AccountId: 011433970860
ContactId: 492eff24-b73f-4030-8fea-72a5582b7d33
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 703809 ms
Total Talk Time (AGENT): 259882 ms
Total Talk Time (CUSTOMER): 230887 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/492eff24-b73f-4030-8fea-72a5582b7d33_20250528T18:59_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling because we had a claim denied um for a patient, so I just wanna check because I have a card on file.
[CUSTOMER][NEUTRAL] Um, so I just, uh, I just wanna see if the patient does have active coverage or did at the time of service.
[AGENT][NEUTRAL] OK, so you're needing.
[AGENT][NEUTRAL] Information regarding a claim and eligibility, is that correct?
[CUSTOMER][NEUTRAL] Right, we had a claim and it was denied saying that you guys weren't able to find the patient's information. So when I look it up, we have a card for your, you know, we have a card in the system and we send it to the address information on the card, so I just wanna see, did the patient have active coverage during that time period?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, I can help you with this. And who am I speaking with?
[CUSTOMER][NEUTRAL] With APL.
[CUSTOMER][NEUTRAL] Sure, my name is [PII]
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Direct line [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and what is the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] 02563037ML8
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, and any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], so I'm, I'm so sorry. OK, [PII], [PII] is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And what's the data service?
[CUSTOMER][NEUTRAL] Sure, this is, it's a date range from [PII] to [PII].
[AGENT][NEUTRAL] Alright, just one moment then.
[CUSTOMER][NEUTRAL] And the bill amount was
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The bill amount was $833.
[AGENT][NEUTRAL] Oh, bear with me just a moment later. my, my screen is, um, not moving, so just one second.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] OK, and the remittance that you received was from American Public Life Insurance?
[CUSTOMER][NEUTRAL] Yeah, it says APL American Public Life Insurance expanding the benefits of Verizon [PII]. It says, um, RE [PII], the business part of the enclosed information was submitted to American Public Life Insurance Company. However, we weren't able to locate the correct policy with the information provided. If you'd like us to do further research for our files, please send the following information, including a copy of the insurance ID card and any recent name changes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said that was dated.
[CUSTOMER][POSITIVE] And we got it
[AGENT][NEUTRAL] I'm sorry, go.
[CUSTOMER][NEUTRAL] Yeah, [PII] at [PII] is when.
[CUSTOMER][NEUTRAL] No, you're fine. [PII] [PII] is when we got the last letter, and then the first letter that said the exact same thing, we got that one.
[CUSTOMER][NEUTRAL] Um [PII].
[AGENT][NEUTRAL] OK, and can you verify do you have a copy of the claims information?
[AGENT][NEUTRAL] That you
[CUSTOMER][NEUTRAL] Um, I'm just looking at it looks like you guys sent that back along with the um UBO4 form.
[AGENT][NEUTRAL] OK, so it sounds like maybe on the UBO4, does it have the correct policy number? I don't see, I mean, we, I, I'm not showing.
[AGENT][NEUTRAL] A claim on file for any of those dates for that date range that you provided for me?
[CUSTOMER][NEUTRAL] Sure, let me look at the [PII].
[AGENT][NEUTRAL] I'm just making sure that something.
[CUSTOMER][NEUTRAL] Yeah, it shows that.
[CUSTOMER][NEUTRAL] [PII] yeah it shows it down at the bottom. I could fax this information over. I could fax the card, the claim, the letter I could fax all that. I don't know if you guys do fax.
[AGENT][NEUTRAL] OK, so you would need to send the claim, her primary insurance company's explanation of benefits if you want to include. What's the name of the facility or the provider you're calling on behalf of?
[CUSTOMER][NEUTRAL] Carl Eureka Hospital.
[CUSTOMER][POSITIVE] Yes, and I can definitely send that primary EOP. That's not a problem.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Yes, because based on what you're reading to me, I'm not sure why it would have been. I mean, the policy that's 02563037 is the correct.
[AGENT][NEUTRAL] That is the correct policy number?
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What, well, obviously, we received it if you received that letter. The correct mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Our claims fax number is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] Attention claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I will go ahead and I'll fax all that information over there and then we'll see, we'll, we'll go from there and see if maybe the claim will, the third time might be a charm.
[AGENT][NEUTRAL] Yes, ma'am, cause again, do you know, I mean, how are you all submitting that to us before?
[CUSTOMER][NEUTRAL] Uh, mailing it. It was going to that address on the back of the card that [PII].
[AGENT][NEUTRAL] Yes, ma'am I'm, I, I honestly don't know. um.
[AGENT][NEUTRAL] So yes ma'am, just try and fax it and again the date range was [PII] and total bills is 8:33, is that correct?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] Yes, OK, so I, I don't, I'm sorry. I wish I could answer that better, but.
[AGENT][NEUTRAL] This person was active. It is showing as active.
[CUSTOMER][NEUTRAL] That's OK, we'll see.
[CUSTOMER][NEUTRAL] OK, well, like I said, I'll fax all this over and we'll see if maybe it's time to go through.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK then. Well, is there anything else, [PII] that I can help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][NEUTRAL] OK, well, you're welcome and then just one last thing [PII], um, let me get those dates again from you on those letters that you received.
[CUSTOMER][NEUTRAL] Sure, let me go back.
[AGENT][NEUTRAL] Because you said it was 2 of them.
[CUSTOMER][NEUTRAL] First one I think was [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, the first one is [PII].
[CUSTOMER][NEUTRAL] And I think the second one is [PII]. Let's see.
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] And both of them are the same letter, they just say that that.
[AGENT][NEGATIVE] Unable to locate this number?
[CUSTOMER][NEGATIVE] Yeah, and then above, um, well I don't like that man somebody wrote that on there I don't know what that is.
[CUSTOMER][NEUTRAL] And you know what it looks like actually? Somebody must have.
[CUSTOMER][NEUTRAL] They actually, they, they faxed it.
[CUSTOMER][NEGATIVE] And all of it was returned. It was, it was faxed. Oh wow.
[CUSTOMER][NEUTRAL] Now that I'm scrolling through all the documents.
[CUSTOMER][NEUTRAL] She faxed it to [PII].
[CUSTOMER][NEUTRAL] Uh, and she included the primary she faxed it over 211 of 25 to that fax number.
[CUSTOMER][NEUTRAL] She faxed the primary EOB and the claim and then uh it looks like you guys returned the fax cover letter, the primary EOB the claim and then that letter.
[AGENT][NEUTRAL] OK, and her name is [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and you're sure that the
[CUSTOMER][NEUTRAL] It looks like you guys got it at [PII].
[AGENT][NEUTRAL] Mhm. OK. Go ahead.
[CUSTOMER][NEUTRAL] Yeah, it looks like it went through you and you guys got it [PII] of 25 at [PII].
[AGENT][NEUTRAL] I mean, I see that we have received other claims for this number from your provider. I mean, you know, same facility, so I, I can't, I'm perplexed on this. If that's indeed the policy number that's reflected on the claim.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] And her information is correct on all of the documents.
[AGENT][NEUTRAL] Now if there's something wrong with the policy number somewhere or some of the other information then yes that would kick it out but if it's.
[AGENT][NEUTRAL] The policy number you gave me is on the documents being sent to us.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] I don't understand.
[CUSTOMER][NEUTRAL] I don't know. I, I, I don't know. I'll try to fax it again this time. I'll include the card. Maybe that'll help. Looks like before they didn't put the card, so I don't know, maybe that'll make a difference and we'll see.
[AGENT][POSITIVE] Yes, please, please do include that if that's not something that we've included before just to definitely see if that makes a difference.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then [PII], I did wanna give you our portal website so that in the future once we process claims here you should be able to check the status by going to [PII].
[AGENT][NEUTRAL] Again, that would be for checking claim status.
[CUSTOMER][NEUTRAL] OK and you said secure. [PII]?
[AGENT][NEUTRAL] Uh-huh, secured, make sure you put a D on it [PII].
[CUSTOMER][POSITIVE] Alright, I'll definitely check that out next.
[AGENT][NEUTRAL] OK. Well, is there anything else I can help you with at the moment or at least try to help you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much. I appreciate your help.
[AGENT][POSITIVE] OK, well thank you again for calling APL and I hope you have a wonderful afternoon.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] All right, thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye.