AccountId: 011433970860
ContactId: 7bb38545-d8aa-407d-a28c-14dd4621a8ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1483319 ms
Total Talk Time (AGENT): 313602 ms
Total Talk Time (CUSTOMER): 411973 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/7bb38545-d8aa-407d-a28c-14dd4621a8ff_20250515T16:29_UTC.wav
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[CUSTOMER][NEUTRAL] But I get the corre.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII] from Bonsecurs Medical Group, and I'm calling because I would like to check a claim status, please.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] A I help you with claim status. Um, can I please get your callback number, ma'am just in case the call is disconnected.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes. Callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you ma'am and then what is the name of the patient and the date of birth and policy number?
[CUSTOMER][NEUTRAL] Yeah. Policy number is 021377.
[CUSTOMER][NEUTRAL] 27.
[CUSTOMER][NEUTRAL] Member's name is [PII].
[CUSTOMER][NEUTRAL] And date of birth on [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy real quick for us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK and what is the data service for [PII] and the charge amount?
[CUSTOMER][NEUTRAL] Um, date of service on [PII], the present year, [PII], and total charge is 112.
[CUSTOMER][NEUTRAL] Dollars.
[AGENT][NEUTRAL] OK and then what are the charges after the primary and insurance paid their part?
[CUSTOMER][NEUTRAL] No, actually, we have the American Public Life is the primary insurance.
[AGENT][NEUTRAL] OK. All right. And can you please spell the first name for your medical center for me, please?
[CUSTOMER][NEUTRAL] The first name, yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] M as in
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what is the name of your facility one more time, please?
[CUSTOMER][NEUTRAL] Of the facility is Bunseer Piedmont Auto.
[AGENT][NEUTRAL] OK, I'm going to put you on a quick hold while I look up this claim and I'll be right back with you, [PII].
[CUSTOMER][POSITIVE] OK, yeah, thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you so much for holding for me. I have looked up the claim for the date of service of [PII] and the amount of $112. I do not find a claim on file for that date of service.
[CUSTOMER][NEUTRAL] OK, [PII], and can you confirm the PO box where I can resend the, the claim, please?
[AGENT][NEUTRAL] Yes ma'am, the PO box is [PII].
[AGENT][NEUTRAL] And that will be in [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[AGENT][POSITIVE] You're very welcome. Is there?
[CUSTOMER][NEUTRAL] I'm sorry, can we,
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Yes, actually I have another client that I would like to check.
[AGENT][NEUTRAL] OK, and what is the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, just give me one second.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK. The policy number is 02.
[CUSTOMER][NEUTRAL] 33
[CUSTOMER][NEUTRAL] 43
[CUSTOMER][NEUTRAL] 78.
[CUSTOMER][NEUTRAL] The member's name is [PII].
[CUSTOMER][NEUTRAL] And date of birth, [PII].
[AGENT][NEUTRAL] OK, let me pull up that one.
[AGENT][NEUTRAL] OK, and that's the data service for this one.
[AGENT][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] On service date on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is the charge amount?
[CUSTOMER][NEUTRAL] The total charge amount is $190 but this is across from, from Blue Cross Blue Shield, and they already paid, so you are billed for $15.
[CUSTOMER][NEUTRAL] Of a copy.
[AGENT][NEUTRAL] $15.
[AGENT][NEUTRAL] And that's 15.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $15?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $15.15.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you and then what is the um name of the facility for this one?
[CUSTOMER][NEUTRAL] The name of the facility is Premier Family Medicine.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold again so I can look this one up for us and I'll be right back, [PII].
[CUSTOMER][POSITIVE] OK, thank you, [PII].
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII] so looking on this one.
[AGENT][NEUTRAL] The claim number, ma'am, is 357.
[AGENT][NEUTRAL] 8965 and the claim has been denied because office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It's possible that you can send me the you'll be the explanation of benefits through a fax.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So can I provide you provide you a fax number so.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] You can send it.
[CUSTOMER][NEUTRAL] Thank you. So the PO box, I'm sorry, the fax number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And we allow me one moment.
[AGENT][POSITIVE] Yes ma'am, take your time.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Um, the fax number is [PII].
[CUSTOMER][NEUTRAL] 396-442
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much, [PII] for holding for me. I've got that fax on its way to you now, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, actually, yes, because I have um 3 claims more. Can you help me with that, please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. What is the next, um, member's name, I'm sorry, member's name, date of birth, and policy number?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. Policy number is 02137652.
[CUSTOMER][NEUTRAL] Member's name is [PII].
[CUSTOMER][NEUTRAL] And date of birth on [PII].
[AGENT][NEUTRAL] OK thank you and then what's the date of service for this one and the charge amount?
[CUSTOMER][NEUTRAL] Mhm. Date of service on [PII].
[CUSTOMER][NEUTRAL] And this is the same situation as the previous claim. The total charge is $190 but this is a crossover from Cigna, so the bill amount to American public life is $20.
[AGENT][NEUTRAL] OK, and then what is the name of the facility for this one?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Woolworth Medical Center.
[CUSTOMER][NEUTRAL] Woodward.
[CUSTOMER][NEUTRAL] Medical Center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna put you on a hold again. I'll be right back so I can look this one up for us.
[CUSTOMER][NEUTRAL] Sure. OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me. I have this claim ready for you now. Uh, the claim number is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3581696
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And the claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] I'm sorry, it was denied because what?
[AGENT][NEUTRAL] Office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Thank you, [PII]. And can you please send this um explanation of benefits?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] To the same fax number that I gave you.
[AGENT][POSITIVE] Yes ma'am, it's gonna be a quick hold again. I'll be right back.
[CUSTOMER][NEUTRAL] Thank you. You are on hold.
[AGENT][POSITIVE] OK, thank you for holding for me we can move on to the next one now.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Um, the member's ID of the next one?
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 33
[CUSTOMER][NEUTRAL] 43
[CUSTOMER][NEUTRAL] 79.
[CUSTOMER][NEUTRAL] The member's name is [PII].
[CUSTOMER][NEUTRAL] And date of birth on [PII].
[AGENT][POSITIVE] Thank you, let me pull up that policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK and then what is the data service for [PII] and the charge amount?
[CUSTOMER][NEUTRAL] Um, the total amount of the, the claim is $292.
[CUSTOMER][NEUTRAL] But this is a cruiser from Blue Cross Blue Shield and you were billed for $15.
[AGENT][NEUTRAL] OK and then can you please give me the date of service?
[CUSTOMER][NEUTRAL] Oh, sure. On [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then what is the name of the facility for this one?
[CUSTOMER][NEUTRAL] Name of the facility um is Piedmont Orthopedics.
[CUSTOMER][NEUTRAL] H A
[AGENT][POSITIVE] OK, quick hold again I'll be right back with you.
[CUSTOMER][NEUTRAL] OK. Thank you. You are on hold.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Thank you for holding for me. um, would this claim be under a different group name?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Um, the claim, would it be under a different group name?
[CUSTOMER][NEUTRAL] Um, no.
[AGENT][NEUTRAL] OK, then, um, I do not have a claim on file for that group name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you confirm the PO box where I can send it? Um, or it's the same that you gave me before?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] It's the same one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Let me take the note.
[CUSTOMER][NEUTRAL] OK, [PII], and finally, I have another claim.
[AGENT][NEUTRAL] Yes, ma'am. And what is the member's name, date of birth, and policy number for this one?
[CUSTOMER][NEUTRAL] Yeah. Allow me one moment.
[AGENT][POSITIVE] Yes ma'am, take your time.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the member's ID.
[CUSTOMER][NEUTRAL] is 01.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7153
[CUSTOMER][NEUTRAL] 32
[CUSTOMER][NEUTRAL] Member's name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And date of birth on [PII]. I'm sorry, 71.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me find this policy.
[AGENT][NEUTRAL] And um let's see [PII] OK and then what is the data service for this one and the charge amount?
[CUSTOMER][NEUTRAL] Date of service on [PII].
[CUSTOMER][NEUTRAL] And total charge is $306.
[AGENT][NEUTRAL] OK, and what were the charges after the primary? Oh wait, no, this one right here is gonna be different.
[CUSTOMER][NEUTRAL] 306.
[CUSTOMER][NEUTRAL] No, actually, for this one, your primary.
[AGENT][NEUTRAL] OK, on this one I will need to um transfer you on over to Web TPA so that they can help you with the claim on this one. Let me give you that phone number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What's the phone number?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And it's gonna be a brief hold while I transfer you on over.
[CUSTOMER][NEUTRAL] I'm sorry, sorry, before you transferred me, can you please provide me the reference number of our conversation?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], and today's date and you spell it [PII]
[CUSTOMER][NEUTRAL] Of this call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] are white.
[CUSTOMER][POSITIVE] Thank you, [PII] for your help. I really appreciate it.
[AGENT][POSITIVE] You're very welcome. No problem at all, Ms. [PII]. I hope you have a blessed rest of your day and thanks for calling APL. Bye-bye, ma'am.
[CUSTOMER][POSITIVE] Thank you. Take care. Bye-bye.