AccountId: 011433970860
ContactId: 6516c08c-92bb-4917-be93-e2c2922e8905
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385049 ms
Total Talk Time (AGENT): 162051 ms
Total Talk Time (CUSTOMER): 156142 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/6516c08c-92bb-4917-be93-e2c2922e8905_20250505T19:12_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, [PII]. My name is [PII], and I'm calling from Republic EMS, and I wanted to see if you able to help me with eligibility for one patient.
[AGENT][NEUTRAL] OK, I can help you with that. Could I get the spelling of your name?
[CUSTOMER][NEUTRAL] Uh yes, it's um [PII]
[AGENT][NEUTRAL] Oh, OK. [PII], sorry about that. And what is a good call back number for you?
[CUSTOMER][NEUTRAL] It's um [PII] and this is the direct line.
[AGENT][POSITIVE] Thank you. And
[AGENT][NEUTRAL] OK, and what is your, uh, the, I'm sorry, the policy number you're calling on?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, the policy number they provided to me is 19874.
[AGENT][NEUTRAL] OK, that is not a policy number.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] He did say they just call me um today um but they said that it was it on the card that he had um said group number so um he couldn't find a like an actual memory.
[AGENT][NEUTRAL] Do you have an outpatient?
[AGENT][NEUTRAL] Do you see on the card, the, uh, that's just what he provided. Do you have a copy of the card?
[CUSTOMER][NEUTRAL] No, no, I don't have a copy of the card. um, he called a moment ago and just provided the information.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, let me get
[AGENT][NEUTRAL] OK, let me get that group number one more time.
[CUSTOMER][NEUTRAL] OK, it's um 19874.
[AGENT][NEUTRAL] And what is his first and last name?
[CUSTOMER][NEUTRAL] It was the the husband that called um the patient's name is [PII] So.
[AGENT][NEUTRAL] Is he, OK, so he's the policy holder. What is his first and last name?
[CUSTOMER][NEUTRAL] Um, date of birth
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, his first and last name, let me see, I don't think uh.
[AGENT][NEUTRAL] What is the patient's first and last name?
[CUSTOMER][NEUTRAL] Um, [PII] son.
[AGENT][NEUTRAL] Let's see, yes.
[CUSTOMER][NEUTRAL] And his name is [PII].
[AGENT][NEUTRAL] And that's spelled as, how's his last name spelled?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] SON.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and your patient again, her first, last name and date of birth.
[CUSTOMER][NEUTRAL] Yes, it's um [PII] and then son um [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying that information. And let me provide you with their policy number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 216-0978.
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][NEUTRAL] OK, and you did say you were calling for benefits and eligibility today?
[CUSTOMER][NEUTRAL] Uh yes, um, so I, I know this is most, most likely gonna deny for time finding because he just called us today, but the data service was for [PII].
[AGENT][NEUTRAL] [PII], so you're checking claim status.
[CUSTOMER][NEUTRAL] Uh, no, no, um, so we never submitted the claim. We, um, the patient never notified us that the, um, we needed to submit the claims to you guys until the husband called, um, a moment ago, um, because they had a primary United Healthcare, and, um, we kept, we billed the patient but they didn't get back to us until today which was the patient's husband, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I told him that it was probably most likely past time me filing um for this but just wanted to see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the policy does not have a timely filing limit, um, and were these services for outpatient services?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it was for an emergency ambulance transport.
[AGENT][NEUTRAL] OK, so it looks like, um, please be advised verifying benefits is not guaranteed payment. Uh, his policy would have covered the charges. Uh, he does have a benefit that pays up to $1000 a calendar year. Um, it looks like we did receive the hospital claim for that date of service and the maximum amount was already paid on this date.
[AGENT][NEGATIVE] Uh, for the calendar year. So, however, it would not be past the timely filing, but, uh, he has exhausted those benefits. She has exhausted her benefits for [PII].
[CUSTOMER][NEUTRAL] Already paying.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, benefits between [PII]. OK. And then, um, um, we, um, to submit the claim for denial, um, may I please have the address where we will send it to?
[AGENT][NEUTRAL] Sure, uh, to mail in a claim, you'd mail it to [PII].
[AGENT][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 124 and do you guys have a payer ID?
[AGENT][NEUTRAL] Yes, the payer ID is 60801.
[CUSTOMER][POSITIVE] 2 OK, thank you so much for your help. I appreciate it and may I please have a reference number?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] To reference our call, you will use my name, [PII] and today's date.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] they stay.
[CUSTOMER][POSITIVE] No, that'd be all, thank you so much. You have a good day.
[AGENT][POSITIVE] You're welcome. Have a wonderful day and thank you for calling APL. Bye bye.
[CUSTOMER][POSITIVE] Alright thank you bye.