AccountId: 011433970860
ContactId: 498aa2d5-b66d-4871-9b34-c4a3242eb7e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329209 ms
Total Talk Time (AGENT): 95568 ms
Total Talk Time (CUSTOMER): 136255 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/498aa2d5-b66d-4871-9b34-c4a3242eb7e2_20250507T13:48_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII], I'm [PII]. I'm calling from a provider's office and um I need to get eligibility for a patient.
[AGENT][NEUTRAL] Sure [PII], I could assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Um, call back is [PII].
[CUSTOMER][NEUTRAL] [PII] 1.
[CUSTOMER][NEUTRAL] And the policy number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 02276561.
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Birthday is [PII].
[AGENT][NEUTRAL] Thank you [PII]. This policy was terminated [PII] and she has no active policy here at American Public Life. This was for medical, correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so that was just 2 days. I have a data service in [PII], but it wasn't until the [PII], so she didn't have that insurance.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I could check to see if that claim was on file.
[CUSTOMER][NEUTRAL] Oh, OK, it was for [PII] for.
[CUSTOMER][NEUTRAL] $74.
[AGENT][NEUTRAL] For medical, correct?
[CUSTOMER][NEUTRAL] Oh wait, 424. Yes, for medical.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For $350?
[CUSTOMER][NEUTRAL] Um, well.
[CUSTOMER][NEUTRAL] That's part of it. There's 424 on the claim. There's two lines. One is for 3.
[AGENT][NEUTRAL] What's your procedure code?
[CUSTOMER][NEUTRAL] Um, 5
[CUSTOMER][NEUTRAL] 9025 is for the 350.
[CUSTOMER][NEUTRAL] And then I have a procedure code of 59426 for 74.
[AGENT][NEUTRAL] You said 59025?
[CUSTOMER][NEUTRAL] 59025, yes.
[AGENT][NEUTRAL] I'm not let me pull up the policy to make the claim itself because I only see one line.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Did this, how did I think I'm looking at I don't know what happened to this claim.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Who's the provider?
[CUSTOMER][NEUTRAL] For the 3 you said?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yep, I only see one line of the 59025.
[CUSTOMER][NEUTRAL] OK, and that I've got let me see what my.
[CUSTOMER][NEUTRAL] That's Medicaid for.
[CUSTOMER][NEUTRAL] How did that process?
[AGENT][NEUTRAL] When you say how do it, did it process meaning is the outcome of it or what do you mean how did it process?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] There was no payment made on that claim.
[CUSTOMER][NEUTRAL] Yes, it
[AGENT][NEUTRAL] And the reason why there was no payment made on the claim because the policy was terminated.
[CUSTOMER][NEUTRAL] OK, alright, that's good enough. I, um, I don't know what happened to that client because there should be two lines on it unless it was.
[AGENT][NEUTRAL] Did you guys submit it electronically because some weird stuff be going on when it crosses over.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] I've just seen, I've seen some weird stuff.
[CUSTOMER][NEUTRAL] I know it.
[CUSTOMER][NEUTRAL] I know I we're getting claims from one of our payers that.
[CUSTOMER][NEGATIVE] They split the claims up and I mean they process them separately and it's it just screws everything up.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I know it does.
[CUSTOMER][NEUTRAL] I think that's
[CUSTOMER][NEUTRAL] Yeah, so, um, is there a call reference number I can use?
[AGENT][NEUTRAL] We don't provide those [PII], however, you can use my name and today's date as a reference. Would you like the claim number?
[CUSTOMER][NEUTRAL] Um, yes, please.
[AGENT][NEUTRAL] The claim number is 3,504,700. That's 3,504,700, and my name is [PII], and today's date is a reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, [PII], thank you very much.
[AGENT][POSITIVE] You're welcome thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thanks. Goodbye.