AccountId: 011433970860
ContactId: 9bda21ba-b6c0-40a7-8a8b-3de3bd80cd48
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1221069 ms
Total Talk Time (AGENT): 456004 ms
Total Talk Time (CUSTOMER): 343399 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/9bda21ba-b6c0-40a7-8a8b-3de3bd80cd48_20250603T15:41_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, good morning. My name is [PII] and it's spelled [PII] I. I am calling from a provider's office and I am trying to um
[CUSTOMER][NEUTRAL] Verify that these patients have medical coverage. Um, we keep getting you know we use the same.
[CUSTOMER][NEUTRAL] For claims one says requesting more information and one of them says dental, so I'm not really sure what's going on.
[AGENT][NEUTRAL] OK, I can verify your eligibility. [PII], may I have a policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is 02502864.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, yes, one of them is two separate ones, but one of them is [PII], [PII].
[AGENT][NEUTRAL] OK, he's not on this plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is this for medical or dental?
[CUSTOMER][NEUTRAL] Uh, the other one is [PII].
[CUSTOMER][NEUTRAL] It's medical, so that's why I'm trying to see if they have um the, one of the EOBs we got back says that is dental and one of them says, just says asking for other information. So I don't know what they have and he um actually he
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] His name is uh the insured name on here.
[AGENT][NEUTRAL] OK, because I don't show [PII] on that one. Let me see.
[AGENT][NEUTRAL] OK. I do show a medical and it's under a different name. I do show a dental and it's under a different name.
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] And just the about.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] I was working on both of them. Hs is [PII].
[AGENT][NEUTRAL] OK, so under the these plans that we have, [PII] is the subscriber and there are no dependents on her plan.
[AGENT][NEUTRAL] So for her medical,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She does have a medical policy. The policy number is 02502947.
[AGENT][NEUTRAL] And she is the only person on this plan.
[AGENT][NEUTRAL] And this policy is effective [PII] and it is active.
[AGENT][NEUTRAL] The first one you gave me is a dental policy.
[CUSTOMER][NEUTRAL] OK, uh, and that's the card that both of them scanned in and his name is the one on the card, so I'm not real sure.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] What is going on? Um.
[AGENT][NEUTRAL] If there's any other policy, let me see.
[CUSTOMER][NEUTRAL] Well, I take that back. They each have a card scanned in with the same.
[CUSTOMER][NEUTRAL] OK, um, so.
[CUSTOMER][NEUTRAL] These
[CUSTOMER][NEUTRAL] We received an EOB for her for a claim that says it's a dental policy.
[AGENT][NEUTRAL] And that
[CUSTOMER][NEUTRAL] Only, there are no medical.
[AGENT][NEUTRAL] OK, so they must have processed it. Do you have a claim number on that one?
[CUSTOMER][NEUTRAL] I do. It's 360-1671.
[AGENT][NEUTRAL] OK, let me get that one pulled up. Looks like it processed on [PII].
[AGENT][NEUTRAL] So let me get this pulled up. It looks like they should have sent this over.
[AGENT][NEUTRAL] To the medical side.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So it maybe are we sending it to the wrong place, um, because we have it to be sent to [PII].
[AGENT][POSITIVE] And that is correct. Let me see.
[AGENT][NEUTRAL] So this one came up.
[AGENT][NEUTRAL] OK, so it's built on the dental form, so that's why it went over to the dental side.
[AGENT][NEUTRAL] But this
[CUSTOMER][NEUTRAL] I'm not even sure how when I'm, I build it out on a 1500.
[AGENT][NEUTRAL] Yes, this one came in and it's actually on a dental, it says American Dental Association dental claim form at the top.
[AGENT][NEUTRAL] So, this one came in, and that's why it went over to the dental side. But I'm seeing that there is no coordination of benefit attached from the primary. So I can give you the fax number and you can resubmit that one under the medical ID.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so they have a, she has a primary policy?
[AGENT][NEUTRAL] In order, let me see, this is a hospital indemnity plan. So, OK, I'm sorry, take that one back. The normal plans that we have have to have a medical, but this one is a hospital indemnity plan, so I'll take that back. So we don't need anything, just the claim form. I'm sorry, just the 1500 form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, uh, because she has several claims and the reason why this came up because I did get this ELB today and we were getting ready to, um, mail out a claim for a different data service. So do I just need to need to remil them or um.
[AGENT][POSITIVE] Yes, if they were all submitted on the, I'm sorry.
[CUSTOMER][POSITIVE] With this correct OK.
[AGENT][NEUTRAL] If they were submitted on that dental form.
[CUSTOMER][NEUTRAL] No, I don't know what was in it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, if they're submitted on a dental form, they'll probably process the same way and deny.
[AGENT][NEUTRAL] So we have to have them billed on the 1500 form under the policy ending in 947.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And so for [PII], he doesn't have any coverage.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But he has the exact same, he has the exact same carsca with his n[PII].
[CUSTOMER][NEUTRAL] So is it just not under her?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, there's no other. Let me pull it up and make sure. Do you by chance have his social security number?
[CUSTOMER][NEUTRAL] Um, let me see if it's in here.
[CUSTOMER][NEUTRAL] Because sometimes they give it to us, sometimes they don't.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] I do, no, I don't.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] OK, cause there are several.
[CUSTOMER][NEUTRAL] With his number um.
[AGENT][NEUTRAL] There are tons of [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, and the only thing we have is a um an address. He didn't give us the security number.
[AGENT][NEUTRAL] And what's his date of birth?
[CUSTOMER][NEUTRAL] But he gave us
[CUSTOMER][NEUTRAL] It's 1781.
[AGENT][NEUTRAL] OK, see. The 1st 3 are different dates of birth.
[AGENT][NEUTRAL] Yeah, and none of these are coming up with that date of birth.
[AGENT][NEUTRAL] Not saying
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And none of her policy has him as a dependent.
[AGENT][NEUTRAL] And nothing I'm pulling up is matching his date of birth.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you by chance have a group number for them?
[CUSTOMER][NEUTRAL] I do. It's 19205.
[AGENT][NEUTRAL] OK, let's try that.
[AGENT][NEUTRAL] So I have him under.
[AGENT][NEUTRAL] [PII]. I have him under [PII].
[AGENT][NEUTRAL] With an effective date of [PII] and it is active, that would be his medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said [PII]?
[AGENT][NEUTRAL] [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see. Do you have any claims for him?
[CUSTOMER][NEGATIVE] OK, and so he's denied.
[CUSTOMER][NEUTRAL] Yes, um, we got a rejection for his for, um, [PII].
[AGENT][NEUTRAL] Cause I do show.
[AGENT][NEUTRAL] This one on [PII], let's see.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It and this one is saying information received from provider is incomplete cannot process until additional correct information received. So that's what I was trying to do with his what would be.
[CUSTOMER][NEUTRAL] Additional information needed for him.
[AGENT][NEUTRAL] OK, it looks like, was it an office visit as well?
[CUSTOMER][NEUTRAL] Yes, ma'am. They came in the same day for these offices.
[AGENT][NEUTRAL] OK, so it looks like this one processed.
[AGENT][NEUTRAL] Under claim number 3606397.
[AGENT][NEUTRAL] [PII] Family Student Health.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, looks like this one processed the benefit amount of $75 to the provider.
[AGENT][NEUTRAL] Um, would you like me to fax this ELB over to you?
[CUSTOMER][NEUTRAL] Yes, ma'am, was it um an EFT payment or a check?
[AGENT][NEUTRAL] No, this would be a single check.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, can I have your fax number?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes, ma'am. It's [PII].
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so I have [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. I'll fax this right over. Did you have any other dates of service for [PII]?
[CUSTOMER][NEUTRAL] So he has one and I'm not sure if the 5 for 55 of 25.
[AGENT][NEUTRAL] OK, let's see if we have that.
[CUSTOMER][NEUTRAL] And then um there is another one but I don't know if it's gone out yet.
[AGENT][NEUTRAL] OK, so 55, let's see who this one is under.
[AGENT][NEUTRAL] Same provider. It looks like two CPT codes, 868-03.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So I'll fax that one over as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, do you know if the 523-25 was received?
[AGENT][NEUTRAL] OK, 5:23.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEGATIVE] And 523 has not been received as of today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I will get that one submitted.
[CUSTOMER][NEUTRAL] I know now I'm on the [PII] so it may take a while.
[CUSTOMER][NEUTRAL] Um, OK, and for [PII].
[CUSTOMER][NEUTRAL] I know hers was rejected for that 52. Was that 55251 sent out, or did they go to the dental as well?
[AGENT][NEUTRAL] Let me see, let me go back to [PII].
[AGENT][NEUTRAL] Oh, it's thinking one moment. It's sending these EOBs out, one moment.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEGATIVE] Very slow, one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, now let me get back over here.
[AGENT][NEUTRAL] And that was still under medical for [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the data service.
[CUSTOMER][NEUTRAL] Uh, 5525.
[AGENT][NEUTRAL] OK, let's see, and what was the bill amount on that one?
[CUSTOMER][NEUTRAL] $321.
[AGENT][NEUTRAL] OK, so it looks like this one day process under the claim number 3607413.
[AGENT][NEUTRAL] Let's see what this one process is.
[AGENT][NEUTRAL] OK, so it looks like this one processed, uh,
[AGENT][NEUTRAL] 52.
[AGENT][NEUTRAL] 55
[AGENT][NEUTRAL] Looks like the Benefit max was met on this one.
[AGENT][NEUTRAL] But let me double check and see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like another benefit processed on 55, so the one for 321 did not allow any benefits because they previously processed the claim for that data service.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Under 8:37.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I don't know what other they had because that was the only thing they she had here.
[CUSTOMER][NEUTRAL] Was that one for CPT 86803.
[AGENT][NEUTRAL] It looks like it was a lab that came in prior to that claim being received with the same data service. So it looks like there was a lab on the same day as well.
[CUSTOMER][NEUTRAL] Yes, that, that's what it was. It was just a lab visit.
[AGENT][NEUTRAL] Yes. So that one came in first, so we processed for that data service applying the benefits. That's why the 321 did not receive any payments because the max was met for that day.
[CUSTOMER][NEUTRAL] OK, what was, do you see the bill amount for that lab? That was the only lab she had on that day.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah, it looks like it came from LabCorp.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] So that one came from LabCorp.
[AGENT][NEUTRAL] You want me to fax over that 321 as well?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Was there another data service for calling?
[CUSTOMER][NEUTRAL] It was at 52 and then I have a 14523 that hasn't been sent yet.
[AGENT][NEUTRAL] Oh OK, OK.
[AGENT][POSITIVE] Want to make sure I didn't miss any.
[CUSTOMER][NEUTRAL] No, ma'am, it was said.
[AGENT][NEUTRAL] OK. So I'll faxed over the 2 for Rodney and the 1 for Carlin.
[AGENT][NEUTRAL] And then you can rebuild those and fax those over to the numbers.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see, we missing anything else?
[CUSTOMER][NEUTRAL] Um, where does this need to be faxed to?
[AGENT][NEUTRAL] You can fax them to 877.
[AGENT][NEUTRAL] 3659423 attention claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. So I got Rodney together. I got [PII] faxed over. So you should be receiving those shortly.
[AGENT][NEUTRAL] And [PII], is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] That was all. Thank you so much. Um, but may I have a reference number for our call?
[AGENT][NEUTRAL] Yes, it's Monique, M O N I Q U E. Last initial is [PII] along with today's date.
[CUSTOMER][POSITIVE] All right. Thank you so much for your help, [PII].
[AGENT][POSITIVE] To, you're so welcome and thank you for calling American Public Life. Have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. You as well.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye-bye.