AccountId: 011433970860
ContactId: 47c58f6c-d009-43c6-aa8d-54819d4baba8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282619 ms
Total Talk Time (AGENT): 123251 ms
Total Talk Time (CUSTOMER): 110310 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/47c58f6c-d009-43c6-aa8d-54819d4baba8_20250129T15:32_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi. Um, I just have a question. Um, I received a medical bill and I just have a couple of questions, um, about it.
[AGENT][NEUTRAL] Can I have your name and a callback number and that policy number?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my policy number is 02389034.
[AGENT][NEUTRAL] Thank you, [PII]. Could you verify your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] Um, address would be [PII].
[CUSTOMER][NEUTRAL] Um, and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] The email address that we may have on file or there is no email address. Would you like to add an email address on file?
[CUSTOMER][NEUTRAL] Uh, not right now.
[AGENT][NEUTRAL] And what is the callback number just in case your call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're calling in regards to a claim status?
[CUSTOMER][NEUTRAL] Um, yes, so I have a procedure done.
[CUSTOMER][NEUTRAL] Back in October and um community care, which is my primary insurance, um picked up some of it and then um APL uh denied their payment, so I just wanted to see why.
[AGENT][NEUTRAL] Do you have a date of service?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, so there's multiple claims on file for that date of service. Do you have a like a bill amount?
[CUSTOMER][NEUTRAL] Yeah, the bill amount is 54662.
[AGENT][NEUTRAL] That was the total bill amount or the bill amount remaining after the primary made a payment?
[CUSTOMER][NEUTRAL] After the primary made a payment.
[AGENT][NEUTRAL] What's the total bill amount?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It does not say.
[AGENT][NEUTRAL] Do you have a claim number or something from APL?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] No, I never received anything from APL.
[CUSTOMER][NEGATIVE] Saying that they did not pay anything.
[AGENT][NEUTRAL] You have a procedure code?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Who say anything mention a procedure code.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I have an account number, but I don't think that.
[AGENT][NEGATIVE] No, that's not gonna help us cause that's not here at American Public Life.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, um,
[AGENT][NEUTRAL] 8075.
[AGENT][NEUTRAL] 75.
[AGENT][NEUTRAL] Let me see if this is.
[AGENT][NEUTRAL] What's the name of the facility?
[CUSTOMER][NEUTRAL] Uh, gastroenterology Specialists incorporated.
[AGENT][NEGATIVE] Got you. So it looked like by the time the claim made it here to American public life, your benefits were exhausted.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me verify how much what's your benefits per calendar year.
[AGENT][NEUTRAL] It looks like your benefits per calendar year is $2000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And your benefits were exhausted for date of service.
[AGENT][NEUTRAL] [PII] for a
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Look like a um anesthesia.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's why there was no payment made on it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, is there um a way we could resubmit or anything?
[AGENT][NEUTRAL] I mean, you can resubmit it, but still there won't be any benefits available because your benefits were exhausted. Once your $2000 for the calendar year has been maxed out, there's no available benefits for that year. Then your benefits start over [PII], however, claims for [PII] won't be allowed to be paid for [PII] with [PII] benefits because that's the past year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Gotcha. OK. All right. Um, thank you for explaining. I understand now. Um.
[AGENT][NEUTRAL] You're welcome. Would you like the claim number?
[CUSTOMER][POSITIVE] Uh, no, I'm OK, thank you.
[AGENT][NEUTRAL] Alright, is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] I don't think so. Thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and have a great day. Goodbye.
[CUSTOMER][NEUTRAL] You too bye.