AccountId: 011433970860
ContactId: 72d70064-9510-4f38-a500-b93b941f25ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316029 ms
Total Talk Time (AGENT): 131801 ms
Total Talk Time (CUSTOMER): 65916 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/72d70064-9510-4f38-a500-b93b941f25ba_20250212T19:27_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK. And my name is [PII] and I want to check the account status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] How many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] On policy number 02368524.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and date of birth, [PII].
[AGENT][NEUTRAL] And the policy number was 2368124?
[CUSTOMER][NEUTRAL] 0236 02368524.
[AGENT][NEUTRAL] 852 4. OK, hold on one moment.
[AGENT][NEUTRAL] Alright, here we go and thank you so much for verifying and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] [PII] and date of service and uh bill amount 1936.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] And the provider of Riverside Emergency physician partners.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim twice. We originally received it on [PII]. The claim number is 349.
[AGENT][NEUTRAL] 452 2.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] As outpatient services are not covered on this policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Can I, may I know the reason?
[AGENT][NEUTRAL] The reason is outpatient services are not covered under the policy, so it's not a covered service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then can I be patient?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we are not the major medical insurance company. Um, it would be whatever the procedures are for outstanding or remaining balances.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK. Then, sorry?
[AGENT][NEUTRAL] We do not determine patient responsibility here. We're not a major medical insurance company. So whatever the procedures are for uh remaining balances, whether it's a write-off, if it's a bill, um, you would just have to follow those for your company. We don't, we don't advise of patient responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is there any other insurance?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Not that we see on our end, no, but American Public Life is not a major medical insurance company like Aetna or Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We offer limited medical benefits or gap insurance. So this is not a covered policy under a covered service under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But then, is there anything else?
[AGENT][NEUTRAL] Um, no, that's the only, that's the claim status. Did you have any other questions?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Alright, was there anything else I could assist you with?
[CUSTOMER][NEUTRAL] And can I get the card reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Bye-bye.