AccountId: 011433970860
ContactId: 659d960f-4631-4f4d-a1db-72576fc78b1e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 933789 ms
Total Talk Time (AGENT): 226673 ms
Total Talk Time (CUSTOMER): 320003 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/659d960f-4631-4f4d-a1db-72576fc78b1e_20250507T14:08_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] calling from provider office.
[CUSTOMER][NEUTRAL] Hello? Can you hear me?
[AGENT][POSITIVE] How can I assist you today?
[CUSTOMER][NEUTRAL] Yeah, I just want uh.
[CUSTOMER][NEUTRAL] Just give me one minute.
[CUSTOMER][NEUTRAL] Yeah, I'm calling from provider office to check in the claim status. So can you please help me with the claims?
[AGENT][POSITIVE] Sure. Can I have a callback number for you and that policy number, and I'll be able to assist you.
[CUSTOMER][NEUTRAL] OK, the callback number is [PII].
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] And the policy number is 02021778 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] What is this member's name and date of birth that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] OK. The first name is [PII] and the last name is [PII]
[AGENT][NEUTRAL] What is the first name?
[CUSTOMER][NEUTRAL] The first name is
[CUSTOMER][NEUTRAL] Mhm [PII]
[AGENT][NEUTRAL] [PII]? And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yes, right.
[CUSTOMER][NEUTRAL] Yeah, the date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service that you're calling to check the status of a claim for and I'll be able to assist you.
[CUSTOMER][NEUTRAL] OK. Uh, you want the data service?
[AGENT][NEUTRAL] Yes, that is correct. You're calling to check the status of a claim. I need the date of service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, yeah. The date of service is [PII] and the total charge amount is $678 even.
[AGENT][NEUTRAL] Could you repeat your bill amount?
[CUSTOMER][NEUTRAL] Yeah, the bill amount is $678 even.
[AGENT][NEUTRAL] Repeat that. Did you say $678?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] And what is your procedure code?
[CUSTOMER][NEUTRAL] OK, just let me check. Actually this claim was recently billed. Uh, one second, one second, yeah, we had that EOB and the claim is denied for the 18 and the CPT code is 99284.
[CUSTOMER][NEUTRAL] Hello, are you there?
[AGENT][NEUTRAL] There was a payment of $309.37 made on that claim. Would you like the check number?
[CUSTOMER][NEUTRAL] Just give me one minute, uh, let me check in my system.
[CUSTOMER][NEUTRAL] OK. So can you please start with the claim number?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] The claim number is 3549463. That's 3549463.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the process date?
[AGENT][NEUTRAL] What was the claim number that I gave you?
[CUSTOMER][NEUTRAL] That is 349-463.
[AGENT][NEUTRAL] Oh my God.
[AGENT][NEUTRAL] The claim was received [PII]. It was processed [PII] for a payment of $309.37. Would you like the check number?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh yeah, just give me one minute. Let me note down all those things. It was received on [PII] and processed on January.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Got it.
[CUSTOMER][NEUTRAL] Yeah, yeah, please give me the check number.
[AGENT][NEUTRAL] 2021945. It's 2021945.
[CUSTOMER][NEUTRAL] OK, and can you please help me with the paid address, which address that claim has paid?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so I just looked it up. It looked like it went to [PII].
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Yeah, is there any bulk amount?
[AGENT][NEUTRAL] Just $309.37.
[CUSTOMER][NEUTRAL] $309.37.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you please give me that a large amount?
[AGENT][NEUTRAL] That is the amount that was paid on the claim, the $3309.37 a single check for the $309.37 do.
[CUSTOMER][NEUTRAL] Is that the same?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, OK, just give me one minute.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, and the reference number for this one, this claim.
[AGENT][NEUTRAL] We don't provide reference numbers. You can use my name and today's date as a reference. It's [PII], and today's date is a reference.
[CUSTOMER][NEUTRAL] We don't
[CUSTOMER][POSITIVE] Oh, I'm so sorry. Can you please hold on.
[CUSTOMER][NEUTRAL] And repeat once again.
[AGENT][NEUTRAL] What would you like for me to repeat?
[CUSTOMER][NEUTRAL] Your name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The spelling of my name or you want me to pronounce my name? Which one is it that you are requesting?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No, I noted down that. Uh, can you please help me with the other claim? I have one more.
[AGENT][NEUTRAL] Yes, what is the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 960168919.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEGATIVE] The policy number is too long to be a policy here at American Public Life.
[CUSTOMER][NEUTRAL] OK, I have that. So I'm so sorry about that. Uh, the policy number is 02003443ML7.
[AGENT][NEUTRAL] And what is this member's name and date of birth, [PII]?
[CUSTOMER][NEUTRAL] Yeah, the first name is [PII] and the last name is [PII] uh, I'm sorry, [PII]
[AGENT][NEUTRAL] And what is her date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] It's [PII], and the total charge amount is $678 even.
[CUSTOMER][NEGATIVE] And as as per checking the EOB I'm not able to find any.
[AGENT][NEUTRAL] We're requesting the EOB.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 3967.
[CUSTOMER][NEUTRAL] K
[AGENT][NEUTRAL] This claim was received [PII].
[AGENT][NEUTRAL] It was processed [PII].
[AGENT][NEUTRAL] We're requesting the EOB from the primary insurance company because this is a gap insurance, Dora.
[CUSTOMER][POSITIVE] Oh, I'm so sorry, can you please repeat?
[AGENT][NEUTRAL] What part do you want me to repeat?
[CUSTOMER][NEUTRAL] It would
[CUSTOMER][NEUTRAL] Uh, it was denied for?
[AGENT][NEUTRAL] Requesting the primary EOB. This is the gap insurance, so the member has a primary insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, do you have that information?
[AGENT][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] OK. I have one last claim.
[AGENT][NEUTRAL] You will have to contact the insurer.
[CUSTOMER][POSITIVE] OK, no problem. I'll do that.
[AGENT][NEUTRAL] So how many claims do you have for me to check the status of? Because you just told me that you only had one more when this claim when you asked me to check this claim. So how many is it that you have?
[CUSTOMER][NEUTRAL] This this one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] No, no, this one is lost.
[AGENT][NEUTRAL] OK, what is the policy number?
[CUSTOMER][NEUTRAL] Last in my list.
[CUSTOMER][NEUTRAL] Yeah, one second. And the policy number is
[CUSTOMER][NEUTRAL] 20480526
[AGENT][NEUTRAL] Thank you and this is not pulling up a policy number. Could you verify the policy number?
[CUSTOMER][NEUTRAL] Um, as for checking in my system, I have this one, only that policy number.
[AGENT][NEUTRAL] Could you repeat the number?
[CUSTOMER][NEUTRAL] Yeah, that is 02480526.
[AGENT][NEUTRAL] What is the member's name and date of birth?
[CUSTOMER][NEUTRAL] OK. The first name is [PII], that is [PII], initial is [PII] and the last name is [PII]. That is [PII]
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what is the date of service that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] [PII]. And the total charge amount 17 $1,404 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] 89. How many procedure lines are there?
[CUSTOMER][NEUTRAL] Uh, actually it was, uh, bill in December and we don't have EOP in our system.
[AGENT][NEUTRAL] Do you know how many procedure lines there was on this claim?
[CUSTOMER][NEUTRAL] Oh yeah, just give me one minute.
[CUSTOMER][NEUTRAL] OK. As per checking, there is one procedure code that is 99254.
[CUSTOMER][NEUTRAL] And the claim was built on this.
[AGENT][NEUTRAL] I'm not showing that claim on file.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] For [PII], correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is the bill amount?
[CUSTOMER][NEUTRAL] The bill amount is $1,400404 1404.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] $1,444.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] There's no claim on file for the data service with that amount.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is
[AGENT][NEUTRAL] [PII] and there is no claim on file for their bill amount or the date of service.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Actually, the bill amount is 1404.
[AGENT][NEUTRAL] There's no claim on file for the data service.
[CUSTOMER][NEUTRAL] What can be done for this claim because we have submitted uh the claim.
[AGENT][NEUTRAL] So that means that you can resubmit the claim because there was no claim on file unfortunately and I can't provide you with any information that's not in the system, [PII] so you will have to resubmit the claim. Could you verify how you submitted the claim the first time because we have not received it and it's not on file.
[CUSTOMER][POSITIVE] OK, then we'll submit that. OK. Thank you for helping me today. Have a good day ahead.
[AGENT][POSITIVE] Thanks for calling APL and have a great day, [PII]. Nice speaking with you. Goodbye.
[CUSTOMER][NEUTRAL] Bye-bye. Goodbye.