AccountId: 011433970860
ContactId: 481675e1-9bce-40b4-97c2-70d049964964
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 537390 ms
Total Talk Time (AGENT): 246672 ms
Total Talk Time (CUSTOMER): 129089 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/481675e1-9bce-40b4-97c2-70d049964964_20250521T20:16_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII], and I'm calling about a claim.
[AGENT][NEUTRAL] OK, I can help you with that, [PII]. Could I get a callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the policy number you're calling on today?
[CUSTOMER][NEUTRAL] 01699430
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII].
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying the policy. You didn't say status today. What is the data service you're checking?
[CUSTOMER][NEUTRAL] 801
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII].
[AGENT][NEUTRAL] The page I'm sorry, 227.
[AGENT][NEUTRAL] 2024.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Oh, that's right. I, I work from home too, so I know how it is.
[AGENT][NEUTRAL] And he will pick right now too, OK, so would this be a um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In short filed claim or provider filed?
[CUSTOMER][NEUTRAL] Provider.
[AGENT][NEUTRAL] Provider, OK, I'm not showing the claim on file.
[CUSTOMER][NEUTRAL] Oh it should be
[AGENT][NEUTRAL] 42 27 24 to 2, is it a hospital bill?
[CUSTOMER][NEUTRAL] Yeah, the hospital bill, um, let's see, I think the last time we called they gave a claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull the image.
[AGENT][NEUTRAL] And what was the claim number that was provided?
[CUSTOMER][NEUTRAL] 345-074-0
[AGENT][NEUTRAL] 0740 let me see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that claim was denied for the explanation of businesses.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so the claim in question.
[AGENT][NEUTRAL] 27 we requested the explanation of benefits. Uh, did you guys, uh, submitted that information?
[CUSTOMER][NEUTRAL] Yeah, it looks like they faxed them.
[AGENT][NEUTRAL] OK, let me see
[CUSTOMER][NEUTRAL] This is faxed on [PII].
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, I'm not showing we've received the um we ever received the explanation of benefits.
[CUSTOMER][NEUTRAL] Is the fax number [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] That is the correct fax number.
[CUSTOMER][NEUTRAL] Yeah, it says your fax has successfully been sent attention claims.
[AGENT][NEUTRAL] OK, I mean you can send it again. There is no timely filing for the policy, um.
[AGENT][NEUTRAL] Yeah, I'm not showing. Let me look at something real make sure.
[AGENT][NEUTRAL] What is the total, um, bill charges?
[CUSTOMER][NEUTRAL] Total bill charges are.
[CUSTOMER][NEUTRAL] $134,311?
[AGENT][NEUTRAL] OK, so it looks like we did get another claim.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But that was received [PII], so it looks like we received the claim again, but uh on the second time we requested the explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah, I'm not sure because it says it went through um.
[CUSTOMER][NEUTRAL] I mean I could ask him to send it again and we'll see.
[CUSTOMER][NEUTRAL] Yeah, because I got the fax number in here as.
[AGENT][POSITIVE] And you do have the option to also send a delight.
[CUSTOMER][NEUTRAL] 877.
[AGENT][NEUTRAL] Electronically.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Uh, you have the option to the payer ID is 60801.
[CUSTOMER][NEUTRAL] What's the payer ID?
[CUSTOMER][NEUTRAL] Alright, and what day, uh, so the claim number that I gave you, what was the day that that claim was received on?
[AGENT][NEUTRAL] OK, so the 345-074-0 was received on [PII].
[CUSTOMER][NEUTRAL] And then the other one was did they deny that one as a duplicate or?
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] No, they actually uh requested the explanation of benefits again. They didn't deny it as a duplicate. That one was received on [PII] and the claim number for this one is 3559423.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So maybe if I put the claim number on there when I fax it that might help.
[AGENT][NEUTRAL] Uh, even if you just sent the ELB alone, um,
[CUSTOMER][NEUTRAL] Because the
[AGENT][NEUTRAL] I mean, you can, we, you know, it normally gets matched up. Uh, I mean, it's just showing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Like I said, the 2nd submission, which is not even the date that you're saying that it was faxed, we had already received the claim a 2nd time.
[CUSTOMER][NEUTRAL] Yeah, it looks like
[AGENT][NEUTRAL] Without the ELB.
[CUSTOMER][NEUTRAL] Yeah it looks like they.
[CUSTOMER][NEUTRAL] Looks like we talked to someone on [PII], which as soon as they got the phone they faxed that EOB.
[AGENT][NEUTRAL] Let me check that.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Hm, you said 4:14.
[CUSTOMER][NEUTRAL] Spoke with [PII] this day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, she gave this other claim number to the 3559423.
[AGENT][NEUTRAL] OK, let me check there is a.
[AGENT][NEUTRAL] There's an updated policy, but it wouldn't have been entered under there um.
[AGENT][NEUTRAL] Let me check the notes
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Uh-huh. I just, yeah.
[AGENT][NEUTRAL] I don't show, yeah, I, I don't know of a career that works here.
[AGENT][NEUTRAL] But I don't show a call under either policy uh in [PII] this [PII], correct?
[CUSTOMER][NEUTRAL] Yeah, that's how we got the fax number of the [PII], but I'll go ahead and request it to be sent again.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK, OK, yeah, because that's definitely our fax number, so I guess they spoke with uh someone uh but I don't, I'm not showing it, um.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Storage.
[AGENT][NEUTRAL] But uh like I said, you can uh submit it electronically or fax it again. Uh, like I said, there's no timely filing for the policy, so.
[AGENT][NEUTRAL] You can still get that information in.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] Is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Nope, that's it. I'll just take the call reference number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] To reference the call, you will use my name, [PII] and today's date.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] You're welcome. You have a wonderful day. Thank you for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.