AccountId: 011433970860
ContactId: 756de329-453e-4400-b273-d7e93ad4c4e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352839 ms
Total Talk Time (AGENT): 114663 ms
Total Talk Time (CUSTOMER): 176840 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/756de329-453e-4400-b273-d7e93ad4c4e9_20250214T13:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII] calling from provider of checking up on claim status. I have only 2 claims to verify the same patient.
[AGENT][NEUTRAL] I can help.
[AGENT][NEUTRAL] Can you help?
[AGENT][NEUTRAL] I can help you, [PII], with the policy number?
[CUSTOMER][NEUTRAL] Yeah, just give me a second here. The policy number was 02458526.
[AGENT][NEUTRAL] OK, I, you went away, could you repeat the policy number?
[CUSTOMER][NEUTRAL] Yeah, definitely. It is 02458526.
[AGENT][NEUTRAL] And a phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] My, my callback number was you're asking?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] Repeat your phone number please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] My name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and you said that you're checking claim status?
[CUSTOMER][POSITIVE] Yes, exactly.
[AGENT][NEUTRAL] What's the date of service in charge?
[CUSTOMER][NEUTRAL] [PII] and the total charges are $142 even.
[AGENT][NEUTRAL] You said [PII] for $142?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and the amount was $142 even.
[AGENT][NEUTRAL] 25. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Can I can barely understand what you're saying.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I may have to repeat the, the question.
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][POSITIVE] It's not a problem.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Alright, so I'm showing the claim denied because office visits are not covered under the policy, um, the claim number is 3558841.
[AGENT][NEUTRAL] And I show that the claim was received on [PII], processed on [PII].
[CUSTOMER][POSITIVE] Yes, actually, here I have it.
[CUSTOMER][NEUTRAL] Yeah, actually I have a specific question for this client. Can I ask you?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, initially the claim was paid by [PII] and uh uh the claim is processed deductible $7474.42 and could you please confirm me the.
[AGENT][NEGATIVE] OK, you keep going away [PII], you keep going away and I can't hear the question.
[CUSTOMER][NEUTRAL] Yes, so right now you're audible.
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] Uh, am I audible to you right now?
[AGENT][NEUTRAL] I can hear you, yes.
[CUSTOMER][NEUTRAL] Yes, yes, actually, initially the Aetna was processed deductible $74.42 and later the claim was submitted to secondary American Public Life, yes the APL and uh the initial Aetna was process then why secondary was not paid for the service.
[AGENT][NEUTRAL] Office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK. The [PII] was office visit and that is
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, not covered with this policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you very much for that. Uh.
[CUSTOMER][NEUTRAL] And could you please provide me the member policy?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I need, uh, could you please provide me the member policy?
[AGENT][NEUTRAL] When you say the member policy, what do you mean?
[CUSTOMER][NEUTRAL] I mean, uh, the.
[CUSTOMER][NEUTRAL] What is the patient policy?
[AGENT][NEUTRAL] What type of policy do they have?
[CUSTOMER][NEUTRAL] Mm, OK. I'm sorry for that. And could you please uh provide me the same date of service with a different bill amount, $484.39.
[AGENT][NEUTRAL] Hey, this is the only data service that I show for this patient.
[CUSTOMER][NEUTRAL] Mm, actually, uh, I have the claim here. Can I provide you that?
[AGENT][NEUTRAL] Give me 1 2nd, let me check again. Is it a facility charge?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, yes, it is a facility charge.
[AGENT][NEUTRAL] OK, what's the total charge?
[CUSTOMER][NEUTRAL] $484.32.
[AGENT][NEUTRAL] OK, give me a second.
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] So do you have you received the explanation of benefits?
[AGENT][NEUTRAL] And you have the claim number? so what questions do you have?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, same as actually the claim was denied as, uh, uh, non-covered visits, uh, as 96 uh non-core charges as per the CO 96 conduct charge. I mean like.
[CUSTOMER][NEUTRAL] Uh, as per the provider, I just know it is also 99213 office visit. Could you please confirm me, uh, this is all the same dinner, the office which is not, not covered under patient plan.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] What's the total charge of the claim?
[CUSTOMER][NEUTRAL] $484.39.
[AGENT][NEUTRAL] OK, I do not show that claim on file. Did you say you had a claim number?
[CUSTOMER][NEUTRAL] Yeah, I have a claim number, uh, that is.
[AGENT][NEUTRAL] And what is that number?
[CUSTOMER][NEUTRAL] 3558841
[AGENT][NEUTRAL] Yeah that's the one we just went over.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, yeah, got it. I thought uh the claim was again, it's a duplicate claim. Yes, got it. And could you please, uh, spell out your name for my documentation.
[AGENT][NEUTRAL] You'll use my name in today's date as reference for today's call. [PII] of my [PII]. Did you have any other questions?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, no, thank you very much for that. And it is your reference as well, right?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] My name in today's date, yes.
[CUSTOMER][POSITIVE] Yeah, got it. Thank you, [PII]. Thank you, [PII]. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You, you're welcome. Thank you for calling [PII]. Have a good day as well.