AccountId: 011433970860
ContactId: 9b4ae297-6d8d-4367-826b-04dbf66c397f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364850 ms
Total Talk Time (AGENT): 155694 ms
Total Talk Time (CUSTOMER): 121753 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/9b4ae297-6d8d-4367-826b-04dbf66c397f_20250624T14:20_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I'm calling from Brown and Brown, we're a broker's office calling on behalf of a member. Uh, he received an EOB or explanation of benefits from American Public Life saying that his claim was denied. I am due to apparently he wasn't covered at the time, but I'm showing that he was, so I'm just trying to see what's going on with the claim.
[AGENT][NEUTRAL] OK, I can take a look at that for you, [PII]. Could I get a callback number for you?
[CUSTOMER][NEUTRAL] Of course, [PII].
[AGENT][NEUTRAL] Thank you. And the policy number you're calling on?
[CUSTOMER][NEUTRAL] Yep, 01458880.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the insured is [PII], uh,
[AGENT][POSITIVE] Insured, I'm sorry.
[CUSTOMER][NEUTRAL] Uh, OK, so claimant is [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you said this is for a claim that was denied uh policy no longer effective at the time of service?
[CUSTOMER][NEUTRAL] That's what it's, uh, we are awaiting information to confirm eligibility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Do you have a claim number or a date of service?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] I have both, um, claim number is 3605922 data service 12924.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I see it here.
[AGENT][NEUTRAL] For $5100.
[AGENT][NEUTRAL] OK, so, um, I do show, let me look here.
[AGENT][NEUTRAL] So I showed um the policy.
[AGENT][NEUTRAL] Canceled. I do show that she was dropped and there's a gap. Let me see, I do show another policy picking up.
[AGENT][NEUTRAL] But not until [PII].
[AGENT][NEUTRAL] Let me see if she's on this one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do show the, the, the policy number you provided, uh, was no longer active effective [PII]. Then there's a gap in coverage and I show a new policy picking up but not effective until [PII]. So you're saying that uh those coverage that should they have just um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, just, you know, one end at [PII] and then the other pick up at [PII]. Should there not be a break in coverage?
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] Yeah, I don't believe there should be a break in coverage. I believe it's full year.
[AGENT][NEUTRAL] OK, let me.
[CUSTOMER][NEUTRAL] He just confirmed with the contract, but I don't believe there was any.
[AGENT][NEUTRAL] Let me pull the group up and see 17678.
[CUSTOMER][NEUTRAL] 33522.
[AGENT][NEUTRAL] Let me pull
[AGENT][NEUTRAL] Someone else from the group.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see here
[AGENT][NEUTRAL] OK, let me, so what I will do is send this claim back um first make sure that they correct the um take a look at the.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] The termination date on the policy number you provided. Let me get that policy number one more time. I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I have the EOB as um policy is 01458880, um, and I'm looking at the policy. I just pulled up the policy documents and it's showing looks like, um, policy anniversary date is [PII] of the following year and each [PII] thereafter.
[AGENT][NEUTRAL] OK, OK, so it looks like it's uh it's not entered correctly and so what I can do is go ahead and have them correct the pay due date to reflect, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It covering them through the end of uh December and then we'll send the claim back through for reprocessing.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Awesome. OK. I appreciate it. Thank you so very much.
[AGENT][POSITIVE] OK, and [PII], is there anything else I can help you with? No problem.
[CUSTOMER][POSITIVE] No, that is it. I appreciate it.
[AGENT][POSITIVE] You're welcome. You have a wonderful day. Thank you for calling APL.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye.