AccountId: 011433970860
ContactId: 7a8d6ca8-c85b-4c1d-a9d3-c8cffb5720dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 861450 ms
Total Talk Time (AGENT): 266482 ms
Total Talk Time (CUSTOMER): 232849 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/7a8d6ca8-c85b-4c1d-a9d3-c8cffb5720dc_20250520T15:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider's office checking on the claim status.
[AGENT][NEUTRAL] I can verify claim status. May I have a policy number?
[CUSTOMER][NEUTRAL] Sure. The member ID is D as in Delta 43,509,100.
[AGENT][NEUTRAL] That is not our policy number.
[AGENT][NEUTRAL] Do you have the social security number?
[CUSTOMER][NEUTRAL] Yes, I have. That is.
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] Social Security number is [PII].
[AGENT][NEUTRAL] May I have the first and last name and the date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And can you spell the last name? It did not pull up with that social security number.
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for verifying that information. One moment, let me get this pulled up.
[AGENT][NEUTRAL] May I have a date of service?
[CUSTOMER][NEUTRAL] Sure. The date of service is [PII] and the bill amount is $56 even.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well.
[AGENT][NEUTRAL] One moment let me get this pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like this policy terminated on [PII], and there is no active policy on file. This is for medical, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] If we receive this claim.
[AGENT][NEUTRAL] So it looks like the claim processed under claim number 3543739.
[AGENT][NEGATIVE] And they denied for eligibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEGATIVE] It denied for eligibility because there is no active policy.
[CUSTOMER][NEUTRAL] OK. Can I get the uh effective date for this plan?
[AGENT][NEUTRAL] Sure. Policies effective [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And just give me a moment.
[AGENT][NEUTRAL] I'll give you the policy number as well.
[CUSTOMER][NEUTRAL] OK, thank you. And when was the patient?
[CUSTOMER][NEUTRAL] OK, can I get that?
[AGENT][NEUTRAL] It's 022.
[AGENT][NEUTRAL] 58072.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And uh when was the patient updated COP last time?
[AGENT][NEUTRAL] I'm sorry, can you repeat that question?
[CUSTOMER][NEUTRAL] Sure. When was the patient updated coordination of benefit last time?
[AGENT][NEUTRAL] It looks like there was no activity since [PII], which is when the policy terminated.
[CUSTOMER][NEUTRAL] Thank you. And I have uh one more date of service for the same member. Could you please check that?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That date of service is [PII].
[CUSTOMER][NEUTRAL] The amount is $56 even.
[AGENT][NEUTRAL] That one processed under [PII] also denied for eligibility.
[AGENT][NEUTRAL] [PII], I'm sorry. Can I have a good callback number for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. That is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh could you please spell your name for me?
[AGENT][NEUTRAL] Yes, it's [PII] Last initial is [PII]
[CUSTOMER][POSITIVE] Thank you, [PII]. And uh how many uh members you can help me?
[AGENT][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, just have one more member.
[AGENT][NEUTRAL] OK, let me put in the note.
[CUSTOMER][NEUTRAL] If you can, could you please help me with that?
[AGENT][NEUTRAL] Yes, I will. One moment, let me put these notes in.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have a policy number?
[CUSTOMER][NEUTRAL] Sure. That is D as in Delta 435-09203.
[AGENT][NEUTRAL] That is not our policy number.
[AGENT][POSITIVE] I can use the social name search.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. That is [PII]. First name is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Last name is [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Policy number will be 02.
[AGENT][NEUTRAL] 266763
[AGENT][NEUTRAL] And may I have a date of service?
[CUSTOMER][NEUTRAL] Mhm. That is.
[CUSTOMER][NEUTRAL] [PII], but the amount is.
[CUSTOMER][NEUTRAL] Sorry, but the amount is $307 even.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Looks like this one processed under claim number 3502979.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] Looks like no benefits were payable on this claim. Let me get it pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like they were non-covered services.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] Uh, wellness screening is not covered by this policy.
[AGENT][NEUTRAL] And via puncture.
[CUSTOMER][NEUTRAL] OK. Uh, and
[CUSTOMER][NEUTRAL] OK. When was the claim received?
[AGENT][NEUTRAL] One moment, let me go back.
[AGENT][NEUTRAL] This claim was received on 9-9-2024.
[CUSTOMER][NEUTRAL] When it was processed.
[AGENT][NEUTRAL] 910 of 24.
[CUSTOMER][NEUTRAL] OK. I just wanted to confirm that the claim number you gave is 352979.
[AGENT][NEUTRAL] 3502979
[CUSTOMER][NEUTRAL] OK, thank you. Could you please fax that DOB?
[AGENT][NEUTRAL] Sure, may I have your fax number?
[CUSTOMER][NEUTRAL] Sure. That is [PII].
[AGENT][NEUTRAL] I have [PII]. I'll fax that right over.
[AGENT][NEUTRAL] Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] OK, thank you. And I just have
[CUSTOMER][NEUTRAL] Yeah, I have 2 more data services for the same member. Could you please help me with that?
[AGENT][NEUTRAL] Sure, I I have a next day service.
[CUSTOMER][NEUTRAL] OK, thank you. That is [PII] and the bill amount is $175 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] This one processed under claim number 3536246.
[AGENT][NEGATIVE] And no benefits for?
[CUSTOMER][NEUTRAL] OK. So, sorry, what is.
[CUSTOMER][NEUTRAL] Sorry, I heard only 35 after that.
[AGENT][NEUTRAL] It's 353-624-6.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let's look at this.
[AGENT][NEUTRAL] This claim was received on [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let's see why it did not.
[CUSTOMER][NEUTRAL] It's also the same dinner.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Looks like the calendar year max for outpatient office visits were met. So it looks like the benefit max was met on that one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For this one also, could you please fax that to you?
[AGENT][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. May I have your next date of service?
[CUSTOMER][NEUTRAL] Mhm. That is [PII] and the bill amount is $284 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And it looks like we have not received data service 123-2025.
[CUSTOMER][NEUTRAL] OK. What is the timely fi limit for submit the claim?
[AGENT][NEUTRAL] There is no time limit to submit a claim.
[CUSTOMER][NEUTRAL] OK. And uh can I get the effective termination date for this one?
[AGENT][NEUTRAL] Let's see, this policy is active, there is no term date.
[AGENT][NEUTRAL] Policy is effective [PII].
[CUSTOMER][NEUTRAL] Thank you. Can I get the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Thank good morning. Can I get the call reference number, please?
[AGENT][NEUTRAL] It will be my name, which is [PII]. Last initial is [PII] along with today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you morning. Thank you so much for your assistance and patience. Have a nice day. Bye.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life, [PII]. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Sure, sir. Bye.