AccountId: 011433970860
ContactId: 55d89c5a-48bc-4088-b475-74a1eb872fb2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 617770 ms
Total Talk Time (AGENT): 173585 ms
Total Talk Time (CUSTOMER): 138331 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/55d89c5a-48bc-4088-b475-74a1eb872fb2_20250527T14:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Pub. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider office. I'm calling regarding the claim status. Before proceeding, I would like to share you this call is recorded for training and quality purpose. Is it OK for you?
[AGENT][NEUTRAL] Could you please spell your name for me?
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII]. Last name first is [PII].
[AGENT][NEUTRAL] And may I please have a callback number and then the policy number?
[CUSTOMER][NEUTRAL] Sure. It is [PII] with the extension [PII].
[AGENT][NEUTRAL] OK, I got [PII] and then the phone went out.
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the policy number please?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] It will be 02298883. Mike Lima number 8?
[AGENT][NEUTRAL] It's 02298883.
[CUSTOMER][NEUTRAL] 988883
[AGENT][NEUTRAL] OK, the phone is continuing to go out. Could you repeat that again?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 02298883 M Mike and Lima number 8.
[AGENT][NEUTRAL] I'm pulling the information up for you now.
[CUSTOMER][NEUTRAL] Sure, can you also spell out your name for me, please?
[AGENT][NEUTRAL] Could you repeat that please?
[CUSTOMER][NEUTRAL] Can you spell your name for me?
[AGENT][NEUTRAL] Yes it is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] With the last initial of [PII], today's date as the call reference.
[CUSTOMER][NEUTRAL] Oh first is [PII]
[AGENT][NEUTRAL] It is, it is [PII].
[CUSTOMER][NEUTRAL] Oh sorry, there we go.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] And may I have the patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Sure. [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you, and you're calling in for status of claim. May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh data service is November 27, 2024. The total charge $500 even and previously we submitted primary UOP on January, sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm pulling that information up for you as well.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] And thank you so much for verifying the policy. You're calling in for status of claim for the date of service of 11-27-24. Total bill charge $500. Now for that claim, the previous claim did deni for the primary EOB, but we did receive that claim in a second time, and that receipt date was [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 357.
[AGENT][NEUTRAL] 91
[AGENT][NEUTRAL] 89, it is showing that that claim process and that it denied, we get you the correct denial.
[AGENT][NEUTRAL] That it shows that we received the incorrect EOP so we're needing the explanation of benefit that matches the claim information. Let me look that image up as well.
[CUSTOMER][NEUTRAL] Yeah, after that, we again submitted on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You said you are submitted it again on [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I did state that the, that we had received in was on in March.
[AGENT][NEUTRAL] And that claim denied for the incorrect EOB.
[CUSTOMER][NEUTRAL] I'm just gonna
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you help me with one more claim with different member?
[AGENT][NEUTRAL] OK, so did you understand the reason of that denial?
[CUSTOMER][POSITIVE] Yeah, you receive incorrect, you'll be right.
[AGENT][NEUTRAL] Yes, that EOB that we need to receive would have to match that claim that was submitted in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and may I please have the next policy number?
[CUSTOMER][NEUTRAL] Sure. It's 02145415. Mike Lima number 8.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] [PII], the total charge $1700 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And we submitted primary UB.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][POSITIVE] And I'm pulling that up for you as well.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you can also check claim status via our secured portal that is [PII], and for that claim, it does show that we received it on [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It was processed on [PII]. That claim number is 3587802. It shows that the claim processed and denied for the primary EOB.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] You're welcome. And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Thank you so much for calling American Public Life, have a great day.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yeah bye.