AccountId: 011433970860
ContactId: 698810ba-5e6c-4e02-ab68-f06ac3ff31f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437119 ms
Total Talk Time (AGENT): 140652 ms
Total Talk Time (CUSTOMER): 148460 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/698810ba-5e6c-4e02-ab68-f06ac3ff31f9_20250226T19:03_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 [PII], my name's [PII] and I'm calling with the provider's office, and I was calling to um get claim status.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII], may I please have the policy number?
[CUSTOMER][NEUTRAL] 01954452.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] And this is for a medical claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Um, it looks like it's for [PII] for 1134.
[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][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] For that claim, it does show that we received it on [PII]. It was processed on [PII]. That claim number is 3565099. It shows that that claim processed and it denied.
[AGENT][NEUTRAL] Let me pull that denial up for you.
[AGENT][NEUTRAL] That the primary insurance did not cover. Let me pull the claim image up as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I saw that see that we received the claim with the total amount of $1,134 but the EOB that we received.
[AGENT][NEUTRAL] It's not the complete total bill, so that EOB is showing that the primary insurance did not cover the services that we received in on the EOB, but we have to have the completed EOB for this member.
[CUSTOMER][NEUTRAL] OK, what does the EOB look like?
[AGENT][NEUTRAL] It will be that we received in only shows the billed amount of the $19.04.
[CUSTOMER][NEUTRAL] I wonder.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] How weird.
[CUSTOMER][NEUTRAL] Did you receive it electronically or was it mailed paper or can you tell?
[AGENT][NEUTRAL] I wouldn't be able to tell.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you, do you cover the it looks like Blue Cross and Blue Shield.
[CUSTOMER][NEUTRAL] On this claim they paid $81.60 and.
[CUSTOMER][NEUTRAL] Co-pay is $50. Do you guys even cover that?
[AGENT][NEUTRAL] I don't, we can't process claims over the phone we have to receive that claim in to review that claim.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, can I fax you the claim in the EOB or the can I fax you just, I guess you just need the EOB then right if I.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, we need the EOB that's gonna show the complete total bill charge of 1134.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK, because you have the claim for 11, do you have the claim what is?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] I wonder, let me see.
[CUSTOMER][NEUTRAL] I don't know what they sent you.
[CUSTOMER][NEGATIVE] That's so bizarre.
[CUSTOMER][NEUTRAL] I'm just trying to figure out what they sent you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 1134. Yeah, it looks like they sent out a claim for 1904 1st.
[CUSTOMER][NEUTRAL] And then for 1,11496.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] Bizarre. I don't understand that. OK.
[CUSTOMER][NEUTRAL] Should I go ahead and send you the claim and the EOB or what do you think?
[AGENT][NEUTRAL] If you would like, you're more than welcome to submit the all of the documentation. If you do have the separate EOB that is indicating the 1904, even though we already have it, you can submit that in and the one with the 111496 in as well and then that will be reviewed to know that the total is combined at the 11:34.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, I do.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and then and I can fax it to you?
[AGENT][NEUTRAL] Yes, you do have the option to fax it. Are you ready for that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What? Yes.
[AGENT][NEUTRAL] It is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] And that is attention claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um the claim that you received on file um for this patient was for 1,134.
[AGENT][NEUTRAL] Yes, that's the total bill.
[CUSTOMER][NEUTRAL] 1,134. OK, let me see what the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I will send that to you and the claim number was 356-5099.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, OK, thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life, [PII]. Have a great day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you, bye.