AccountId: 011433970860
ContactId: 797ab10d-c672-4cfb-a154-f71f8928d97f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1180339 ms
Total Talk Time (AGENT): 335494 ms
Total Talk Time (CUSTOMER): 555111 ms
Interruptions: 12
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/797ab10d-c672-4cfb-a154-f71f8928d97f_20250108T16:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, hi, [PII]. Good morning. My name is [PII] calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] The member I didn't have it yet. The letter starts with D Delta 43728565.
[AGENT][NEUTRAL] OK, do you have a copy of the card? Um, our number's gonna start with a 0.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The ID card for American Public Life will begin with a 0. Can you look at the ID card and see if there's another number on the card?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Uh, I don't have the member ID card.
[AGENT][NEUTRAL] Spell the patient's first and last name please?
[CUSTOMER][NEUTRAL] [PII]'s first name is [PII].
[AGENT][NEUTRAL] And the last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm sorry, I missed the beginning of the last name. Can you repeat the last name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] F I T Z P A T R I C K.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK, what's the policy number, uh, [PII]?
[CUSTOMER][POSITIVE] Thank you so
[CUSTOMER][NEUTRAL] It's fine.
[AGENT][NEUTRAL] I'm sorry, not the policy number, your phone number in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII] extension is [PII].
[AGENT][NEUTRAL] OK, repeat the phone number for me please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 615
[CUSTOMER][NEUTRAL] 949
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Extension is [PII].
[AGENT][NEUTRAL] [PII]. OK, your number is [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK. Can you tell me the state that the patient lives or reside?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] You are a medical or dental provider?
[CUSTOMER][NEUTRAL] Medical [PII].
[AGENT][NEUTRAL] And what is [PII] date of birth?
[CUSTOMER][NEUTRAL] Member's date of birth is [PII].
[AGENT][NEUTRAL] OK, and you stated that you are checking for a claim status?
[CUSTOMER][POSITIVE] You're right.
[AGENT][NEUTRAL] OK, and the date of service?
[CUSTOMER][NEUTRAL] It's for [PII]. bill amount is $935 even.
[AGENT][NEUTRAL] OK, thank you. Let me give you the policy number for American Public Life. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] It's 235.
[AGENT][NEUTRAL] 866 8.
[AGENT][NEUTRAL] And I'm searching for the uh claim status for you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] It has.
[CUSTOMER][NEUTRAL] and name.
[AGENT][NEUTRAL] OK, so I show the claim was received [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was processed on [PII]. I'm sorry, [PII] was the date it was processed.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The received date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there was no payment made on this claim?
[AGENT][NEUTRAL] Um, it says that the benefit maximum for this date of service has been met.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the claim number?
[CUSTOMER][NEUTRAL] Also we have submitted and, yeah, go ahead.
[AGENT][NEUTRAL] Yeah, yeah, I'm seeing it 123456 other claims received but they were denied as duplicates of the previous of the first one you submitted.
[CUSTOMER][NEUTRAL] Yeah, the reconsideration was submitted on [PII].
[AGENT][NEGATIVE] Yeah, it was denied as a duplicate.
[AGENT][NEUTRAL] And so the original claim number is 338.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1616.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] And the second one you you submitted for reconsideration claim number is 343.
[AGENT][NEUTRAL] 6156.
[CUSTOMER][NEUTRAL] And that was in duplicate, right?
[AGENT][NEUTRAL] Denied as a duplicate, correct.
[CUSTOMER][NEUTRAL] And the original claim status was was denied for maximum benefit met.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I know how many units were allowed?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so it's $1 maximum. The maximum benefit per calendar day is $75.
[CUSTOMER][NEUTRAL] I just wanted to verify how many units were allowed per year or per day.
[AGENT][NEUTRAL] It's not based on units, ma'am. It's based on $1 a maximum per calendar day.
[CUSTOMER][NEUTRAL] You have said it at the maximum.
[AGENT][NEUTRAL] So we received another claim for that date of service and we paid the $75 benefit.
[AGENT][NEUTRAL] When we received your claim we denied it as the maximum benefit is exhausted.
[CUSTOMER][NEUTRAL] Alright, just give me a second. I'm just checking with the information you have stated.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting on the line, [PII]. In that case, could you please verify me the date the maximum benefit was met?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Thank you so much for holding on the line, [PII], but still, I just wanted to confirm our date of service is only for [PII], but you have stated that the date was, uh, [PII], so still it is after the date of service, right? So I don't think it's the same process.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Could you repeat the question or the statement?
[CUSTOMER][NEUTRAL] I just wanted to confirm the claims date of services for [PII], right, but it was the maximum benefit was met on [PII], so it was met after the date of service only, right?
[AGENT][NEUTRAL] Well, we didn't receive the claim until [PII], so although the data services in October, the claim was not submitted to us and we received it on [PII].
[CUSTOMER][NEUTRAL] S
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we received a claim prior to [PII] for the same date of service and processed the benefit.
[AGENT][NEUTRAL] Different provider.
[CUSTOMER][POSITIVE] Alright, thank you so much for the information. I'm just checking my billing summary do you have any other claim.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][POSITIVE] Alright, no problem. Thank you so much for that information. I do have two more claims to the status. Could you please help me with that also?
[AGENT][POSITIVE] Uh, you're welcome.
[AGENT][NEUTRAL] Give one moment, let me document this call.
[CUSTOMER][NEUTRAL] Uh huh, I'm just waiting for the call reference number for this one.
[AGENT][NEUTRAL] It's gonna be the same, my name and today's date.
[AGENT][NEUTRAL] For the entire call, the number is the same. Use my name and today's date as your reference.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you to me.
[AGENT][NEUTRAL] You can also check your status online at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So this is
[AGENT][NEUTRAL] And what is the next policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The next number ID is
[CUSTOMER][NEUTRAL] 645-556
[AGENT][NEUTRAL] OK, do you have a copy of the card?
[CUSTOMER][NEUTRAL] No, I don't. OK, yeah, that is fine with the member's name and date of birth.
[AGENT][NEUTRAL] That's the payer ID number.
[AGENT][NEUTRAL] Spell the first and last name please?
[CUSTOMER][NEUTRAL] Sure the member's name is [PII].
[AGENT][NEUTRAL] Spell the first and last name for me please.
[CUSTOMER][NEUTRAL] [PII]. And the last name is [PII], yeah, you're welcome.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what state does the patient live or reside?
[CUSTOMER][NEUTRAL] I'm just checking with that information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you, and the state of the patient is.
[AGENT][NEUTRAL] And the date of birth.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK, thank you for that information. The policy number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's 249.
[AGENT][NEUTRAL] 884-3.
[AGENT][NEUTRAL] And what's the data service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the total charge is $1280 even.
[AGENT][NEUTRAL] OK, I show that there was no benefit payable on this one because the maximum benefit was paid on another claim for the same date of service. Your claim number is 34354.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 0038.
[CUSTOMER][NEUTRAL] Was it 343-540-038? I'm sorry, OK, go ahead.
[AGENT][NEUTRAL] And the claim
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the the the claim was received [PII].
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] But it also noted for maximum benefits met.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Hold on for a second.
[CUSTOMER][NEUTRAL] And the claim number will be sent by the same name, right?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] is the same.
[CUSTOMER][NEUTRAL] But upon checking out in my billing summary, I don't see any other claim was billed on the same date of service.
[AGENT][NEUTRAL] It's from a different provider.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so you're stating that the other claim was built on the same date of service was processed by different providers.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So with that you won't be able to take the claim before the process.
[AGENT][NEGATIVE] You can resend it but it'll be denied as a duplicate because the maximum benefit is already exhausted for that day.
[CUSTOMER][NEUTRAL] Would you able to help me with the patient's account number which was billed on the same date of service?
[AGENT][NEUTRAL] No ma'am, because it's from a different provider's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you help me with the mailing address for the reconsideration?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Could you help me with the mailing address for the reconsideration?
[AGENT][NEUTRAL] [PII] it's the same mailing address [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You think that I can.
[AGENT][NEUTRAL] State is [PII].
[CUSTOMER][POSITIVE] It's good.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm just checking with the mailing address.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Can you confirm me the mailing address I was it [PII]? I do have too many numbers [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the zip code is [PII], was it right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] uh.
[CUSTOMER][NEUTRAL] And what will be the timely filing limit?
[AGENT][NEUTRAL] Are you resubmitting the claim or you appealing the claim?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Submitting the dispute.
[AGENT][NEGATIVE] It's 180 days from the date that it was denied.
[CUSTOMER][NEUTRAL] Which is [PII], uh.
[AGENT][NEUTRAL] Or the date that you received the denial.
[CUSTOMER][NEUTRAL] That is [PII], right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, thank you so much for that information. Can I move on with the next member ID?
[AGENT][NEUTRAL] OK, I'll do the last one. What's the policy number for the last uh member?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The last member ID I have with you which is 02558821.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what's the date of service in charge?
[CUSTOMER][NEUTRAL] Yes, the date of service is for [PII], and the total charge amount is $1280 even.
[AGENT][NEUTRAL] OK, the claim was received [PII].
[AGENT][NEUTRAL] Processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And it denied for the same reason, the maximum daily benefit is exhausted.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me know when you're ready for that claim number.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] That number is 353.
[AGENT][NEUTRAL] 7891.
[CUSTOMER][NEUTRAL] Also for this one also is based on the dollar amount or the unit.
[AGENT][NEUTRAL] Dollar amount
[CUSTOMER][NEUTRAL] And the dollar amount is?
[AGENT][NEUTRAL] $75 per day.
[CUSTOMER][NEUTRAL] Just for the confirmation for the previous and also with about $75.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I just wanted to confirm that for this one also there was uh other claim billed on the same date of service which was processed by the different provider and it has been already met with the $75 right?
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And he won't be able to reprocess a claim since.
[CUSTOMER][NEUTRAL] The mailing address for the reconstruction is the same.
[AGENT][NEGATIVE] There are no more benefits available because the daily benefit is $75. That benefit was paid on another claim from a different provider, which exhausted the daily benefit.
[CUSTOMER][NEGATIVE] So the daily benefit was exhausted as other provider was paid on it.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's the same mailing address and the timely filing limit for reconsideration.
[AGENT][NEUTRAL] Um, and actually, give me just a second.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] So the mailing address for uh the appeal is gonna be the same address previously given.
[CUSTOMER][NEUTRAL] Mhm. And the time of filing is 180 days from the denial date which is [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much and thanks for assistance, and I'm done for the day. Thanks for your wonderful assistance. Wishing you to have a great day, yeah.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You have to take it bye bye.