AccountId: 011433970860
ContactId: 465819ee-2228-48d7-9d43-5677a045bf30
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1013159 ms
Total Talk Time (AGENT): 295485 ms
Total Talk Time (CUSTOMER): 308758 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/465819ee-2228-48d7-9d43-5677a045bf30_20250331T20:44_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is uh uh [PII], and I'm calling for the provider, [PII] to check on a claim status. Please be informed this call has been recorded and monitored for training and quality purposes. May I know if I can help you with the patient's information and the provider's information?
[AGENT][NEUTRAL] OK, so first off, what is your name again?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. And your callback number?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line, no extension.
[AGENT][NEUTRAL] Thank you. And you have one claim that you're needing to check status on then, is that correct?
[CUSTOMER][NEUTRAL] I have, I, I have 3 claims.
[AGENT][NEUTRAL] OK. Are the claims for the same patient or 3 different patients?
[CUSTOMER][NEUTRAL] 3 different patients.
[AGENT][POSITIVE] Yes and I can help you and you will use my name and today's date as your call reference number for each.
[CUSTOMER][NEUTRAL] No call.
[AGENT][NEUTRAL] Also, any
[CUSTOMER][POSITIVE] No problem. It's crazy and today's date.
[AGENT][NEUTRAL] [PII], that is correct, and any information that I provide for you on the claims that I checked will be a verification of benefits and not a guarantee of payment. And lastly, [PII], if we do have the claims on file and you need a copy of the explanation of benefits, you may print them by going to our portal. Once you have the claim number, it's secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is your first patient's policy number then?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Member ID that is 024963.
[CUSTOMER][NEUTRAL] 55.
[AGENT][NEUTRAL] Thank you, one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] And what is your patient's name then and their date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Uh, the date of service of [PII] and the bill amount is $225 even.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] OK, this claim was received. The received date was [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 4097.
[AGENT][NEUTRAL] And the reason for the denial ban states this service.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Is not covered.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] When performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] So I just, one moment, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So not covered, uh, covered as for providers guidelines.
[AGENT][NEUTRAL] For the member's policy, the member's plan.
[CUSTOMER][NEUTRAL] All right, so it is not covered under members plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] All right. Thank you for holding the line. Just hold on one moment, OK?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And may I know which CPT code is not covered as per patient's policy?
[AGENT][NEUTRAL] The one on the claim, do you have it?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] 76819.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] May I know the timely filing to submit a corrected claim?
[AGENT][NEUTRAL] A corrected claim, there's no timely filing. An appeal must be filed within 180 days from the date of the decision and submitted to our appeals department attention appeals.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 180 days from the process yet, right?
[AGENT][POSITIVE] Correct, from the decision, that is correct.
[CUSTOMER][NEUTRAL] All right. And what is the mailing address to submit a corrected claim?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Alright, one moment.
[CUSTOMER][NEUTRAL] So it's [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And the mailing address for appeal is the same, right?
[AGENT][NEUTRAL] That is correct and it must be sent to attention appeals department.
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] All right. And is there any specific form for appeal?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][NEUTRAL] And is the denied will be required while we submitting the claim?
[AGENT][NEUTRAL] I'm sorry, what was the question again?
[CUSTOMER][NEUTRAL] Is the denied explanation of benefit is required while resubmitting the claim?
[AGENT][NEUTRAL] No, just any additional information that you want to provide to have reviewed, but again, the most important thing is it is sent to attention appeals department.
[AGENT][NEUTRAL] And labeled as an appeal request.
[CUSTOMER][NEUTRAL] So that is, it is, it is not mandatory, right? The dinner is not mandatory, right?
[AGENT][NEUTRAL] Uh, I'm sorry, what was the question?
[CUSTOMER][NEUTRAL] Ma'am, I, I'm asking you, I mean to say, is the denied explanation of benefit is required while resubmitting the claim?
[AGENT][NEGATIVE] It is not.
[CUSTOMER][NEUTRAL] Is it mandatory to attach? All right, it is not right?
[AGENT][NEUTRAL] It is not
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] No problem. I will give you the next policy uh member ID. One moment.
[AGENT][NEUTRAL] One moment.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] So, uh the next
[CUSTOMER][NEUTRAL] Member ID is 024.
[CUSTOMER][NEUTRAL] 86
[CUSTOMER][NEUTRAL] 292.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Data service and total bill amount please.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $100 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, there is no claim on file for date of service [PII].
[CUSTOMER][NEUTRAL] No claim on file, right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And you will need to send a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And menu is
[CUSTOMER][NEUTRAL] For the previous claim?
[AGENT][NEUTRAL] For, for this state of service when you submit the claim, you will also need to send us the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I'm gonna
[CUSTOMER][NEUTRAL] All right. One moment.
[CUSTOMER][NEUTRAL] All right. And is the patient active on the data service?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, could you help me with the patient's policy effective date and the term date?
[AGENT][NEUTRAL] There is no term date. The effective date is [PII].
[CUSTOMER][NEUTRAL] The patient is still active.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] All right. And are you a primary or secondary?
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] We are not a major medical insurance. We are the supplement. That's why you need to send us the primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] You're a secondary. You're a secondary, right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] All right. And may I know when, when was the last co benefit updated?
[AGENT][NEUTRAL] There is no coordination of benefits. Again, we are not a major medical insurance company.
[CUSTOMER][NEUTRAL] All right. And may I know the, what is the preferred mode of submission?
[AGENT][NEUTRAL] It may be electronically submitted, faxed, or mailed.
[CUSTOMER][NEUTRAL] It is electronic fax or mail, right?
[AGENT][NEUTRAL] Payer ID, that is correct.
[CUSTOMER][NEUTRAL] And what is the claim submission timely filing limit?
[AGENT][NEUTRAL] There's no timely filing limit?
[CUSTOMER][NEUTRAL] All right. And may I have the claim submission, mailing address and the payer ID?
[AGENT][NEUTRAL] The claims mailing address is the same as the address that I gave you a moment ago and the payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much. One moment.
[CUSTOMER][NEUTRAL] The call reference number, your name, and today's date, right?
[AGENT][POSITIVE] That, that is correct, ma'am.
[CUSTOMER][NEUTRAL] Right, I have the last claim.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and the policy number, please?
[CUSTOMER][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] The policy, the member ID is A as in Alpha 6. There are 3 consecutive zeros.
[CUSTOMER][NEUTRAL] 375.
[AGENT][NEUTRAL] OK, now, [PII], that is not gonna be a policy number for APL.
[CUSTOMER][NEGATIVE] Oh, no, no.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh yes, I have the correct member ID now that is W as in Whiskey, R as in Romeo.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, that's
[AGENT][NEUTRAL] OK. Uh, uh, let me just stop you then to save you from giving me, that is not our policy number either.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That is not an American public life policy number.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] All right, one moment, let me check.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] All right. So, and the member ID is as I gave you previously, that is A as in Alpha.
[AGENT][NEGATIVE] And as I explained to you, that is not correct.
[CUSTOMER][NEUTRAL] 63 consecutive zeros.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] That is not our policy number.
[CUSTOMER][NEGATIVE] This is, this is also you're not.
[CUSTOMER][NEUTRAL] All right. Could you please check with the member, uh, the patient's name and the date of birth?
[AGENT][NEUTRAL] I can't search by date of birth.
[CUSTOMER][NEUTRAL] So you will not be able to give me the uh information?
[AGENT][NEUTRAL] Are you sure that it's American Public Life Insurance Company?
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] I can try to search by the name. I cannot search by date of birth.
[CUSTOMER][POSITIVE] All right, ma'am. No problem then.
[CUSTOMER][POSITIVE] I'll make a note. Thank you for your assistance. Have a nice day.
[AGENT][NEUTRAL] Do you want
[AGENT][POSITIVE] Well, you're very welcome, [PII]. Is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] No. No.
[AGENT][POSITIVE] OK, well, thank you so much then for calling APL and I hope that you have a nice rest of your day.