AccountId: 011433970860
ContactId: 6cfa8ea1-0fe9-4f5b-8643-dc21eaaef8a1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 962039 ms
Total Talk Time (AGENT): 270250 ms
Total Talk Time (CUSTOMER): 448457 ms
Interruptions: 15
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/6cfa8ea1-0fe9-4f5b-8643-dc21eaaef8a1_20250404T16:07_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII]. I'm calling for. It is [PII] to check on the status on general claim status with the data services [PII]. Please be informed that this call has been recorded and monitored.
[AGENT][NEUTRAL] OK, so unfortunately I don't mean to cut you off, however, I would need your name and a callback number and then the policy number of the member being the name and date of birth, unfortunately.
[CUSTOMER][NEUTRAL] Uh yeah. So my first name is [PII]. It is [PII] Initial to my last name is [PII], and my callback number is [PII]. It's a direct line extension.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the policy number [PII] of the member?
[CUSTOMER][NEUTRAL] Yeah. So the policy number is 02212597.
[CUSTOMER][NEUTRAL] But the thing is uh.
[AGENT][NEUTRAL] And what is this member's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, so the member's first name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] And [PII], you're calling to verify benefits and eligibility for what place of service and I'll be able to assist you.
[CUSTOMER][NEUTRAL] So I just need the general claim status.
[AGENT][NEUTRAL] OK, what's the date of service that you're calling to check the status of the claim for?
[CUSTOMER][NEUTRAL] Yeah, so date of service is [PII] and total charges uh this claim is $756 even.
[AGENT][NEUTRAL] And do you have a procedure code?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, so the procedure code is procedure code is 71046. It is outstanding balance is $43. 33 cents and
[CUSTOMER][NEUTRAL] Yes, so we have to submit this, so I just need the claim status.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] How much you
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] You do have a claim number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh yes, do we need?
[AGENT][NEUTRAL] Yes, what is the claim number that you have?
[CUSTOMER][NEUTRAL] That you paid on that.
[CUSTOMER][NEUTRAL] It is 355-0504.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I see in our system uh as for the previous notes, so this uh this claims the lien process and on.
[AGENT][NEUTRAL] Um, no, it says that the claim was considered as a duplicate.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so when did you receive this duplicate claim?
[AGENT][NEUTRAL] So we received the duplicate the duplicate claim [PII] and it was processed [PII].
[CUSTOMER][NEUTRAL] OK. It's a duplicate claim services, so.
[AGENT][NEUTRAL] In the original claim there was no payment made because the services are not covered under the policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. So this is not.
[AGENT][NEUTRAL] And that was submitted [PII] and it was processed [PII].
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK, so this is not for us for the member policy, is it correct?
[AGENT][POSITIVE] Yes, that is correct, [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, just a second. Uh, so may I know the original claim receive date?
[CUSTOMER][NEUTRAL] OK, so $141.29.
[AGENT][NEUTRAL] [PII], it was processed [PII].
[CUSTOMER][NEUTRAL] it.
[CUSTOMER][NEUTRAL] But I see in our system, so this claim has been denied stating the services were rendered after the coverage was terminated. Is that correct as for the UV?
[AGENT][NEUTRAL] No, it's the services were not, services are not covered under the policy is why there was no payment made on the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] So can I please get which if it is not covered as for the member's policy.
[AGENT][NEUTRAL] All of them. Treatment received in the office is not covered, nor is office visits.
[CUSTOMER][NEUTRAL] Office visit as per the member's policy.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] So can I please get CBD codes?
[CUSTOMER][NEUTRAL] Uh, just wanna do like that.
[AGENT][NEUTRAL] The CPT code is the code that you provided me, which is the 710461034F 3008F 300730777 and 99204.
[CUSTOMER][NEUTRAL] OK. It is out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] you can
[CUSTOMER][NEUTRAL] right
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, uh, they'll go they'll make you better.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] How they.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] you know that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] So when the time to file for the correct claim?
[AGENT][NEGATIVE] There's no timely filing. However, even if you send in a a corrected claim, it's still gonna be denied as services are not covered. The policy does not cover office visits nor the treatment received in the office.
[CUSTOMER][NEUTRAL] It's the documentation purpose.
[CUSTOMER][NEUTRAL] It's a documentation purpose, so that's why I'm asking you.
[AGENT][NEUTRAL] OK, sure, send it on. Would you like the address?
[CUSTOMER][NEUTRAL] Uh, so there is no estimated time frame to submit this family filing for the credit claim?
[AGENT][NEGATIVE] No, there's no timely filing. No, there's no timely filing.
[CUSTOMER][NEUTRAL] OK, so can I please get address?
[AGENT][NEUTRAL] The address will be addressed to the APL claims department at [PII]. That's PO Box 248,950, Oklahoma City, [PII].
[CUSTOMER][NEUTRAL] OK, so I'm not understanding, so it's [PII].
[AGENT][NEUTRAL] It's [PII]. The city and state is [PII] with a zip code of [PII], [PII].
[CUSTOMER][NEUTRAL] ZIP code is [PII]. OK. And so when is the time to find you to submit an a bill?
[AGENT][NEGATIVE] There is no timely filing.
[CUSTOMER][NEUTRAL] So many the mailing address to submit an a bill?
[AGENT][NEUTRAL] The same address as the claims address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK. So is there any specific appeal form?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. Can I please get claim uh claim number?
[AGENT][NEUTRAL] The claim number is 355-0504.
[CUSTOMER][NEUTRAL] Could you please give me the caller reference number and shall I move to the next one, [PII].
[AGENT][NEUTRAL] We don't provide reference numbers. [PII], however, you can use my name in today's as a reference.
[CUSTOMER][NEUTRAL] OK, so let me do the next one claim.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, so the policy number is
[CUSTOMER][NEUTRAL] 669-448-50
[AGENT][NEUTRAL] That's not pulling up a policy.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] So do we need a social security number?
[AGENT][NEUTRAL] So could you verify the policy number again? Look at the card or you can give me the social you have the social?
[CUSTOMER][NEUTRAL] Yes, uh, the social security number last four digit is [PII].
[AGENT][NEUTRAL] I need the whole 9.
[CUSTOMER][NEUTRAL] OK, just give me a second. I'll provide you.
[CUSTOMER][NEUTRAL] The whole social security number is [PII].
[AGENT][NEUTRAL] And what is this member's name?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the date of service that you're calling to verify claim status for [PII]?
[CUSTOMER][NEUTRAL] of service or not
[CUSTOMER][NEUTRAL] Yeah, so date of service on a claim is.
[CUSTOMER][NEUTRAL] [PII] and total charges are.
[AGENT][NEUTRAL] Is it [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] There's no claim on file for [PII].
[CUSTOMER][NEUTRAL] Uh, [PII], total charges are $185 even.
[CUSTOMER][NEUTRAL] I have this claim number. Do we need claim number?
[AGENT][POSITIVE] Yes you, yes, if you have a claim number, yes, I would definitely that would definitely help because I'm not showing a claim on file for that data service.
[CUSTOMER][NEUTRAL] Because we have received UV.
[AGENT][NEUTRAL] So what is the claim number?
[CUSTOMER][NEUTRAL] Yeah, so the claim number is.
[CUSTOMER][NEUTRAL] E as in Echo, L as in Lima, 623.
[AGENT][NEUTRAL] That's not a claim number here in American Public Life.
[CUSTOMER][NEUTRAL] Um, just a second, I'll be check. OK give me a second. I'll check one more time.
[CUSTOMER][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] So I have just one more claim number. It is 9322412.
[CUSTOMER][NEUTRAL] 386-497-00.
[AGENT][NEGATIVE] That's too long to be a claim number here at American Public Life.
[CUSTOMER][NEUTRAL] So that date of service claim is not on file, is that good?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] So man, so is the patient active on the date of service?
[AGENT][NEUTRAL] The patient's policy has been active since [PII] and is currently active.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII], is that correct?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Patients selective. So are you primary or secondary?
[AGENT][NEUTRAL] We're not a primary insurance company.
[CUSTOMER][NEUTRAL] So I just secondary.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sorry you secondary is it correct?
[AGENT][NEUTRAL] So this is a hospital indemnity policy.
[CUSTOMER][NEUTRAL] I'll do it to the
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] So I'm not sure if the member has any other insurance policy, so I'm not sure which policy this will be for the member.
[CUSTOMER][NEUTRAL] OK, uh, no problem. So, when was the last year be updated?
[AGENT][NEUTRAL] Repeat yourself.
[CUSTOMER][NEUTRAL] So when was the last coordination of benefit update?
[AGENT][NEUTRAL] We don't coordinate benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So may I the preferred mode of submission claim.
[AGENT][NEUTRAL] If you can submit a claim, would you like the address to submit a claim?
[CUSTOMER][NEUTRAL] Uh, no, uh, I mean, uh, prefer more mode of submission like electronically or the paper submission, just prefer mode.
[AGENT][NEGATIVE] So, repeat your question because I'm not understanding you.
[CUSTOMER][NEUTRAL] I mean it's the preferred mode of claim submission is electronically submission is available.
[AGENT][NEUTRAL] Yeah, you can submit it electronically or you can submit it by mail. The payer ID for electronic submission is 64556.
[CUSTOMER][NEUTRAL] Or the paper submission is available.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so may I, may I know the claim submission timely filing?
[AGENT][NEUTRAL] There's no time to found.
[CUSTOMER][NEUTRAL] So when the uh mailing address claim submission.
[AGENT][NEUTRAL] The mailing address would be.
[AGENT][NEUTRAL] Address to [PII]. That's [PII]. That's [PII].
[CUSTOMER][NEUTRAL] It's a 2 address [PII]. So I think it's.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] So could you please give me the call reference number, call reference number, your name and date, is that correct?
[AGENT][NEUTRAL] We don't provide reference numbers. Yes, that is correct.
[CUSTOMER][POSITIVE] OK, [PII]. So thank you for your assistance, [PII]. Have a great day.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day. Goodbye.
[CUSTOMER][NEUTRAL] OK. Bye-bye