AccountId: 011433970860
ContactId: 718fd55c-eb4c-40a2-8d03-24ded25d03b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1031550 ms
Total Talk Time (AGENT): 397699 ms
Total Talk Time (CUSTOMER): 284338 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/718fd55c-eb4c-40a2-8d03-24ded25d03b3_20250521T19:45_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 is [PII]. I'm calling from the provider's office in order to check what the claim status.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][POSITIVE] Awesome
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII] and it's a direct line without an extension.
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure, the policy number for this patient is 4021.
[CUSTOMER][NEUTRAL] 07201. Patient's name is [PII]. Last name is [PII], and the date of birth is for [PII].
[AGENT][NEUTRAL] And thank you so much [PII] for verifying the policy. You're calling in for status of claim. May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the first date of service for this patient is for I do have four claims for the same patient, and the first date of service is for [PII], sorry, yeah, uh, [PII] with the total charges that is for 3 $10 even.
[AGENT][NEUTRAL] For $310?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm pulling that information up for you. I'm still here.
[CUSTOMER][POSITIVE] Yeah, thank you. Yeah.
[CUSTOMER][NEUTRAL] we didn't
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] And for this member, you can also check claim status via our secured portal that is [PII], and it does look like we received this claim in 3 times. The first time we received it, it was 823-24.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] That claim number is 34.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 97725. It denied that office visits and or procedures are not covered under the member's plan.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Office visit and the procedure, uh, procedure code does not cover, uh, does not covered by the.
[CUSTOMER][NEUTRAL] That's not covered under the patients plan name, right?
[AGENT][NEUTRAL] Correct, it is not covered under the patient's plan.
[CUSTOMER][NEUTRAL] And can I get the patient's plan?
[AGENT][NEUTRAL] This is their supplemental gap plan.
[CUSTOMER][NEUTRAL] And can I, can you provide me with the patient's effective and term date?
[AGENT][NEUTRAL] The effective date is showing [PII] and currently active.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK. And for this 11 moment, let me check whether you have paid any a client before for the patient, OK? Give me a moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Did you need the other information for the other two claims that we did receive in?
[CUSTOMER][NEUTRAL] Yeah, so for this CPT 9,921,493,000 like you'll not be paying the claim, right?
[AGENT][NEGATIVE] Correct, this member does not have that benefit for this plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And next date of service is for [PII].
[AGENT][NEUTRAL] OK, so my question was, did you need the other information for the two claims that was received?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, I'm sorry, yeah.
[AGENT][NEUTRAL] So we did receive the claim in as I stated 3 times, so I can go ahead and give you those claim numbers and just advise you that those claims did deny as a duplicate of the first submitted claim and those claim numbers are 351.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 8169.
[AGENT][NEUTRAL] And the other one is 3587496.
[CUSTOMER][NEUTRAL] OK, and can you provide me the uh duplicate claim received and processed it?
[AGENT][POSITIVE] Yes, let me get that for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So for the claim number of 351-8169, it was received on [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for the claim number ending in 7496.
[AGENT][NEUTRAL] That receipt date was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, for this one, can you uh send me the cop copy of an UB through fax?
[AGENT][NEUTRAL] OK, are you needing for all three, or?
[AGENT][NEUTRAL] Just that one that's showing the reason of the denial.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'll just
[CUSTOMER][NEUTRAL] Uh, no, only the 3.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can send that request over, but you can also pull it up via our secure portal as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I please have the next day of service and total bill?
[CUSTOMER][NEUTRAL] Yeah, the state of services for [PII].
[AGENT][NEUTRAL] Total bill please.
[CUSTOMER][NEUTRAL] Yeah, 3 $10 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And for that claim as well, we did receive it in 3 times.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Original claim was received on.
[AGENT][NEUTRAL] I'm pulling that information up for you.
[AGENT][NEUTRAL] So for the original claim, that receipt date was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 349.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 7707. The claim also denied office visits and or procedures are not covered.
[CUSTOMER][NEUTRAL] OK, duplicate claim numbers.
[AGENT][NEUTRAL] The duplicate claim number is 351.
[AGENT][NEUTRAL] 81
[AGENT][NEUTRAL] 84 and the receipt date on that one is [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The next one, receipt date was [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That claim number is?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEGATIVE] Uh 214 of 25 and process is not.
[AGENT][NEUTRAL] Let me, let me pull that one back up. Hold just one second please. I do apologize. The process date was [PII].
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 47.
[CUSTOMER][NEUTRAL] of
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And are you ready for the claim number?
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number is 3587493.
[CUSTOMER][NEUTRAL] I go to uh.
[CUSTOMER][POSITIVE] OK, thank you. And uh
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Can you fax the copy of you for this one as well, all the three of them?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Now, what I'm probably gonna be able to do is only submit you the one for the previous, the reason of the denial, which is that it's not covered. The other duplicates, I may not be able to submit those because those, all these EOB's has been submitted previously.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] May I have the next date of service?
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The next date of service is going to be for [PII].
[AGENT][NEUTRAL] That total bill, please.
[CUSTOMER][NEUTRAL] Yeah, 2 $45 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And for that claim we do receive that one as well 3 times.
[AGENT][POSITIVE] I'm getting that information for you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And for that claim, the day that we received that on [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That claim number is 3379535. That claim processed and it denied.
[CUSTOMER][NEUTRAL] 01 moment. That is 337-937. I'm sorry, I didn't get the claim number that is 337.
[AGENT][NEUTRAL] It is 337-9535.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim denied, office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yeah it will be.
[AGENT][NEUTRAL] And the next receipt date was [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That claim number is 3518.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] 177.
[AGENT][NEUTRAL] That one denied as a duplicate of the previous submitted claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the next claim number.
[CUSTOMER][NEUTRAL] something
[AGENT][NEUTRAL] It's 356.
[AGENT][NEUTRAL] 876 9.
[AGENT][NEUTRAL] That claim was received on [PII] 25.
[AGENT][NEUTRAL] And it was processed on [PII] 25.
[AGENT][NEGATIVE] And that one denied as a duplicate as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And the next date of service is for [PII].
[AGENT][NEUTRAL] Total bill, please.
[CUSTOMER][NEUTRAL] $1060 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do
[AGENT][NEUTRAL] And for that claim, we received it on 8-23-24.
[AGENT][NEUTRAL] It was processed on [PII] 24.
[AGENT][NEUTRAL] That claim number is 349.
[AGENT][NEUTRAL] 7717 that claim denied that office procedures.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 349.
[CUSTOMER][NEUTRAL] Yeah, one moment that 849.
[CUSTOMER][NEUTRAL] Sorry, 349.
[AGENT][NEUTRAL] It is 349-7717.
[AGENT][NEUTRAL] That claim denied office procedures are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The next receipt date is [PII] or 24.
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 351.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 81
[AGENT][NEUTRAL] 81.
[AGENT][NEUTRAL] That when denied as a duplicate of the previous claim.
[AGENT][NEUTRAL] The next claim number is 358.
[AGENT][NEUTRAL] 74
[AGENT][NEUTRAL] 87.
[AGENT][NEUTRAL] It was received on [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] That claim denied as a duplicate and office procedures are not covered.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK, I heard this.
[CUSTOMER][NEUTRAL] Yeah, so for this one also, can you fax a copy of an AOB please?
[AGENT][NEUTRAL] Yes, and may I have that fax number?
[CUSTOMER][NEUTRAL] Yeah, 317.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's the next digits, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Into the attention.
[CUSTOMER][NEUTRAL] Uh, my name, [PII].
[AGENT][NEUTRAL] OK, I will get that request submitted over and is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, can I get the call reference number?
[AGENT][NEUTRAL] Yes, the call reference would be my first name [PII], which is spelled [PII]
[AGENT][NEUTRAL] R R
[AGENT][NEUTRAL] E [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Last initial of [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome, thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] Yeah.