AccountId: 011433970860
ContactId: 5b3ebda0-9f5f-42e2-91e0-86cd19cbe38b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1355969 ms
Total Talk Time (AGENT): 355962 ms
Total Talk Time (CUSTOMER): 432276 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/5b3ebda0-9f5f-42e2-91e0-86cd19cbe38b_20250324T12:57_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to change status. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII], how are you?
[CUSTOMER][POSITIVE] Yeah, I'm doing great. Yes, sir. Thank you for asking. And may I have your name, ma'am?
[AGENT][POSITIVE] That's good. You're welcome.
[AGENT][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah, ma'am. OK, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] No, no. [PII].
[CUSTOMER][NEUTRAL] OK, OK. [PII], [PII]. OK, OK. [PII], [PII], like, got that. Have you got my name?
[AGENT][NEUTRAL] Or a lion.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And [PII], may I
[AGENT][NEUTRAL] Yes, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] And it's not their client.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry, I didn't, I didn't hear that last part.
[CUSTOMER][NEUTRAL] No, it's that. I'm saying that uh it is airline. It's no extension. Yeah, yeah, yeah. Right.
[AGENT][NEUTRAL] Oh, it's a direct line.
[AGENT][NEUTRAL] OK. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, [PII]. That's 126246.
[CUSTOMER][NEUTRAL] 8 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm having a
[CUSTOMER][NEUTRAL] 3 clients in my hand.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And may I have um the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Member's first name is [PII], the member's name is [PII] F.
[CUSTOMER][NEUTRAL] They make and the patient's date of birth will be
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] Mm. The amount will be $608 even.
[AGENT][NEUTRAL] $608?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, and again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And um do you mind, hold on one second, I'm just searching for the claim for you.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] And that was [PII] for $608.
[CUSTOMER][NEUTRAL] Morning, ma'am.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment. Everything's coming up now.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so for [PII], we don't have a claim on file for [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. The previously we had uh spoke with the rep called [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] They are resubmitted the claim on um the uh the claim is not on file on um.
[CUSTOMER][NEUTRAL] [PII], yeah. [PII], so that we have resubmitted the claim on [PII].
[CUSTOMER][NEUTRAL] Uh, can you please check that for me? Can I get a caller reference number so it will be easier for you?
[AGENT][NEUTRAL] Yes, the call reference number for the entire call is going to be my name in today's date. Um, let me check and see if any claims have been received, but when I put that date of, if the claim had been received, when I put that date of service in, it would have came up, even this the resubmitted claim. So let me take a look and see. Hold on one moment.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Please
[AGENT][NEUTRAL] So the last claim that we received.
[AGENT][NEUTRAL] Um, we received it on February. Hold on, it's, it's going back to the other screen.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] It's just taking its time. I apologize.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] You don't want to apologize, right?
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's normal thing. Yeah.
[AGENT][NEUTRAL] OK, so the last claim we received was, uh it was received on [PII], but we haven't received or processed. You know what? Hold on one second, because there's another.
[AGENT][NEUTRAL] There's a, there's another policy that was active as of [PII]. I can check to see if the claim is there, but it probably won't be processed because that that policy wasn't active on the data service. Did you want me to check and see if it happened to go to the new account or new policy?
[CUSTOMER][NEUTRAL] No, um, this is me, [PII], uh, yeah, I have a concern like, uh, the patient's, uh, policy with you, uh, with the commercial generic is active from [PII], [PII]. Like, uh, the data services on
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], the patient is active on the rate of service and previously on the call on uh [PII].
[CUSTOMER][NEUTRAL] The same, uh, have, uh, the same, like, uh, there is no claim on the file. So we have, uh, submitted the claim to the mailing address. Please verify the mailing address [PII] with electronic payer ID.
[CUSTOMER][NEUTRAL] 73124.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Is the mailing address, right, [PII]? Yeah. Actually, we are, yeah, uh, it's showing that we have submitted the file on [PII] to this mailing address and this electronic pay ID. So, don't you see any file that has been submitted on, don't you see any claim that has been submitted on [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] With this on this data service and the build amount.
[AGENT][NEUTRAL] So there is no claim on file for [PII]. What I was saying is she, the policy that we're working with, they, they do have that. This was, this was active on the data service, but there's a policy that's active now. So I was trying since you sent it in recently, I was thinking maybe it was applied to the other policy, but I didn't, I checked and it wasn't there either, so we have not received the claim.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] There is a timely filing?
[CUSTOMER][NEUTRAL] OK. So I have to not like
[CUSTOMER][NEUTRAL] No claim on file. Yeah, I know that. There's no timely file limit for submitting the claim or the claim. It has been listed here. So,
[CUSTOMER][NEUTRAL] The claim has submitted to address previously we have submitted.
[CUSTOMER][NEUTRAL] Actually, the claim has been, it's secondary claim that has been submitted to you through by Medicare as a crossover claim. Um, so you are saying that we have to submit a claim to the
[CUSTOMER][NEUTRAL] Mailing address, right? I have said before. Is it right, [PII]?
[AGENT][NEUTRAL] You can, you can mail it, you can fax it, or you can send it electronically.
[CUSTOMER][NEUTRAL] OK. To the address uh which you have said before. Yeah.
[AGENT][NEUTRAL] With the payer ID.
[AGENT][NEUTRAL] Mhm, that's the right address.
[CUSTOMER][NEUTRAL] OK. OK. I have, I have to risk of.
[CUSTOMER][NEUTRAL] The claim.
[AGENT][NEUTRAL] Are the other claims for the same member or it's different members?
[CUSTOMER][NEUTRAL] It's for the different number. Just a moment, please, please, please, uh, please hold on for a moment.
[AGENT][NEUTRAL] OK, let me note this policy. Hold on one second.
[AGENT][NEUTRAL] Yes, I was just asking so I can note this policy. It's OK. I, I'm just noting.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you repeat that?
[AGENT][NEUTRAL] I was just asking if the other claims that we're going over was the same member so that I can put notes on here if they're not. So I'm just noting the policy.
[CUSTOMER][NEUTRAL] No, no, uh, the claim is for a different member, this one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, here we go.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Yeah, no. I have the claim on the claim.
[CUSTOMER][NEUTRAL] Can I proceed?
[AGENT][NEUTRAL] Yes, I'm noting this, the policy, Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, that's.
[CUSTOMER][NEUTRAL] 000664.
[CUSTOMER][NEUTRAL] 916.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, and [PII], is it alright if I place you on just a brief hold? My system is going um kind of slow. Let me see if it'll pull up. Hold on one moment.
[CUSTOMER][NEUTRAL] OK, ma'am. I'll wait on the.
[AGENT][NEUTRAL] It looks like it's coming together. Hold on one second. Here we are. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. [PII].
[CUSTOMER][NEUTRAL] The member's first name and last name is [PII].
[CUSTOMER][NEUTRAL] [PII] is the member's name.
[AGENT][NEUTRAL] He said
[CUSTOMER][NEUTRAL] And the date of birth is?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You said the policy number is 664?
[AGENT][NEUTRAL] 916.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Perfect. Before that, you have 3 accounts you do zeros.
[AGENT][NEUTRAL] Yeah, um, so that's coming up as a different member, um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have the claim number or the members, I can look up the member's first and last name. Can you repeat it for me because it wasn't this one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Person, uh, patient person last name will be [PII] with um date of birth is [PII].
[AGENT][NEUTRAL] And it's [PII]?
[CUSTOMER][NEUTRAL] Oh [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] Right. All right, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yeah, ma'am. Sure.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. Um, so I do have the policy here. So the correct policy number is 175.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] policy number is 175.
[AGENT][NEUTRAL] Mhm. 1752189.
[CUSTOMER][NEUTRAL] So the policy number for this patient that [PII], right?
[AGENT][NEUTRAL] Right, that's the, that's the that's the correct policy number.
[CUSTOMER][NEUTRAL] Can we say the uh coverage for this patient the permission.
[AGENT][NEUTRAL] This policy has been active since, hold on.
[AGENT][NEUTRAL] Looks like it was active from, actually, I should have gave you this one. Hold on one second. What's the date of service for the member because there there's
[AGENT][NEUTRAL] What's the data service I can look into this more.
[CUSTOMER][NEUTRAL] Right, yeah, [PII], yeah.
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] That $459 even.
[AGENT][NEUTRAL] OK, so disregard the policy number that I gave you, looks like that was set up in error. The policy number, the last policy that they've had was 17520997.
[AGENT][NEUTRAL] But the policy
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The policy still was not active on the data service. Um, it was effective from [PII], and that's the last policy that they had with APL.
[CUSTOMER][NEUTRAL] that policy active from?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Are you from [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] OK. [PII] off.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Uh, the patient does, that was the last policy they have been, uh, with you?
[AGENT][NEUTRAL] Right, that's the last policy they have with us.
[CUSTOMER][NEUTRAL] Is there any other uh active uh policy they have this the patient have to restricted for me, you know?
[AGENT][NEUTRAL] Not with APL.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] With [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] APL APL means can be a full form for that.
[AGENT][NEUTRAL] APL is American Public Life.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, can we, uh, check if patients having any active policy with any other insurance?
[CUSTOMER][NEUTRAL] Is it possible for that?
[AGENT][NEUTRAL] No, we can't do that, but you can reach out to the member and see if they see who their active insurance is, but with APL they have not had insurance since [PII]. So we don't know who they chose after that. You have to reach out to the member.
[CUSTOMER][NEUTRAL] American public.
[CUSTOMER][NEUTRAL] It means American Public.
[AGENT][NEUTRAL] American Public Life is APL.
[CUSTOMER][NEUTRAL] OK. I'm like to work with APL and uh OK, [PII]. So can we go on with the next patient?
[AGENT][NEUTRAL] Um, yes, let me note this, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah. It's A as in Alpha, T as in Tango, and X as in X-ray, 33441101.
[AGENT][NEUTRAL] Alright, so the APL policy number starts with a 01 or 02. It may have an ML 7 or 8 at the end.
[CUSTOMER][NEUTRAL] Sorry, uh, repeat that, [PII].
[AGENT][NEUTRAL] The policy number that you provided is not an APL policy number. Our policy numbers usually have, go ahead.
[CUSTOMER][NEUTRAL] The is
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. OK, [PII]. I think this one.
[CUSTOMER][POSITIVE] Oh, it's commercial but not with you. It's with security. OK, ma'am. Thanks for your time and thanks for your guidance.
[CUSTOMER][POSITIVE] Um, happy Monday [PII].
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yes, you have to give me the caller number. Uh yeah, I have the call number. That is your name and that's it, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII], uh. OK, [PII], thanks for your time and your guidance. Have a great time with you. Bye-bye for now, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you, [PII]. You also, thanks for calling APL. Have a great week. Bye-bye.
[CUSTOMER][POSITIVE] Yeah, having that. Thank you.