AccountId: 011433970860
ContactId: 76325f21-0006-4872-9ceb-b15f17a4a614
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 602549 ms
Total Talk Time (AGENT): 222082 ms
Total Talk Time (CUSTOMER): 166312 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/76325f21-0006-4872-9ceb-b15f17a4a614_20250102T21:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. My name is [PII]. I am calling from Bix Healthcare Services, and I'm calling to speak to someone in regards to checking status on two medical claims I have pending.
[AGENT][NEUTRAL] OK, I can help you. And you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, Ms. [PII], can I get your um callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. OK. And what is the patient's name?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The patient's name is, let me go back up. [PII].
[AGENT][NEUTRAL] OK, and what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][NEUTRAL] And her policy number please?
[CUSTOMER][NEUTRAL] Policy number is, let me go to her card here, ledger.
[CUSTOMER][NEUTRAL] It is 0206921.
[CUSTOMER][NEUTRAL] 2 M as in Mary, L Larry, and number 8.
[AGENT][NEUTRAL] Thank you and then what is the data service you'd like for me to check the claim on?
[CUSTOMER][NEUTRAL] Um, the first one that I have is [PII].
[AGENT][NEUTRAL] OK, and the charge amount?
[CUSTOMER][NEUTRAL] $201.70.
[AGENT][NEUTRAL] OK, and then what is the charge after primary paid their part?
[CUSTOMER][NEUTRAL] After primary pay their part, the balance I have is 106.63.
[AGENT][NEUTRAL] OK and one more time, can you give me the name of the facility that you're calling from?
[CUSTOMER][NEUTRAL] Yes, Helix Healthcare Services with Doctor [PII].
[AGENT][NEUTRAL] OK, I'm going to check this claim for you, Ms. [PII], and I will be right back, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Hi, Ms. [PII], this is [PII] back with you again.
[AGENT][NEUTRAL] So looking on data service 117 of 2024 for that policy number, that, that policy is a lapsed policy.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me give you the correct policy number.
[AGENT][NEUTRAL] Um, so you could resubmit the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 256-919-0.
[CUSTOMER][NEUTRAL] 256-919-0
[AGENT][NEUTRAL] Yes, ma'am, that's the correct policy number, um.
[AGENT][NEUTRAL] So the one that you gave me has been lapsed since, uh, let's see.
[AGENT][NEUTRAL] [PII], so it's been lapsed for a year.
[CUSTOMER][NEUTRAL] Wow, and that's the card that the patient provided the office with when she came in.
[AGENT][NEUTRAL] Yeah, she probably didn't um realized that she had another card. I don't know, um, but yes, the active policy is the one that I gave you the 256-919-0.
[CUSTOMER][NEUTRAL] And this one became effective on [PII].
[AGENT][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] But these are services that was rented last year, November and December.
[AGENT][NEUTRAL] Let me see if she had another active policy during that time, November and December.
[CUSTOMER][NEUTRAL] Yeah, because I have two claims that it was processed by the primary and that patient responsible for the deductible and that's when we sent it out to you guys, to American Public Life.
[AGENT][NEUTRAL] OK, she does have another policy number, um, that lapsed on [PII] of [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] That policy number is 2462335.
[AGENT][NEUTRAL] And it the effective date on it is [PII].
[CUSTOMER][NEUTRAL] [PII] through through what date?
[AGENT][NEUTRAL] Through [PII].
[CUSTOMER][NEUTRAL] So that means that she had a gap in December.
[AGENT][NEUTRAL] She got it in January and it lapsed [PII].
[CUSTOMER][NEUTRAL] OK, yeah, because I have one more claim to review which was for [PII]. So I'm gonna rebuild the [PII].
[AGENT][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] But uh [PII] is what um.
[CUSTOMER][NEUTRAL] Questionable at this point because I don't know. It looks like she did have a cat.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Now, I do show that she has a claim that was filed by Helix Healthcare Services on [PII] is the date of service, um.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] It says about that.
[AGENT][NEUTRAL] It says that office visits are not covered by the policy. That's why the claim was denied.
[CUSTOMER][NEUTRAL] Uh, but that means because she wasn't active because I this was billed with the ID that I originally gave you.
[AGENT][NEUTRAL] Right, this policy, this is the policy number.
[CUSTOMER][NEUTRAL] Correct?
[AGENT][NEUTRAL] 246-233-5
[AGENT][NEUTRAL] The one that was active from [PII] and lapsed on [PII], that was the active policy during that date of service, and the claim was denied because office visits are not covered by the policy. So her policy, whether it's active or inactive, doesn't cover office visits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, but that's the thing with the 2335, they wouldn't have gone through regardless because it, it.
[CUSTOMER][NEUTRAL] Terminated [PII] and the date of service was [PII].
[CUSTOMER][NEGATIVE] So that means it wasn't even used to process that claim because she didn't have coverage at all.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, so she did have a gap in cover which was ATL.
[CUSTOMER][POSITIVE] So she's just gonna be helping.
[AGENT][NEUTRAL] Yeah, it looks like she did.
[CUSTOMER][MIXED] OK, great, um, not great for her, but.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, all right.
[CUSTOMER][NEUTRAL] May I have the reference number, I mean, the claim number for the [PII] claim?
[AGENT][POSITIVE] Yes, I can get that for you. It is.
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 48, I'm sorry, 354-5890.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 354-589-0
[AGENT][POSITIVE] Yes, that's, that's correct.
[CUSTOMER][NEUTRAL] And this was denied on?
[AGENT][NEUTRAL] It was denied on [PII] is the day that it was processed.
[CUSTOMER][NEUTRAL] OK, do you provide reference numbers for the phone calls please?
[AGENT][NEUTRAL] Yes ma'am, you can use my name and today's date.
[CUSTOMER][NEUTRAL] And it's [PII]?
[AGENT][NEUTRAL] Why?
[CUSTOMER][POSITIVE] Right, OK, [PII], thank you so much, [PII]. You have a great day and have a happy new [PII].
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You too [PII] thank you so much for calling APL. You have a blessed [PII] too, ma'am.
[CUSTOMER][POSITIVE] Bye bye take care. Thank you.
[AGENT][NEUTRAL] Bye-bye.