AccountId: 011433970860
ContactId: 4226ab04-496f-4a7c-a914-582e2e179075
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 864270 ms
Total Talk Time (AGENT): 312792 ms
Total Talk Time (CUSTOMER): 364682 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/4226ab04-496f-4a7c-a914-582e2e179075_20250228T18:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling for the provider.
[CUSTOMER][NEUTRAL] Key West HMA physician Management LLC. Please note that this call will be recorded and monitored for quality and training purposes. I'm calling in to check on a client status.
[AGENT][POSITIVE] Sure, I can check on a claim for you. I'm so sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] OK, thank you. And then uh do you have the policy number?
[CUSTOMER][NEUTRAL] It is 20055.
[AGENT][NEUTRAL] I'm sorry, [PII], uh, could you repeat that policy number?
[CUSTOMER][NEUTRAL] Sure. It is 20055.
[AGENT][NEUTRAL] OK, that's going to be a bit too small to be one of our policy numbers. um, do you maybe have their social? I could search for them that way?
[CUSTOMER][NEUTRAL] Um, just give me one quick moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Do you need the complete social security number or just um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Last four digits. Uh, OK, thank you. Just.
[AGENT][NEUTRAL] It would have to be the full social. Uh-huh.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And whenever you're ready.
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I, yes.
[AGENT][NEUTRAL] And what was the name of the insured?
[CUSTOMER][NEUTRAL] The name of the patient is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] Perfect. Thank you for verifying that, [PII]. I did find this policy. Um, did you want me to go ahead and give you that correct policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, are you ready for it now?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, that's 02538053.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That is the correct member ID.
[AGENT][NEUTRAL] That is there, uh, yes, that's the correct number ID.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alrighty and then uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then that bill amount please.
[CUSTOMER][NEUTRAL] $4810.97.
[AGENT][POSITIVE] Got it thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII]. Uh, we pay a benefit of $3000 which did meet their maximum amount payable. Uh, you'll give me one moment, I will get that check information to you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, so you say that this particular um claim is being paid. Am I correct?
[AGENT][NEUTRAL] Uh.
[AGENT][POSITIVE] That's correct, yes, we did pay a benefit of $3000. Did you need that claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, that is 3549589.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I've also got that check number when you're ready.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, that is 20.
[AGENT][NEUTRAL] 22.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 233.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'd like to reconfirm it is 202-223-3.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you so much for confirming that. Could you please help me with the received date, process date, and the pay date?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, OK, bear with me just a moment. So this claim was received [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] Thank you. And you mean the process it is the same as the pay date?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, so that's when this check was issued, um, was, uh, [PII], and I am showing that that check did clear, uh, [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And did you need a copy of this EOB [PII]? I can fax that to you if you'd like.
[CUSTOMER][POSITIVE] Yes, thank you so much and
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] While you fax this information, uh, do you want me to help you with the fax number?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] It is 866.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 825.
[CUSTOMER][NEUTRAL] 486 9. Attention to the patient account number.
[AGENT][NEUTRAL] OK, I'm going to read that number back to you just to make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, that's the one.
[AGENT][NEUTRAL] OK, and then the patient account number is that going to be the um [PII] [PII]?
[CUSTOMER][POSITIVE] That's the one. Thank you so much for verifying that.
[AGENT][POSITIVE] OK. Yes, absolutely. All right. Um, was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] Um, yes, I do have actually, I would like to know the allowed amount and the paid amount.
[AGENT][NEUTRAL] Sure, OK, so of course we did pay that benefit of $3000. Let me see, and I know that met their maximum. Let me see. OK, so that is the maximum, uh, inpatient benefit per calendar year is $3000.
[CUSTOMER][NEUTRAL] OK, and could you please help me with the amount paid?
[AGENT][NEUTRAL] Yeah, we paid that benefit of $3000.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, so the allowed amount and the paid amount are same $3000 with no patient responsibility, am I correct?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] We don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, got it. And could you please help me with the, whether it's a single check or a bulk check?
[AGENT][NEUTRAL] It is a single track.
[CUSTOMER][NEUTRAL] Thank you. And could you please verify the physical address where the payment or EOB was made at the time of the payment?
[AGENT][NEUTRAL] Of course, give me just a moment, let me get that up.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] OK, um, that address this check was sent to was [PII].
[AGENT][NEUTRAL] That [PII] is that um.
[AGENT][NEUTRAL] Oh my goodness, I'm not sure what that is. Is that [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I've seen that very much, uh, zip code [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, that's correct. Thank you so much for verifying it, and you said that you have already, uh, faxed a copy of NOB. May I know how long will it take to, uh, reach us here?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] I am faxing it right now. Uh, you should get it here within 1015 minutes.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And just to reconfirm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, that the issue date was on [PII] and the clear date was on [PII].
[AGENT][NEUTRAL] [PII] is when uh the check cleared, yes.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Thank you so much for confirming all those details and also have another claim here. Will you be able to help me with that?
[AGENT][NEUTRAL] Was this for a different member?
[CUSTOMER][NEUTRAL] Yes, it's for a different member.
[AGENT][NEUTRAL] OK, um, yes, I can help you with that. Give me just a moment I'll let you know when I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And while you uh try to pull up the details, may I know the call reference number?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Reference number would be the same uh for any claims that we check. It would be my first name, last initial, and today's date um so my name is spelled [PII]
[CUSTOMER][NEUTRAL] And your name?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, one moment.
[CUSTOMER][POSITIVE] Thank you so much, sir.
[AGENT][NEUTRAL] OK, I am ready for that next policy number, [PII].
[CUSTOMER][NEUTRAL] Sure, the policy number shows us 145.
[CUSTOMER][NEUTRAL] 172.
[CUSTOMER][NEUTRAL] 0 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK, and then, uh, what was the name and date of birth for this member?
[CUSTOMER][NEUTRAL] It is [PII] and uh date of birth [PII].
[CUSTOMER][NEUTRAL] The last name is spelled as [PII]
[AGENT][NEUTRAL] OK, the date of birth you gave me is not the one that I have for [PII]. I have that date of birth as one of the dependents. Is this for the dependent?
[CUSTOMER][POSITIVE] Oh brilliant.
[CUSTOMER][NEUTRAL] I'm sorry, yes, it is.
[AGENT][NEUTRAL] It is for, no, that's OK, that's for [PII].
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] OK, just wanted to make sure I appreciate you verifying that and then what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and that bill out please.
[CUSTOMER][NEUTRAL] You know I
[CUSTOMER][NEUTRAL] And the bill amount shows us.
[CUSTOMER][NEUTRAL] Um, just give me a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $2,476.50. That's the total charge, and the outstanding amount shows us $397.65.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got it thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm sorry, that date that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] OK, I'm not showing
[AGENT][NEUTRAL] I am not showing that we've received a claim for that date of service for Blake.
[CUSTOMER][NEUTRAL] OK, just give me one quick moment. Let me reconfirm the uh claims mailing address.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Here I could see the claim's mailing address as American Public Life Insurance Company indemnity [PII] [PII].
[AGENT][NEUTRAL] That is correct. Um, I've also got a fax number and a payer ID if you'd like, [PII].
[CUSTOMER][NEUTRAL] Um, sure, help me with that.
[AGENT][NEUTRAL] OK, so that fax number is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you and the electronic payer ID?
[AGENT][NEUTRAL] Yes, that is 60801.
[CUSTOMER][NEUTRAL] Thank you. And may I have the patient's policy effective date and the termination date?
[AGENT][NEUTRAL] Yes, OK, give me just a moment. So this policy's effective date was [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And it is currently active. There is no term date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Got it.
[CUSTOMER][NEUTRAL] Thank you. And could you please confirm if you're the primary or the secondary insurance for the patient?
[AGENT][NEUTRAL] This is a secondary medical policy.
[CUSTOMER][NEUTRAL] Just the last payment.
[CUSTOMER][POSITIVE] Got it, thank you so much. And may I know the timely filing limit to resubmit the claim?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] Got it. And may I know if we can submit an electronic or a paper claim where I mad[PII]?
[AGENT][NEUTRAL] Could you repeat that, [PII]? I'm sorry.
[CUSTOMER][NEUTRAL] May I know if we can submit submit an electronic or paper claim via mail?
[AGENT][NEUTRAL] Yeah, whichever you prefer.
[CUSTOMER][POSITIVE] Either way, thank you so much and uh like I said the call reference number is the same for.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. Yes. My first name, last initial, and today's date.
[CUSTOMER][NEUTRAL] Both the claims it is [PII] yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you so much for your assistance. I hope you have a great day. Stay safe. Happy Friday.
[AGENT][POSITIVE] Of course, thanks for calling APL you too [PII]. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.