AccountId: 011433970860
ContactId: 65f16119-c4df-4f04-9d3b-257d5fe23dae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 599369 ms
Total Talk Time (AGENT): 151771 ms
Total Talk Time (CUSTOMER): 198060 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/65f16119-c4df-4f04-9d3b-257d5fe23dae_20250624T19:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office to check on the claim. Can you spell your name?
[AGENT][NEUTRAL] It is spelled [PII]
[CUSTOMER][POSITIVE] OK. Thank you very much.
[AGENT][NEUTRAL] And may I please have a callback number?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] The policy number is 01829142 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] One second, and the
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Patient name is uh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And it's [PII] and last name is [PII].
[CUSTOMER][NEUTRAL] And data.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you said the member's first name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that's not the member's first name with that date of birth of [PII].
[CUSTOMER][NEUTRAL] It it has
[CUSTOMER][NEUTRAL] Yeah, the, the, it is uh [PII].
[AGENT][NEUTRAL] OK, so the first name is [PII], OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you're calling in for status of claim for this member?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] May I have the date of service and total bill?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge amount is $8,648 even.
[AGENT][POSITIVE] Thank you and you can also check claim status via our secured portal that is [PII] and I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So for that claim, it does show that we received it on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 3596.
[AGENT][NEGATIVE] 805. It processed and it denied that the inpatient max had been met, so the member had no other benefits available.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] Yeah, give me 1 2nd.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, could you say one second the denial reason for me?
[AGENT][NEUTRAL] This will be my last time repeating it. The inpatient max was met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then what we need to do to get the payments?
[AGENT][NEUTRAL] That is to providers discretion.
[CUSTOMER][NEUTRAL] So you're saying that patients don't have the benefits. So is there any we can chance to send a reconfiguration with medical records or appeal?
[AGENT][NEUTRAL] You said is it you're talking about to submit an appeal for us?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] You can submit an appeal, but it's still going to deny that the max has been met. The member has no other benefits available.
[CUSTOMER][NEUTRAL] Uh, one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Can you give the mailing address, mailing address for the future purpose?
[AGENT][NEUTRAL] The mailing address is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Could you spell [PII]?
[AGENT][NEUTRAL] OK, I can, um, I can't spell [PII] for you. You can pull it up via the zip code. Are you ready for the zip code?
[CUSTOMER][NEUTRAL] Yeah OK
[CUSTOMER][NEUTRAL] One second. Yes, I'm waiting for zip code.
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and uh can you provide the claim number and call reference number?
[AGENT][NEUTRAL] OK, so this will be my last time repeating the claim number as I stated it was 359.
[AGENT][NEUTRAL] 6805.
[AGENT][NEUTRAL] And the call reference.
[CUSTOMER][NEUTRAL] OK, OK. Sorry, you're given.
[AGENT][NEUTRAL] Excuse me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, OK. Yeah, I, you are given previously only I did, uh, I did not see that. Can you give the call of that number?
[AGENT][NEUTRAL] The call reference would be my first name, [PII].
[AGENT][NEUTRAL] Last initial of [PII] and today's date.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one second and
[CUSTOMER][NEUTRAL] For this patient, previously we got payments.
[CUSTOMER][NEUTRAL] Could you check at your end?
[AGENT][NEUTRAL] You got payment for what date of service?
[CUSTOMER][NEGATIVE] Uh, for this data service only, we have send the claims to the insurance and one got paid and one is got denied.
[CUSTOMER][NEUTRAL] Uh, but there is a different provider.
[AGENT][NEUTRAL] OK, do you have that total bill?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, I have the details.
[AGENT][NEUTRAL] May I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Can I say the claim number to you?
[AGENT][POSITIVE] Yes, you can give me that.
[CUSTOMER][NEUTRAL] Yes, it's same data service, same bill amount other state claims.
[AGENT][NEUTRAL] May I have the claim number?
[CUSTOMER][NEUTRAL] The insurance is paid 2000.
[CUSTOMER][NEUTRAL] Yes, the claim number is 250-097-119500.
[AGENT][NEUTRAL] That is not one of our claim numbers.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, 1 2nd, give me 1 2nd.
[CUSTOMER][NEUTRAL] Vas?
[CUSTOMER][NEUTRAL] Can at our end it's stating that's uh 250-097-119500.
[CUSTOMER][NEUTRAL] And we have to check on and other details also.
[AGENT][NEUTRAL] OK, so as I previously stated that it is not one of our claim numbers, that is probably from the primary insurance. The only claim that we have for that date of service denied that the inpatient max had been mixed.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] You're setting inpatient maximum benefit me.
[AGENT][NEUTRAL] That is what I previously stated about 3 times.
[CUSTOMER][NEUTRAL] Uh, I did not understanding exact denial.
[AGENT][NEGATIVE] I also stated that the member had no other benefits available.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] OK. Give me 1 2nd.
[CUSTOMER][NEUTRAL] OK, can I go for the 1 2nd.
[CUSTOMER][NEUTRAL] OK.