AccountId: 011433970860
ContactId: 895db634-e176-459a-bea3-3ca696c46787
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 532979 ms
Total Talk Time (AGENT): 127603 ms
Total Talk Time (CUSTOMER): 126857 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/895db634-e176-459a-bea3-3ca696c46787_20250227T20:25_UTC.wav
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[AGENT][POSITIVE] Thank you for calling. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling for provider to check on additional information about a claim that has been denied. Please know this call will be monitored and recorded for quality and training purposes. Hi, how's your day going?
[AGENT][NEUTRAL] You're checking a claim that has been denied and you're checking for additional information or are you checking as to why it was denied?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Why does that so you need some additional information also.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you did receive the claim, the ELB with the claim number on it?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the claim number?
[CUSTOMER][NEUTRAL] The claim number is 012.
[CUSTOMER][NEUTRAL] 82025. J as in Juliet B as in Bravo, R as in Romeo.
[CUSTOMER][NEUTRAL] 0029 R as in Romeo.
[CUSTOMER][NEUTRAL] 0.
[AGENT][NEUTRAL] And what is the insurance company's name on that explanation of benefits?
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] American Public Life Insurance.
[AGENT][NEUTRAL] OK, that's not our, that's not our claim number so did you get that number from the ELB from American Public Life?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Read to me what else is on the explanation.
[CUSTOMER][NEUTRAL] It's claim number, patient's name, insured ID provider name, provider ID check number, group ID.
[AGENT][NEUTRAL] Is there a policy number on the ELB?
[CUSTOMER][NEUTRAL] No, I do have the patient ID and name.
[AGENT][NEUTRAL] And spell the patient's first and last name?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] The first name is spelled as [PII], and the last name is spelled as [PII].
[AGENT][NEUTRAL] The last name is pronounced, is it [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what state does the patient reside?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, this [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And is it a medical claim that you have?
[CUSTOMER][NEUTRAL] Yeah, it is the medical claim, yeah.
[AGENT][NEUTRAL] OK, what is the patient's date of birth?
[CUSTOMER][NEUTRAL] Patient's date of birth is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] One moment, still checking.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] What's the data service of the claim?
[CUSTOMER][NEUTRAL] That of services [PII] for the bill amount of $468 even.
[AGENT][NEUTRAL] And I'm sorry, can you repeat your date of birth for me?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this policy is administered by a different company called Web TPA.
[AGENT][NEGATIVE] So you would not have received an ELB from American Public Life.
[CUSTOMER][NEUTRAL] OK, so we have to submit the claim to them.
[AGENT][POSITIVE] Yes, I'll give you their phone number, let me know when you're ready.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you see anything on the EOB that says web TPA?
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] And their claim number generally starts with a 2.
[CUSTOMER][NEUTRAL] No, this claim number starts with 01.
[AGENT][NEUTRAL] Yeah, I'm thinking you have the wrong insurance company altogether, so you have the actual explanation of benefits in front of you?
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it says American Public Life or American Republic Life?
[CUSTOMER][NEUTRAL] American Public Life.
[AGENT][NEUTRAL] And what is the address on there?
[CUSTOMER][NEUTRAL] Just a second. It is
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It will be on the right top hand corner, right?
[AGENT][NEUTRAL] Uh, somewhere on there.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the claim number on the the form that you have?
[CUSTOMER][NEUTRAL] 01282025. J as in Juliet B as in Bravo, R as in Romeo 0029 R as in Romeo 0.
[AGENT][NEUTRAL] What's the policy number on there?
[CUSTOMER][NEUTRAL] There's no policy number. It's insured ID or name, patient ID or name, that's the.
[AGENT][NEUTRAL] Yeah, that's not our claim number, so I'm not it's kind of confusing.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You have the actual document in your hand?
[AGENT][NEUTRAL] Are you looking at something in your system?
[CUSTOMER][NEUTRAL] We are looking at the system.
[AGENT][NEUTRAL] OK, so that could be incorrect, but let me get you transferred over to Web TPA and see if they can further assist you, OK? Give me one moment.
[CUSTOMER][NEUTRAL] Before that, can you please give me the call reference number for this call?
[AGENT][NEUTRAL] You'll use my name in today's date is your reference, [PII] and first initial of my last name is [PII]. And did you have any other questions, [PII], before we get you transferred?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, give me just a second and have a good day.
[CUSTOMER][NEUTRAL] Welcome to TPA.
[CUSTOMER][NEGATIVE] Due to severe win