AccountId: 011433970860
ContactId: 856b747c-6ee3-45ed-b71d-edbeb2a9327c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 390130 ms
Total Talk Time (AGENT): 113708 ms
Total Talk Time (CUSTOMER): 92477 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/856b747c-6ee3-45ed-b71d-edbeb2a9327c_20250318T14:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, uh, this is [PII] calling from provider's office. I called you regarding a checking claim status.
[AGENT][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] And may I please have a callback number?
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] 02557111.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is spelled as [PII] and the last name is spelled as [PII] And the date of birth will be [PII].
[AGENT][NEUTRAL] OK. And what type of claim is this? Is this dental or medical?
[CUSTOMER][NEUTRAL] Uh, it's a medical.
[AGENT][NEUTRAL] OK, so for the medical number there's a different policy number. Are you ready for that?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] That policy number is 02.
[AGENT][NEUTRAL] 55
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7107.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Uh, the date of service will be [PII] and the bill amount will be $934.96. 934.96 cents.
[AGENT][NEUTRAL] And I did pull that claim up for you.
[CUSTOMER][NEUTRAL] Yup.
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] Sure, sure, take your time.
[AGENT][NEUTRAL] And it does show we received it on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 356-075-9.
[AGENT][NEUTRAL] The claim shows that it processed and it denied that ambulance benefits are payable only if an insured is admitted as an inpatient.
[AGENT][NEUTRAL] So this is considered a non-covered benefit.
[CUSTOMER][NEUTRAL] Non-covered charges, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] See nonco charges under the patient plan or uh provider's plan.
[AGENT][NEUTRAL] Patients plan.
[CUSTOMER][NEUTRAL] OK, just a moment, just give me a minute.
[CUSTOMER][NEUTRAL] Uh, see, uh, as it is an ambulance service, uh, could you please send back for the process?
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] So you said that the ambulance service is not covered under the patient's plan, right?
[AGENT][NEUTRAL] Yes, unless they were considered as inpatient.
[CUSTOMER][NEUTRAL] OK, Mr.
[CUSTOMER][NEUTRAL] OK, uh, what is the final action to be taken for this patient?
[AGENT][NEUTRAL] What do you mean by that?
[CUSTOMER][NEUTRAL] Uh, actually, um,
[CUSTOMER][NEUTRAL] So the policy is not covered, ambulance service for this patient. So do you see any other insurance for the patient?
[AGENT][NEUTRAL] Is there any other incidents?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can only give you information about the claim that you're calling in regards to. I can't give you any other information on this member's policy.
[CUSTOMER][NEUTRAL] OK, so you just said that uh uh the patient is run for the non-covered services and the patient's plan, uh unless uh the patient is inpatient, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please help me with the conference number for the call?
[AGENT][NEUTRAL] The call reference would be my first name [PII], last initial of [PII] and today's date. Is there anything else that I can assist you with today, [PII]? Go ahead.
[CUSTOMER][NEUTRAL] Could you please uh
[CUSTOMER][NEUTRAL] Uh, no. Uh, could you please spell out your name, please?
[AGENT][NEUTRAL] Yes, it is spelled [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, and today's date, right?
[AGENT][NEUTRAL] Yes, and you can also check claim status via our secured portal which is [PII]. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well thank you so much. Have a good day.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day as well.