
[CUSTOMER][NEUTRAL] So, um, is there any patient responsibility?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we're not the major medical insurance company.
[CUSTOMER][NEUTRAL] OK. Thank you so much for the information. So may I, may I know what, what is the mode of the payment, check or EFT?
[AGENT][NEUTRAL] It was a check payment. Did you need the check information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The check number is 202.
[AGENT][NEUTRAL] 4744.
[CUSTOMER][POSITIVE] Thank you so much for the information. So, uh, let me reconfirm the check number. That is 2024744.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Thank you so much, [PII]. And may I know if it was a single payment or a bulk payment?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It was a single check in the amount of $14.79.
[CUSTOMER][POSITIVE] Thank you so much. And could you please help me with the payment mailing address?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] The check was mailed to [PII] and it cleared on [PII].
[CUSTOMER][POSITIVE] Thank you so much for the information, [PII]. So, uh, the payment was cleared on [PII].
[CUSTOMER][NEUTRAL] And could you help me with the patient's account number?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] The patient's account number for the claim?
[AGENT][NEUTRAL] For their account number here with APL.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] For the claim.
[AGENT][NEUTRAL] 245.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 178.
[AGENT][NEUTRAL] 67
[AGENT][NEUTRAL] V like Victor, [PII].
[CUSTOMER][POSITIVE] Thank you so much for the information, [PII]. And may I have the duplicate copy of the UV?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Sure, the fax number will be
[CUSTOMER][NEUTRAL] [PII]. Attention to the patient's account number.
[AGENT][NEUTRAL] OK, so I'll go ahead and fax that over to you now.
[CUSTOMER][NEUTRAL] So, may I know how much time it will take?
[AGENT][POSITIVE] For a fax, you usually give a fax at least an hour. If you haven't received it by the end of day today, just let us know and we'll be more than happy to resend it for you.
[CUSTOMER][POSITIVE] Thank you so much for the information, [PII]. And
[CUSTOMER][NEUTRAL] May I know the process date, uh, pay date and process date will be the same?
[AGENT][NEUTRAL] Hold on, let me go back. Hold on one second.
[AGENT][NEUTRAL] So this claim again was received on [PII].
[AGENT][NEUTRAL] And it was denied on [PII].
[CUSTOMER][NEGATIVE] I'm sorry, [PII]. You uh previously said that it was paid and now you're stating that it is denied.
[AGENT][NEUTRAL] I'm sorry, I'm sorry, I said it incorrectly. It was paid on the, on [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, OK, no problem. So is the process date and pay date same?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Is the process date and pay date the same?
[CUSTOMER][NEUTRAL] Yes, I need the process date as well.
[AGENT][NEUTRAL] Yes, it was it was processed and.
[AGENT][NEUTRAL] Yes, sir. It was processed and paid on [PII].
[CUSTOMER][POSITIVE] Thank you so much for the information, [PII]. So, may I have the call reference number and we can move to another claim?
[AGENT][NEUTRAL] So the call reference number for the entire call is gonna be my name and today's date. And hold on one moment, let me note this policy and then we can move on to the last one. Hold on one second.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So could you please uh spell your name?
[AGENT][NEUTRAL] My name is [PII] The [PII] my last [PII] is [PII].
[CUSTOMER][POSITIVE] Thank you so much for the information, [PII].
[AGENT][NEUTRAL] OK, what's the next member's policy number?
[CUSTOMER][NEUTRAL] Sure, the next member ID will be A as in Alpha 60003175.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, do you have a copy of the member's um ID card available?
[CUSTOMER][NEUTRAL] Um, I do have.
[CUSTOMER][NEUTRAL] Yes, I do have the member's ID card available.
[AGENT][NEUTRAL] And on the ID card, what is the in-hospital or outpatient policy certification number?
[CUSTOMER][NEUTRAL] Just allow me a moment.
[CUSTOMER][NEUTRAL] Thank you so much for your patience, [PII]. Um, I'm not able to look at that information for you. I can't see anything uh related to the in hospital or out, outpatient policy certification number.
[AGENT][NEUTRAL] Do you see any numbers that start with a 01 or 02?
[CUSTOMER][NEUTRAL] No, I'm not able to see that.
[AGENT][NEUTRAL] OK, because the policy number that you provided is not an APL policy number. Do you see APL on the ID card?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I can see that 90 name as 90 degree benefits American Public Life Insurance Company.
[CUSTOMER][NEUTRAL] But like I I.
[AGENT][NEUTRAL] So it says 90 degree.
[AGENT][NEUTRAL] OK, do you have the member's social?
[CUSTOMER][POSITIVE] Yes, I do. I'll just allow me a moment to look at, uh, get that for you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you so much for your patience. Uh, so the SSN number will be [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And what is the um member's first and last name?
[CUSTOMER][NEUTRAL] Sure. The member's first name is [PII] and last name is [PII]
[AGENT][NEUTRAL] Can you spell the first name again?
[CUSTOMER][NEUTRAL] That uh first name will be [PII], and that is [PII]
[AGENT][NEUTRAL] This is hold on one moment.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is her date of birth?
[CUSTOMER][NEUTRAL] Sure. The date of birth is September 28[PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I found the um policy and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number is 701.
[AGENT][NEUTRAL] 236.
[AGENT][NEUTRAL] And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Sure, the date of service will be [PII] of, OK.
[AGENT][NEUTRAL] Wait a minute.
[AGENT][NEUTRAL] Is this a this is for medical?
[CUSTOMER][NEUTRAL] Yes, this is for medical.
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] OK, so she doesn't have, so for one, this policy is no longer active. It was effective from [PII], and this was a disability policy. So she doesn't or didn't have any medical policies with us, and this was the only policy she had.
[CUSTOMER][NEUTRAL] So, uh, it was a disability policy, not the medical policy, right? Uh, and, uh, it was, uh, effective from the [PII] and turned on, uh, [PII].
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, you got it.
[CUSTOMER][NEUTRAL] OK, so just allow me a moment then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for your patience, [PII].
[CUSTOMER][NEUTRAL] So, as you stated that it is a disability policy, not a medical policy. So,
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, is this claim denied?
[AGENT][NEUTRAL] OK, so you want me to check and see if there's a claim on file still, even though it's not.
[AGENT][NEUTRAL] It's a disability policy, not a medical policy?
[CUSTOMER][NEUTRAL] Uh, if you can, uh, check this, could you please check for me once?
[AGENT][NEUTRAL] Sure. What's the date of service?
[CUSTOMER][NEUTRAL] Sure. The date of service is [PII].
[AGENT][NEUTRAL] OK, I can check and see if there's a claim here, but this policy termed in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, it termed in [PII]. It was effective in [PII], but I can see if there's a claim here. Hold on one moment.
[AGENT][NEUTRAL] And there's no claims on file for [PII].
[CUSTOMER][POSITIVE] Thank you so much for the information.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Just allow me a moment, [PII].
[CUSTOMER][NEUTRAL] So I just know need one answer. Uh, is it like the we need to submit this claim to other insurance?
[AGENT][NEUTRAL] You need to reach out to the member and see who their medical insurance is through because this is a disability policy. And then once they let you know who their medical insurance is through, you can try to bill through the, you can try to bill them.
[AGENT][NEUTRAL] Or contact them to see if a claim has been submitted already.
[CUSTOMER][POSITIVE] Thank you so much for the information, [PII].
[CUSTOMER][NEUTRAL] So may I know if uh uh you already provided that information. Just allow me a moment.
[CUSTOMER][NEUTRAL] May I know if you are the primary or secondary for this uh patient?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sir, this, so this
[AGENT][NEUTRAL] I won't be able to answer these questions because that's going to be for medical and this is a disability policy.
[AGENT][NEUTRAL] So there's no secondary or primary is disability.
[CUSTOMER][NEUTRAL] OK, you, uh, mm, as this is a disability policy, you cannot provide me the uh medical, uh, details, right?
[AGENT][NEUTRAL] Right, there's no medical details to give. It's not a medical policy, it's a disability policy.
[AGENT][NEUTRAL] Short-term disability.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and OK, what will be the time if I to update everything.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So may I have the call reference number then?
[AGENT][NEUTRAL] Sure, so there's no call reference number. You can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much for your help, [PII]. Uh, thank you so much for your assistance. That's all from my side. Have a wonderful day.
[AGENT][POSITIVE] Thank you also and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Bye bye.