AccountId: 011433970860
ContactId: 794a2ac5-7f5b-4824-9c63-5f8014556ede
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2101330 ms
Total Talk Time (AGENT): 462703 ms
Total Talk Time (CUSTOMER): 555960 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/794a2ac5-7f5b-4824-9c63-5f8014556ede_20250408T19:05_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling you from the provider office. So I want to know about the current status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it is [PII] and [PII] as an extension.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah. It is 02255738 ML 8.
[AGENT][NEUTRAL] 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] Yeah, it is [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], how many claims in total do you have today?
[CUSTOMER][NEUTRAL] Uh 5.
[AGENT][NEUTRAL] And may I have the date of service and the total bill for this member?
[CUSTOMER][NEUTRAL] Yeah, the service is [PII].
[CUSTOMER][NEUTRAL] Uh it is $200.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider office on the call? I'm sorry, on the claim?
[CUSTOMER][NEUTRAL] Uh, same as diagnostic services.
[AGENT][NEUTRAL] So I'm showing the claim was received on [PII].
[CUSTOMER][NEGATIVE] Wait, uh, sorry, I was not ready.
[CUSTOMER][NEUTRAL] Uh, OK. Uh, oh, what I received, can you repeat it again? Sorry for that.
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And the claim number is 345.
[AGENT][NEUTRAL] 113 2.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider a total of $200.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, oh, it is 200, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and allowed was also 200, right?
[AGENT][NEUTRAL] Yes, the max was 200.
[CUSTOMER][NEUTRAL] Oh, OK, uh, EFT?
[AGENT][NEUTRAL] Well, let me see.
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] Uh, what were you saying before my question?
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] The calendar year max is $1000 that would be the allowed amount. Um, but yes, to this claim, we applied $200.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Did you need the check information?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So the check number is 185.
[AGENT][NEUTRAL] 0211.
[CUSTOMER][NEUTRAL] Uh, uh, uh, Turkish.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] The check was issued on
[CUSTOMER][NEUTRAL] Yeah, continue.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][POSITIVE] Yeah, sorry for that. Continue, you, you're doing great.
[AGENT][NEUTRAL] The check was issued on [PII].
[AGENT][NEUTRAL] And it cleared on [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the address it was sent to was [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, [PII], that's our address right now.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, no, nothing, uh, uh, and what's the bulk amount?
[AGENT][NEUTRAL] You said was it bulk? No, it was a single check.
[CUSTOMER][NEUTRAL] OK, or check out.
[AGENT][NEUTRAL] $200.
[CUSTOMER][NEUTRAL] OK. Perfect. OK. Uh, just to verify one more last time, sorry that I'm asking that again. Like, uh, I'm just confused about the loud amount, like what I have, what I should to write the loud amount, uh, like $200?
[AGENT][NEUTRAL] So this is the member secondary policy. So for this policy, the benefit is to, for this policy, the benefit is, um, let me double check if it's 2 or 1 $1000 per calendar year, that is the allowed amount per calendar year. So however many claims come in, we have up to that $1000 to pay out.
[CUSTOMER][NEUTRAL] Yeah, I know.
[AGENT][NEUTRAL] So that is the allowed amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 413.
[AGENT][NEUTRAL] The reason it was paid $200 is because code 78452 was billed $200.
[CUSTOMER][NEUTRAL] OK OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, OK, and, uh, I want, I just want to know one more thing like, uh, uh, call that phone number will be the same for other, every other patient or it will be different?
[AGENT][NEUTRAL] Mhm. It'll be the same for the entire call. It will be my name and today's date, and the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you spell your first name?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] Uh, got you. Uh, what's your last name, sorry for that again.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] Uh, [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. I got you. All right, uh, I can move to the next place.
[AGENT][NEUTRAL] Um, hold on one moment. I have to note each claim as we finish. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Mm, OK. Uh, for the next member policy number is 021.
[CUSTOMER][NEUTRAL] 66692 MO 8.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it is uh the [PII] with the date of birth of uh um [PII].
[AGENT][NEUTRAL] Thank you for that. And again, just for the call, the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Yeah it is uh [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] Uh, 116 dollars.9 cents.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So I'm not showing a claim on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] Uh, OK, wait, let me just check.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] There are 2 claims on that data of service.
[CUSTOMER][NEUTRAL] One is for.
[CUSTOMER][NEUTRAL] Yeah, one is for 100.
[CUSTOMER][NEUTRAL] 69, 116 dollars.09. Uh, but the total was $247.
[AGENT][NEUTRAL] The other is the
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, I'm sorry, I'm sorry, my apology, my apology, um, I'm sorry, let me just check again.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. So the service for 24.
[CUSTOMER][NEUTRAL] OK, yeah. Yeah, 424, there are two claims. Uh, the total bill amount was $247.01 got $426.
[AGENT][NEUTRAL] OK, and how are the claims sent? The claims have not been received?
[CUSTOMER][NEUTRAL] Uh, like, uh, claim, uh, mhm, OK. So, claim was sent electronically maybe, uh, because like it is processed as a secondary and the first one paid the deductible and there are remaining.
[CUSTOMER][NEUTRAL] Balance
[CUSTOMER][NEUTRAL] That bill to the American Public Life Insurance.
[AGENT][NEUTRAL] OK, so the claims have not been received, but there is no timely filing. So the policy was active on your data service. This policy has been active since [PII], I'm sorry, [PII]. So you can file the claim if you like, but we have not received the claim.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Uh, OK. I just want to make sure one thing, like,
[CUSTOMER][NEUTRAL] And there is no claim on that date of service.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. OK, thank you. Can we move to the next one?
[AGENT][NEUTRAL] OK, what's the next um member's policy number?
[CUSTOMER][NEUTRAL] It is 01491529 ML 8.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill?
[CUSTOMER][NEUTRAL] Yeah, it's uh 425 2024 with the billed amount of $181.12.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Mm, uh, just, uh, same as diagnostic so.
[AGENT][NEUTRAL] Alright, I shall receive the claim on [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII], OK, [PII].
[CUSTOMER][NEUTRAL] [PII], uh huh.
[AGENT][NEUTRAL] And the claim number is 346.
[AGENT][NEUTRAL] 57.
[AGENT][NEUTRAL] 89
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider $181.12.
[CUSTOMER][NEUTRAL] Uh, you paid on [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and speed 181.12, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, uh, check to do.
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] OK, do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Uh, yeah, for sure, no problem.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That's what I thought.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So for this one, I'm um having the claims department look at it because the check um is showing as if it was voided and I don't know if this is an error. So, um, I'm gonna send this over to claims for that one and then they will call you back, um, but did you want to go through the other ones?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, uh, like how they will call me back?
[AGENT][NEUTRAL] The callback number and the extension that you provided, is that good for you?
[CUSTOMER][NEUTRAL] OK, just, OK, no, wait, let me just get you the wallet that I can attend. OK, just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh thank you.
[CUSTOMER][NEUTRAL] Uh yeah. Uh, OK, uh.
[CUSTOMER][POSITIVE] Uh sorry for the delay. I'm ready for that.
[CUSTOMER][NEUTRAL] Number
[AGENT][NEUTRAL] Are you asking me? Yes.
[CUSTOMER][NEUTRAL] Hello, [PII]? Yeah, I'm asking from you.
[CUSTOMER][NEUTRAL] OK. It is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 1076.
[AGENT][NEUTRAL] Oh, you give me a different callback number, OK.
[CUSTOMER][POSITIVE] Yeah, I'm giving you the different and extension.
[AGENT][NEUTRAL] So it's [PII].
[AGENT][NEUTRAL] [PII]. Go ahead.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][POSITIVE] Mhm mhm yeah sorry for that. Continue.
[AGENT][NEUTRAL] I was just trying to make sure I had the right number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I wrote down [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, it is
[CUSTOMER][POSITIVE] Yeah, that's totally correct and extension is [PII], OK?
[AGENT][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm, yeah.
[AGENT][NEUTRAL] And did you want to move to the next one?
[CUSTOMER][NEUTRAL] Yeah, for the next one and uh.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the next one is, yeah. It is, are you ready for that uh ID?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] 018460.
[CUSTOMER][NEUTRAL] 24
[CUSTOMER][NEUTRAL] ML 8
[AGENT][NEUTRAL] 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] Yeah, it is [PII].
[CUSTOMER][NEUTRAL] [PII]. I, I don't know. But uh date of birth is uh [PII].
[AGENT][NEUTRAL] And that was policy number 1846024?
[CUSTOMER][NEUTRAL] 01846024 ML 8 yes.
[AGENT][NEUTRAL] The reason I'm asking is because I'm showing a different member's name.
[AGENT][NEUTRAL] What's the last name?
[CUSTOMER][NEUTRAL] Yeah. Uh, last name is, I'm telling you, I don't know how to pronounce it. Is it [PII] or is it [PII].
[AGENT][NEUTRAL] OK, I understand that. What I'm saying is that it's a totally different member as in the the first and last name does not match what you're giving. So, so that's the only reason I asked to confirm. Can you spell the member's first and last name or do you have their social?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, I can spell the number first and last name.
[CUSTOMER][NEUTRAL] Mhm. OK, it is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And last name is [PII].
[AGENT][NEUTRAL] OK, hold on one moment, let's try with the name.
[CUSTOMER][NEUTRAL] OK. Like, uh, patient name is uh [PII].
[AGENT][NEUTRAL] OK, hold on one moment. Let me locate the policy and then I'll I'll move forward. So is the name that I'm looking for [PII] or the [PII] name that you're giving now?
[CUSTOMER][NEUTRAL] Oh OK uh.
[CUSTOMER][NEUTRAL] Uh, it, uh, OK, sorry. Yeah, it is data service was 1115, yeah, it is [PII], right?
[AGENT][NEUTRAL] And the policy is, oh, I see, so it's 1846021.
[CUSTOMER][NEUTRAL] 18.
[AGENT][NEUTRAL] When I confirmed it with you.
[AGENT][NEUTRAL] When I confirmed it with you, it was a 4 at the end. So that's the difference. There's a 1 at the end. Hold on one moment, let me pull that up.
[CUSTOMER][NEUTRAL] Oh, I can you.
[CUSTOMER][NEUTRAL] OK, can you uh get, provide me the correct one?
[AGENT][NEUTRAL] Sure. 1846021.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 6021. OK.
[AGENT][NEUTRAL] And can you verify the um member's date of birth?
[CUSTOMER][NEUTRAL] Yeah, it is um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the um
[AGENT][NEUTRAL] Data service and the total bills?
[CUSTOMER][NEUTRAL] Yeah, date of service is.
[CUSTOMER][NEUTRAL] Oh wait, I'm just checking, yeah.
[CUSTOMER][NEUTRAL] So, data services.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, [PII] with the billed amount of $200.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 1384.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And also on [PII], the claim um finished processing and we paid a total of $200.
[CUSTOMER][NEUTRAL] Oh, I check details for that patient.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so the check number is 203.
[AGENT][NEUTRAL] 553 4.
[AGENT][NEUTRAL] It's a single check in the amount of $200.
[AGENT][NEUTRAL] It was issued on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And mailed to [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK and the.
[CUSTOMER][NEUTRAL] And uh it is also the large amount the same like $1000 for one clean pair.
[AGENT][NEUTRAL] Uh, let me see how this one was. Hold on, hold on one, give me a second. Hold on one moment.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK, no problem.
[AGENT][NEUTRAL] So yes, so this one is the same except for the max is different. So the calendar year max is $1750 for this policy.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just give me a moment. Just give me a moment.
[CUSTOMER][NEUTRAL] OK, OK. I just, uh.
[CUSTOMER][NEUTRAL] Just want to verify one thing, the allow. Can you hear me now? Sorry, I don't know.
[AGENT][NEUTRAL] Yes, I can hear you.
[CUSTOMER][NEUTRAL] Hello. Uh, thank you. Uh, it was $1,075 right?
[AGENT][NEUTRAL] Um, hold on one moment, let me.
[AGENT][NEUTRAL] You're asking for the calendar year max?
[CUSTOMER][NEUTRAL] I'm sorry, I'm sorry. I, I, yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's $1750 for the calendar year.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] For your assistance today.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're welcome. And for the other claim, I'm getting ready to send a message over to claims so that they can research further and then um you all will receive correspondence once they um figure out about the check.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK. Well, thank you so much for calling APL [PII]. I hope you have a good day.
[CUSTOMER][POSITIVE] Uh thanks you too. Have a nice day. Bye-bye.
[AGENT][POSITIVE] Thank you, you're welcome. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Bye