AccountId: 011433970860
ContactId: a2cb3665-fa66-4b80-802e-0f39251456c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1212729 ms
Total Talk Time (AGENT): 307669 ms
Total Talk Time (CUSTOMER): 341329 ms
Interruptions: 5
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/a2cb3665-fa66-4b80-802e-0f39251456c5_20250415T20:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from Platinum to billing office. How are you doing today?
[AGENT][POSITIVE] I'm great. How are you?
[CUSTOMER][NEUTRAL] I'm doing good, thanks for asking. Before I proceed, this call is being recorded for quality and training purposes. Would you like us to continue recording?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I have called regarding a claim information. Can you help me out with that?
[AGENT][NEUTRAL] I can verify claim status. May I have a policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, it's going to be.
[CUSTOMER][NEUTRAL] E
[CUSTOMER][NEUTRAL] Sorry it's 0.
[CUSTOMER][NEUTRAL] 1,844,850 ML 8.
[AGENT][NEUTRAL] May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Your, your name is [PII], right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII] and the date of birth, [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have a date of service?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] Um, $418 even.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well. One moment.
[AGENT][NEUTRAL] This processed under claim number 355-0944.
[AGENT][NEGATIVE] No benefits are payable. They do not have the office visit, nor do they have the office treatment benefit.
[CUSTOMER][NEUTRAL] For other one like uh for surgery coach.
[AGENT][NEUTRAL] 17003 was denied for no office treatment.
[AGENT][NEUTRAL] 99213, no office visit benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So both are denied for the same reason.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Can you help me out with the UP for this one?
[AGENT][NEUTRAL] May I have a fax number?
[CUSTOMER][NEUTRAL] 702.
[CUSTOMER][NEUTRAL] 8,351,020
[AGENT][NEUTRAL] That is [PII].
[CUSTOMER][NEUTRAL] 1020.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] That's good.
[AGENT][POSITIVE] Thank you. I'll fax that right over. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yeah, I do have other teams as well.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] May I have the next policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 1475658 ML 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and date of birth [PII].
[AGENT][NEUTRAL] Thank you. May I have a date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] Uh, $277 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And that was 130 of 25.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] OK. And it doesn't show that we have received for [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] We do have a claim on file for this one.
[AGENT][NEUTRAL] There is no claim on file for this one.
[CUSTOMER][NEGATIVE] You didn't do
[CUSTOMER][NEGATIVE] Even we received payments for this one.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] Uh, no, but I have check number. Can you check with that?
[AGENT][NEUTRAL] What's the check number?
[CUSTOMER][NEUTRAL] 203-225-0 yeah that's it I think so.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And the main thing is we have received payments for ENM was 99214. That is the reason why I have called you again before previously with saying that uh ENM codes does not, uh.
[CUSTOMER][NEUTRAL] Uh, people, right?
[CUSTOMER][NEUTRAL] Then why for this one we have received payments? I have a question.
[AGENT][NEUTRAL] This is a different policy. All the policies are not the same. Each policies are different.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, I'm trying to locate this one.
[CUSTOMER][NEUTRAL] So when it covers, it does give payments, right?
[AGENT][NEUTRAL] If the policy covers the office visit, yes, it will do a payment for an office visit.
[CUSTOMER][NEGATIVE] From our end, it was denied uh like it partially paid and denied as max benefit occurrence.
[AGENT][NEUTRAL] Is there a check number? Is there a claim number connected to that check?
[AGENT][NEUTRAL] Or policy number connected?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Policy number, yeah, uh.
[CUSTOMER][NEUTRAL] Yeah, it's LB_PG20.
[AGENT][NEUTRAL] That is not our policy number.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's the provider skin and cancer associates?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So it's the data service 13 or 130?
[CUSTOMER][NEUTRAL] 13
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this one processed under claim number 357-423-5.
[AGENT][NEUTRAL] You paid the benefit of $50 to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then what about $10?
[AGENT][NEUTRAL] OK, let me see if there was anything else billed. The $10 becomes patient responsibility. The benefit amount allows $50 for specially $25 for physician.
[CUSTOMER][NEUTRAL] So total paid was 50 and the 1010.
[CUSTOMER][NEUTRAL] Dollars were denied as max benefit occurrence that means it's like uh like.
[AGENT][NEGATIVE] No, no.
[AGENT][NEUTRAL] It means any remaining balance becomes patient's responsibility. The benefit is only
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's a copay or deductible.
[AGENT][NEGATIVE] This one looks like it could have been the copay.
[AGENT][NEUTRAL] Looks like they had a $60 co-pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, uh, you have paid 50. Then what about the 10?
[AGENT][NEUTRAL] It becomes patients responsibility. The benefit only allows 50.
[CUSTOMER][NEUTRAL] Ascope.
[CUSTOMER][NEUTRAL] Ascope.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Let's go with the next one.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] May I have a policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 01617076 ML 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] $277 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII] of 24 for [PII] [PII] is not in our system. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It processed under claim number.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 357-437-6 under policy number 02553630.
[CUSTOMER][NEUTRAL] me.
[AGENT][NEGATIVE] And it looks like this plan has no off benefits.
[CUSTOMER][NEUTRAL] I call back from MBP Insurance.
[AGENT][NEUTRAL] It denied on [PII].
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can you help me out with a UB for this one?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] M.
[CUSTOMER][NEUTRAL] Ah.
[AGENT][NEUTRAL] May I have the next policy number?
[CUSTOMER][NEUTRAL] Mm, yeah.
[CUSTOMER][NEUTRAL] So the next one is going to be 1081392.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and date of birth [PII].
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 22 of 24.
[CUSTOMER][NEUTRAL] 2024 December 2, 2024.
[AGENT][NEUTRAL] In total bill amount?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] One moment, it's going to be $197 even.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] This processed under policy number 019128778.
[AGENT][NEUTRAL] Processed under claim number 3541191. No office visit benefits.
[AGENT][NEUTRAL] This claim processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We are done with 4, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can you help me out with the UB as well for this one?
[AGENT][POSITIVE] Yes, I'll fax that one over as well.
[CUSTOMER][NEUTRAL] the media
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, may I have the final policy number?
[CUSTOMER][NEUTRAL] 02297007 ML 8.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII] and the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And the bill amount to uh it's $277 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] This processed under claim number 357-0565.
[AGENT][NEGATIVE] Looks like the policy terminated, no benefits were payable.
[AGENT][NEUTRAL] This claim processed on [PII].
[CUSTOMER][NEUTRAL] Uh, may I know like when, what is the effective and term date?
[AGENT][NEUTRAL] Policies effective [PII], policy term [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But uh at the date of service, I think the policy is active, right?
[AGENT][NEUTRAL] 116, [PII] policy terminated [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you see any other active insurance for the uh member?
[AGENT][NEUTRAL] Looking up now, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And that is the only policy that I show in our system.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] There's no active policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that.
[AGENT][POSITIVE] You're so welcome. Would you like a copy of this EOB?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'll fax this right over.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I'll fax this right over, [PII]. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, thank you so much have a good day bye bye.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life and have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.