AccountId: 011433970860
ContactId: 9046f7e9-92ee-4ce0-8f49-ae775642e94b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 392559 ms
Total Talk Time (AGENT): 150445 ms
Total Talk Time (CUSTOMER): 127704 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.3, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/9046f7e9-92ee-4ce0-8f49-ae775642e94b_20250402T13:51_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling on behalf of provider. I'm here for the renewal status.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have a call back number and the policy number?
[CUSTOMER][NEUTRAL] The callback number [PII] with an extension [PII]. And the policy number is
[CUSTOMER][NEUTRAL] OK. 562-535-989.
[AGENT][NEUTRAL] OK, so is this a policy number or a social because if it's a social, could you provide it to me again?
[CUSTOMER][NEUTRAL] Yes, it's a policy number, 8, just a 2nd. [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] That's too long to be a policy number here at American Public Life. What is that member's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So that is his social.
[AGENT][NEUTRAL] That you're providing me. What is his date of birth and I'll be able to give you the correct policy number.
[CUSTOMER][NEUTRAL] OK. Uh, the date of birth is [PII].
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII] and [PII], could you um give me the callback number one more time?
[CUSTOMER][NEUTRAL] The callback number [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], what is the date of service that you're calling about?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII]. And I do see that I have a claim number also.
[AGENT][NEUTRAL] 225 2024. What's your claim number?
[CUSTOMER][NEUTRAL] 353-5534
[AGENT][NEUTRAL] 25 2024.
[AGENT][NEGATIVE] So it looks like this claim was submitted multiple times. We requested the EOB the first time and then the second two times you submitted it, you did not attach the information that was requested.
[CUSTOMER][NEUTRAL] And how about the recent one which is denied on [PII]?
[AGENT][NEGATIVE] It was denied due to the lack of the information we requested. You guys did not send it in, so it's considered as a duplicate.
[CUSTOMER][NEUTRAL] OK, so we need to resubmit this claim along with the primary OB?
[AGENT][NEUTRAL] Yes, that is correct because this is a gap insurance, [PII], that only pay towards deductible co-pay and co-insurance for the primary insurance.
[CUSTOMER][NEUTRAL] OK, great. Got it. And the time final limit to submit this uh claim along with the primary will be?
[AGENT][NEGATIVE] Yes, there's no timely fi.
[CUSTOMER][POSITIVE] No timely filing. OK, that is good.
[AGENT][NEUTRAL] And let me give you that policy number because you're giving us the social, the policy number for this member, let me know when you're ready for it.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] It's [PII]. That's [PII].
[CUSTOMER][POSITIVE] OK, got it. Thank you so much. And uh and could you please provide the mail address to submit this claim again?
[AGENT][NEUTRAL] So the mailing address will be addressed to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. And let me provide you the next, uh, member ID number.
[AGENT][NEUTRAL] What is the member's policy number?
[CUSTOMER][NEUTRAL] Mhm. The member's policy number 016593997.
[AGENT][NEUTRAL] What is this member's name?
[CUSTOMER][NEUTRAL] Member's name is [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] And what is the date of service that you're inquiring about?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] And I do see here the bill amount is $1,668 even. And it shows the claim is denied for duplicate.
[AGENT][NEUTRAL] So the first time the claim was submitted 2 328.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] We were requesting.
[AGENT][NEGATIVE] The first time the claim was submitted and then it was denied is the benefits for the date of service was maxed out.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] So then when you guys submitted it for the 2nd time, that means that it was considered as a duplicate because the benefits were maxed out for that date of service.
[CUSTOMER][NEUTRAL] OK, in terms of
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, maximum benefit exhaust in terms of dollars per unit, visit, number of visits.
[AGENT][NEUTRAL] The the dollars.
[CUSTOMER][NEUTRAL] Dollars, OK. I mean, another dollar amount?
[AGENT][NEUTRAL] The dollar amount.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Per calendar day is $250 and before your claim was submitted there was a claim we received that exhausted the benefits.
[CUSTOMER][NEUTRAL] And uh may I have the original claim number which is denied, uh, first?
[AGENT][NEUTRAL] The original claim number was 38 I'm 3382328.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And thank you so much for that information. Could you please provide me the uh reference number?
[AGENT][NEUTRAL] Ma'am, we don't provide reference numbers, however, you can use my name and today's date as a reference.
[CUSTOMER][POSITIVE] OK, great. And thank you so much for all this information and have a nice day.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well. Goodbye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bye.