AccountId: 011433970860
ContactId: 44b40b90-259c-4ce2-8fe6-8f720e7fa464
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553229 ms
Total Talk Time (AGENT): 158253 ms
Total Talk Time (CUSTOMER): 91567 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/44b40b90-259c-4ce2-8fe6-8f720e7fa464_20250228T15:17_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Good morning. Good morning.
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm. And how may I assist you?
[CUSTOMER][NEUTRAL] I'm calling from provider office.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, actually, I'm looking for a claim.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 025384441.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Can [PII], [PII].
[AGENT][NEUTRAL] Thank you. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Um, one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The service is [PII].
[AGENT][NEUTRAL] And how much is the total charge for the claim?
[CUSTOMER][NEUTRAL] Will the
[CUSTOMER][NEUTRAL] 123 5.18.
[AGENT][NEUTRAL] You said 123418?
[CUSTOMER][NEUTRAL] No, 123 518.
[AGENT][NEUTRAL] 518.
[AGENT][NEUTRAL] OK, thank you. And you said it's the date of service of [PII], correct?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] All right. Let me see if I can find this claim for you. For future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Um, let me see, um, let me pull this be one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna put you on a brief hold while I upload that. You'll be OK. Thank you.
[CUSTOMER][POSITIVE] OK. Take your time.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for Mr. [PII]. OK. So I got the EOB to pull up. It looks like um we processed the claim on [PII] and the claim was denied. Um, the reason for this denial is that
[AGENT][NEGATIVE] Yeah, um, DME is not covered under this policy.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Oh, I want to ask you one more thing.
[CUSTOMER][NEUTRAL] Uh, is, uh,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] American Public Life uh is covered deductible, medical deductibles.
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] America, has the insurance cover Medicare Part B deductibles?
[AGENT][NEUTRAL] This is not that type of policy. Um, this one is a secondary supplemental plan to the major medical. So it's not a Medicare plan.
[CUSTOMER][NEUTRAL] But uh you are secondary. Medicare is the primary on this claim.
[CUSTOMER][NEUTRAL] Really
[CUSTOMER][NEUTRAL] Sorry, communic care is the primary on this claim, sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Yeah, that is the primary, correct. Um, yeah, this one is a secondary supplemental plan to the major medical, to the primary insurance. So this one doesn't have any DME coverage.
[CUSTOMER][POSITIVE] Awesome.
[AGENT][NEGATIVE] So the ME is not covered under this plan with us.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK. Now, when you receive the claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, this one was received, let me see one.
[AGENT][NEUTRAL] OK, that is 6164 received on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when you process this claim?
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] But uh you see on [PII].
[AGENT][NEUTRAL] We received [PII], we processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] you process, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And DMA is not covered on this policy.
[AGENT][POSITIVE] Correct. DME is their cover service.
[CUSTOMER][NEUTRAL] So it is a patient responsibility.
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement on the remaining of the claim.
[AGENT][NEUTRAL] So it's up to the provider's discretion.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much. Uh, may I know your name?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] And reference
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much. Have a good day.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. You as well. Have a good day and thank you for calling APL. Bye-bye, Mr.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.