AccountId: 011433970860
ContactId: 97cfd8c1-93a9-491c-9a59-e1818621b90c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1077109 ms
Total Talk Time (AGENT): 279782 ms
Total Talk Time (CUSTOMER): 367854 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/97cfd8c1-93a9-491c-9a59-e1818621b90c_20250612T16:25_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] Follow me.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office and looking on a claim status. Can you help me?
[AGENT][NEUTRAL] May I please have a callback number and then the policy number?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[CUSTOMER][NEUTRAL] And the policy number is
[CUSTOMER][NEUTRAL] 02559264
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And you're calling in for status. You can also check claim status via our secured portal that is [PII]. And may I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] [PII] for $302 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I'm pulling the information up for you now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In claim it does show that we received it on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 361.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0700. It showed that the office visit denied that it's not covered, but for the procedure, it is showing that it made a payment in the amount of $61.49.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the office visit is not covered under the patient's plan, so it's a patient responsibility.
[AGENT][NEUTRAL] That is the provider's discretion.
[CUSTOMER][NEUTRAL] OK. And may I know the patient's plan name?
[AGENT][NEUTRAL] This is their mid-in supplemental.
[CUSTOMER][NEUTRAL] Medle supplemental. And the claim number is 3,610,700.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And may I have the payment information?
[AGENT][NEUTRAL] Yes, the check number is 20.
[AGENT][NEUTRAL] 49.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 021.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2049021.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And it's a single check or a bulk check?
[AGENT][NEUTRAL] A single check.
[CUSTOMER][NEUTRAL] And may I know the check sent out date?
[AGENT][NEUTRAL] That would be the process date, which was 6-9-25.
[CUSTOMER][NEUTRAL] And is the check has been cashed?
[AGENT][NEUTRAL] It was just submitted out on [PII]. Today is the [PII].
[CUSTOMER][NEUTRAL] OK, we need to allow some more this.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Can you fax me the EOB?
[AGENT][NEUTRAL] Yes, may I have a fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Into the attention.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] To the attention of who?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, yeah, may I know when we will receive the fax?
[AGENT][NEUTRAL] It can take up to 24 to 48 hours.
[CUSTOMER][NEUTRAL] OK. And uh uh usually with the check the, uh, you'll be also will send to the provider's office.
[AGENT][NEUTRAL] That EOB was mailed to the provider office with the check, yes.
[CUSTOMER][NEUTRAL] And may I know the check, uh, sent, uh sorry, pay to address of the check?
[AGENT][NEUTRAL] You will have to verify that information.
[CUSTOMER][NEUTRAL] Uh, yes, sure. One moment.
[CUSTOMER][NEUTRAL] Yes, the check was sent to [PII].
[AGENT][NEUTRAL] No, that is not the mailing address that was listed on the claim.
[CUSTOMER][NEUTRAL] OK. And is it is [PII]?
[AGENT][NEUTRAL] No, that's not the mailing address that is listed. I'm pulling that image up.
[AGENT][NEUTRAL] No, that's not the mailing address that is listed on this claim.
[CUSTOMER][NEUTRAL] So it's [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you. I have still 2 more patients to verify. Can you help me if you don't mind?
[AGENT][NEUTRAL] Ma, is it this up under the same policy or a different policy number?
[CUSTOMER][NEUTRAL] Uh different policy number?
[AGENT][NEUTRAL] OK, may I have that policy number please?
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] 02508103 ML 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth, [PII].
[AGENT][NEUTRAL] And the data service and total bill for that claim.
[CUSTOMER][NEUTRAL] [PII] for $632 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And for that claim, it does show that we did receive it on [PII], it was processed on 160.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That claim number is 36.
[AGENT][NEUTRAL] 111.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 34
[AGENT][NEUTRAL] The offices it showed that it denied as noncovered, but the procedures, it shows that it did process and it made a payment in the amount of $76.34.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it was processed on [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Claim number 3611134.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And office visit uh patient. OK. And may I know the payment information?
[AGENT][NEUTRAL] Yes, the check number is 204.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] 9130.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 204-9130. And it's a single check or a bulk check?
[AGENT][NEUTRAL] Yes, it's a single check.
[CUSTOMER][NEUTRAL] And it was issued on [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And it was also sent to [PII].
[AGENT][NEUTRAL] Let me check that for you.
[AGENT][NEUTRAL] No, there's a different mailing address listed on this claim.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, that's the correct mailing address.
[CUSTOMER][NEUTRAL] Oh, OK. And the claim number is 3611134.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And can you also fax me the EOB for this one?
[AGENT][POSITIVE] Yes, I can submit that to you.
[AGENT][NEUTRAL] And do you have another policy that you would like for me to verify?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And this check is also in process since it's recently issued, I.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Shall I provide you the last policy number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, yeah, it's 02252.
[CUSTOMER][NEUTRAL] Uh, no, one moment. Sorry, it's uh 02329711.
[AGENT][NEUTRAL] That is 02329711.
[CUSTOMER][NEUTRAL] Yeah, 023-29711.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] [PII], date of birth, [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] [PII] for 180 $180 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So for that claim, it does show that we received it on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 36.
[AGENT][NEUTRAL] 11
[AGENT][NEUTRAL] 537. It shows that their claim denied that office procedures are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] Actually, it was not an office visit.
[AGENT][NEUTRAL] I'm pulling the image up that we received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I did not state that office visits are not covered. I stated office procedures are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] No this procedures.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] But generally, this procedure code is uh covered by your insurance. And even for other patients, we have got the payment for this procedure code.
[AGENT][NEUTRAL] OK, so what I'm advising is this member policy does not cover office procedures.
[CUSTOMER][NEGATIVE] OK. So it was received on [PII] and denied on [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And the claim number is 3611537.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then I don't office procedures are not covered under the patients. It's also a meddling supplement plan, am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] Usually only the office visit will be not covered and we will, will be patient and it's the uh regular service.
[CUSTOMER][POSITIVE] And we are getting payment from your end.
[CUSTOMER][NEUTRAL] For the meddling policies.
[AGENT][NEUTRAL] What are you meaning?
[CUSTOMER][NEUTRAL] Yeah, actually, this code is covered under the meddling supplement plan.
[AGENT][NEGATIVE] This code is not covered. Office procedures are not covered under this patient's plan.
[CUSTOMER][NEUTRAL] One more.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Uh, for submitting and reconsideration or appeal, uh,
[CUSTOMER][NEUTRAL] May I have the timely filing limit?
[AGENT][NEGATIVE] We have no timely filing.
[CUSTOMER][NEUTRAL] For a period of time, uh, reconsideration as well.
[AGENT][NEGATIVE] We have no timely filing.
[CUSTOMER][NEUTRAL] OK. And may I have the mailing or fax number for submitting a reconsideration or an appeal?
[AGENT][NEUTRAL] Yes, that mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And are you ready for the fax?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 94
[AGENT][NEUTRAL] 23 and that is attention claims department.
[CUSTOMER][NEUTRAL] And can you fax me the UBS then?
[AGENT][POSITIVE] Yes, I sure can.
[CUSTOMER][NEUTRAL] For this one?
[AGENT][NEUTRAL] And is there anything else I can assist you with today Rees?
[CUSTOMER][NEUTRAL] Um, no, that's all. Thank you. And can you spell your name for me?
[AGENT][NEUTRAL] Yes, it is spelled [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] and today's state used as the call reference.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. [PII]. And last name initial [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And call reference for the entire call will be your name and today's date.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And uh all 3 UBs will be received within 24 to 48 hours. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, thank you. Thank you so much for the information you provided me on this call.
[AGENT][POSITIVE] You're welcome and is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] No, that's all. Thank you for asking and thank you for the information you provided me.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life. Have a great day, [PII].
[CUSTOMER][POSITIVE] You too as well. Thank you. Bye.
[AGENT][POSITIVE] Thank you, bye.