AccountId: 011433970860
ContactId: 4e9b92f0-919c-4659-ae22-c9382ece2e00
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 667280 ms
Total Talk Time (AGENT): 254670 ms
Total Talk Time (CUSTOMER): 206195 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/4e9b92f0-919c-4659-ae22-c9382ece2e00_20250107T17:31_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi [PII], this is [PII]. I'm calling from the office to check on the claim status. Could you please go and help me?
[AGENT][NEUTRAL] OK, [PII], you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that and what is your callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] What was the extension again, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Yeah, I have 2 plans.
[AGENT][NEUTRAL] Are they for the same member or different patients?
[CUSTOMER][NEGATIVE] Different issues.
[AGENT][NEUTRAL] OK [PII], so again my name is [PII] and you will use my name along with today's date as your call reference number for each one.
[AGENT][NEUTRAL] And also any information that I provide for you on either claim will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] And lastly, [PII], if we have the claims on file and you need a copy of the explanation of benefits, you may print them from our portal by going to [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 020
[CUSTOMER][NEUTRAL] 331-42.
[CUSTOMER][NEUTRAL] [PII] 7.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And what is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The patient's name is [PII]. 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 for him please?
[CUSTOMER][NEUTRAL] The date of service [PII] they charge $1,668 even.
[AGENT][NEUTRAL] OK, give me the amount one more time please, [PII].
[CUSTOMER][NEUTRAL] Sure, it's 1668.
[AGENT][NEUTRAL] OK, thank you. Now this policy we do not have a claim on file under this policy for that data service this policy was not active for that date of service either.
[CUSTOMER][NEUTRAL] [PII]. The policy was not active.
[AGENT][NEUTRAL] You said [PII]. What is the date of service?
[CUSTOMER][NEGATIVE] No sorry.
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hey this claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] That.
[AGENT][NEGATIVE] It was denied.
[AGENT][NEUTRAL] The claim number is 3262526.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the reason for the denial states the maximum benefit payable for this state of service has been met.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] If I there for maximum benefit met, right?
[AGENT][POSITIVE] That is correct. Maximum benefit for this state of service has been met.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I know how many service partic stations?
[AGENT][NEUTRAL] This outpatient benefit maximum was $1000 per covered person per calendar day.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] And it was met on another plane.
[AGENT][NEUTRAL] For a different provider.
[CUSTOMER][NEUTRAL] OK, OK, that is any provider discount amount?
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] This is not major medical insurance. This was a limit I'm sorry, this was a supplemental plan to the member's primary health care insurance. We do not determine patient responsibility.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] up to
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and then may I know your last name initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The patient have only $1000 right? that already patient was met, right?
[AGENT][NEUTRAL] The maximum benefit was met for this data service on another claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] OK I'm on the next number ID.
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Shall I want the next member ID?
[AGENT][NEUTRAL] Uh, just one moment, [PII], and let me finish my note. I have to make a note on each claim that I check.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, I know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And what is your next patient's policy number, please?
[CUSTOMER][NEUTRAL] Sure it's 589246-447.
[AGENT][NEUTRAL] OK, now that is not a policy number for our company, [PII], that is not an American public life policy number.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that a social security number?
[CUSTOMER][NEUTRAL] Won't be SSN number for this number.
[AGENT][NEUTRAL] No, what's the number you gave me the SSN number because that's not a valid policy number.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I have this number only I have my.
[CUSTOMER][NEUTRAL] Fine.
[CUSTOMER][NEUTRAL] Go ahead and verify the patient's name and date of birth?
[AGENT][NEUTRAL] I can't search by the date of birth. I can try by the name.
[AGENT][NEUTRAL] What is the name?
[CUSTOMER][NEUTRAL] The first name is [PII] The last name is [PII]
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, any informa OK, just one moment.
[CUSTOMER][NEUTRAL] So like
[AGENT][NEUTRAL] And the patient's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And what
[AGENT][NEUTRAL] What is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] The date of service [PII] sorry date of service is [PII] total charges $2,583 even.
[AGENT][NEUTRAL] Say the amount again.
[CUSTOMER][NEUTRAL] 2583.
[AGENT][NEUTRAL] And the data services [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, before that, uh, we didn't submit a claim to you. I just need a patient, uh, eligibility only for this one. I know the patient effective date and termination date for the policy because I just need to file a claim.
[AGENT][NEUTRAL] You do need to file a claim. OK. So the
[AGENT][NEUTRAL] Effective date on this policy was [PII].
[AGENT][NEUTRAL] Termination date [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, may I know the mailing address?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] [PII] claim mailing address.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Humanity pay ID.
[AGENT][NEUTRAL] 60801
[CUSTOMER][NEUTRAL] And the time limit.
[AGENT][POSITIVE] Very timely filing.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And we will have to have a copy of the primary insurance company's explanation of benefits also.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] When at the time the limit.
[AGENT][POSITIVE] And the correct.
[AGENT][NEGATIVE] As I explained, there is no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the correct policy number that you should have for this policy is 02123371.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, and thank you for your assistance. Have a nice day.
[AGENT][POSITIVE] Well, you are certainly very welcome. So that's all I can help you with today, [PII]. Thank you again for calling APL and I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.