AccountId: 011433970860
ContactId: a2a25fc3-9131-494a-9662-5b39731a6f73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 582770 ms
Total Talk Time (AGENT): 193604 ms
Total Talk Time (CUSTOMER): 123095 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/a2a25fc3-9131-494a-9662-5b39731a6f73_20250331T22:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from San Luis Valley Health. I'm calling to check on the claim status.
[AGENT][NEUTRAL] OK, I can help you with the claim status, Ms. [PII]. Um, can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] That's [PII] and it's [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[AGENT][NEUTRAL] OK, and then what's the date of service and the charge amount?
[CUSTOMER][NEUTRAL] [PII] or 24 and it was for the bill amount of.
[CUSTOMER][NEUTRAL] 379.
[AGENT][NEUTRAL] OK, and then what were the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] The primary left a deductible of 173 and 25 cents.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, Miss [PII], while I look up this claim for us and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 79.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK Miss [PII], I've got the claim pulled up for you. Uh, the claim number is 3556594 and the claim was denied, uh, the reason.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Um, OK, can you hear me? Yes, I'm here. My computer is just spinning for a minute. I'm so very sorry. OK, the claim was denied because the charges submitted are not payable because services were rendered prior to the policy's effective date.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You're fine.
[AGENT][NEUTRAL] So the patient wasn't insured until [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Of when was that?
[AGENT][NEUTRAL] That's [PII], but that's not making sense. Hold on, let me look back at it, make sure I got the right one pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Service date was [PII]. That's correct.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] And then um the bill amount was 379 but it looks like we did receive a payment, but it was not the full um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Deductible that was left.
[AGENT][NEUTRAL] What is the claim number for that payment that you received?
[CUSTOMER][NEUTRAL] See if I can pull that up.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So on ours it says 2 um 202-4311 DC 3341.
[AGENT][NEUTRAL] That looks like that could be.
[CUSTOMER][NEUTRAL] Is that actually from you?
[AGENT][NEUTRAL] Uh, no, that looks like it could be Blue Cross because that BC?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Makes me think Blue Cross, um.
[AGENT][NEUTRAL] Let me keep looking.
[AGENT][NEUTRAL] I'll pull it up again to see if there's any other duplicates or anything that might.
[AGENT][NEUTRAL] 29 2024.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] 356-859-4.
[AGENT][NEUTRAL] See if this one tells us anything different because it's the same amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know I do have another um claim number actually.
[AGENT][NEUTRAL] OK, what do you have?
[CUSTOMER][NEUTRAL] I have 3558611.
[AGENT][NEUTRAL] Let me look that one up.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Yeah, that one is like a duplicate number um.
[AGENT][NEUTRAL] 356-859-4, that one is for the same amount that you gave me and it says.
[AGENT][NEGATIVE] That the refund was received claims rejudicated as appropriate.
[AGENT][NEUTRAL] That's what the remark says on that one.
[CUSTOMER][NEUTRAL] So is it um patients responsibility for the rest of it because it does say.
[CUSTOMER][NEUTRAL] Let's see here, it does have a paid amount though on this claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, now,
[CUSTOMER][NEUTRAL] And it has $90.27.
[AGENT][NEUTRAL] And that was from that claim number that you gave me earlier?
[CUSTOMER][NEUTRAL] That one is from the claim 3558611.
[AGENT][NEUTRAL] OK, 3
[CUSTOMER][NEUTRAL] And it does say um American Public Life on it.
[AGENT][NEUTRAL] OK, so that would be the payment for the claim. We don't give patient responsibility uh we leave that up to the provider to determine if they want to collect or not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna put a note on here.
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] OK, is there anything else I can help you with or any other questions you may have?
[CUSTOMER][NEUTRAL] Uh, no, that should do it. Um, can you spell your name for me please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, it's [PII]
[AGENT][NEUTRAL] And you can use my name and today.
[CUSTOMER][NEUTRAL] And what was that reference number?
[AGENT][NEUTRAL] You can use my name and today's date for your reference number.
[CUSTOMER][NEUTRAL] Oh go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That should do it then thank you.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. You have a good day and thank you a rest of your night. Thanks for calling APL.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] Mm bye-bye, ma'am.