AccountId: 011433970860
ContactId: 8a5c69f8-55c8-4998-ad4e-05bb082ec134
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306579 ms
Total Talk Time (AGENT): 114183 ms
Total Talk Time (CUSTOMER): 90179 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/8a5c69f8-55c8-4998-ad4e-05bb082ec134_20250206T18:25_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] calling from Pro to checking the claim status.
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] Yes, sure. One moment.
[CUSTOMER][NEUTRAL] The policy number is 2549961.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] And you're calling in for status of claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] May I have the date of service and total bill?
[CUSTOMER][NEUTRAL] The data service for [PII] and the bill amount is $1,763.
[AGENT][NEUTRAL] OK, that was 1760.
[CUSTOMER][NEUTRAL] Yes, $63.00.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] And I'm pulling it up for you now.
[CUSTOMER][NEUTRAL] Sure, sir.
[AGENT][NEUTRAL] And I did pull that claim up for you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And it does show that we did receive that claim. The receipt of that claim was on.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 124 of 24. I apologize, 123 of 24, and it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 353.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 642-3 is showing that that claim processed and it denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The outpatient treatment benefits for this amount.
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][NEUTRAL] It's on the patient plan or provide the plan?
[AGENT][NEUTRAL] For the patient's plan.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] May I know what, what service is not covered?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Looks like it's only have one service listed on there, so this is a non-covered benefit for this member.
[CUSTOMER][NEUTRAL] OK. How can I get the reimbursement for this plan?
[AGENT][NEUTRAL] It's a facility charge, correct?
[CUSTOMER][NEUTRAL] OK, yes.
[AGENT][NEUTRAL] So it's a non-covered benefit.
[CUSTOMER][NEUTRAL] How can we get the email for this time?
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] How can we get the reimbursement for these claims?
[AGENT][NEUTRAL] This claim is not covered by our policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if we can't cover, then you would, you would get with the provider if they're gonna submit it to the insured.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] May I know the uh billing mail address?
[AGENT][NEUTRAL] You can submit that to PO box.
[AGENT][NEUTRAL] 248
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Um, what is available to send the, uh, billing?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Could you say that again, please?
[CUSTOMER][NEUTRAL] What is the TFL limit to send an appeal?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] OK, sure. Is there any fax number?
[AGENT][NEUTRAL] Yes, the fax number is [PII].
[AGENT][NEUTRAL] [PII] and that is attention claims department.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, can I get the call reference number?
[AGENT][NEUTRAL] The car reference will be my first name [PII], last initial of [PII] and today's date.
[CUSTOMER][NEUTRAL] Sorry, can I just spell your name, ma'am?
[AGENT][NEUTRAL] It is spelled [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you. Thanks for the information. Have a good day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day as well.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Bye-bye.