AccountId: 011433970860
ContactId: a7894d2a-bfd8-44dc-aa09-d01c4b619b37
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 586690 ms
Total Talk Time (AGENT): 189686 ms
Total Talk Time (CUSTOMER): 367419 ms
Interruptions: 7
Overall Sentiment: AGENT=0, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/a7894d2a-bfd8-44dc-aa09-d01c4b619b37_20250213T21:02_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] Hi, [PII]. My name is [PII] and I'm calling for uh [PII]. And please be informed the call has been recorded and monitored for quality and training purposes, and I'm calling for a claim status.
[AGENT][NEUTRAL] I'll be happy to verify claim status, [PII]. May I have a policy number?
[CUSTOMER][NEUTRAL] Yes, policy number it is uh.
[CUSTOMER][NEUTRAL] 02444790 M as in Mike, L as in Lima and number 8.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] Yes, callback number it is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, patient's name it is uh [PII], and date of birth it's on [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have the date of service?
[CUSTOMER][NEUTRAL] Yes, date of service it's on [PII] for the amount of $615.02 615.02.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well. One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2414831000077.
[AGENT][NEGATIVE] This processed under claim number 352-5510. Looks like no benefits were payable on this claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Looks like the primary insurance did not pay.
[CUSTOMER][NEUTRAL] OK, I I need to.
[AGENT][NEGATIVE] Looks like there are no bill amounts on several lines.
[CUSTOMER][NEUTRAL] Have you had any
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And the first line, the 99396, this policy does not provide benefits other than sickness and injury. So it was not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Thank you so much, uh, [PII]. So you mean to say that the, uh, pressure code is not gotten as per the Medicaid guidelines.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much. Yes, and could you please help me with the receipt date for the claim?
[AGENT][NEUTRAL] Yes, this claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And uh basically the
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much, sir. And may I know the dinner date for the plane, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you so much, yeah, yes, and, uh, one moment, let me check on this one. And uh meanwhile, could you please help me with the apple's mailing address and the family calling number?
[AGENT][NEUTRAL] Yes, you have 180 days from denial. The address will be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] I can be that um.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, one moment, please. Yes, I do have like one more claim also for different number. Could you please help me the same as well.
[AGENT][NEUTRAL] Sure. One moment.
[CUSTOMER][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh all of
[CUSTOMER][NEUTRAL] I see that.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] May I have a policy number?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, policy number is 017.
[CUSTOMER][NEUTRAL] 19417 M as in Mike L as in Lima and number and uh number 8.
[AGENT][NEUTRAL] Same.
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, patient's name is uh [PII] is I'm not wrong, and date of birth it's on [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have a date of service?
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yes, date of service it's on [PII] and the amount it is uh $3,369.30. 3369.30.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][POSITIVE] Sure, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] I get up.
[CUSTOMER][NEUTRAL] Yeah, the date of that is [PII].
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] Looks like this claim processed on the claim number 3478009.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] And it looks like we, we denied it as the primary insurance did not pay.
[CUSTOMER][POSITIVE] So you can just like right.
[CUSTOMER][POSITIVE] Thank you so much, sir. Yes, and could you please also help me with the uh receipt date for this claim?
[AGENT][NEUTRAL] Received on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much. So nice. Thank you so much, sir. So this is also same as the previous one. The service is not for us for the medical guidelines.
[AGENT][NEUTRAL] Denied on [PII].
[CUSTOMER][NEUTRAL] Just one moment
[AGENT][NEGATIVE] It looks like the primary insurance did not pay.
[CUSTOMER][NEUTRAL] So, uh, the primary, OK, sir, please go ahead.
[AGENT][NEUTRAL] So if you have a
[AGENT][NEUTRAL] If you have a corrected EOB, you can resubmit the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much, yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No it's
[CUSTOMER][NEUTRAL] Thank you so much, uh, [PII], and, uh, is there another claim receipt for this one or this is the only claim which is received on uh [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yes. Thank you so much. And I would like to also confirm the claim's mailing address that would be uh one moment.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yes, thank you so much. So it is [PII]48,950 Oklahoma City, Oklahoma 73124.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you so much. And also the timely filing limit for the claim to be submitted.
[AGENT][NEUTRAL] Um, the claim to be submitted, there's no time for an appeal. There's 180 days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. So 180 days from the date, uh, from the date, uh, date of service.
[AGENT][NEUTRAL] The pill is 180 days from the date of denial.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, uh, but for initial claims it's coming in 80 days from the date of service.
[AGENT][NEUTRAL] For any other claims, there's no time limit to submit a claim.
[CUSTOMER][NEUTRAL] There's no family calling. OK. Thank you so much. Yeah. And the apple s mailing address and family falling will be the same as the previous one for this one.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] To submit the um corrected EOB, there's no time limit.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Thank you so much. Yeah, and they require only the primary will be or along with the place.
[AGENT][NEUTRAL] No, we have the claim if you want to just submit the EOB.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] On the app. Thank you so much. And could you please also help me with the attention for the apples.
[AGENT][NEUTRAL] Claims.
[CUSTOMER][POSITIVE] Attention please thank you so much.
[CUSTOMER][NEUTRAL] And is there any specific form the platform?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, is there any specific form like that for?
[AGENT][NEUTRAL] The fax number?
[CUSTOMER][NEUTRAL] Any specific form or any pharmacy now, uh, any form is required to submit for please.
[AGENT][NEUTRAL] I'm sorry, I'm not understanding your question. There's so much background.
[CUSTOMER][NEUTRAL] I'm so sorry, [PII]. I would like to know like uh any uh form is required to submit an apply.
[AGENT][NEUTRAL] You would just have to um submit any necessary information that you feel will help your appeals case.
[CUSTOMER][NEUTRAL] Yeah they yeah.
[CUSTOMER][POSITIVE] OK, and the documents. Thank you so much.
[CUSTOMER][NEUTRAL] Yes, and uh may I have a call reference number for this one, please?
[AGENT][NEUTRAL] Yes, it will be my name which is [PII] Last initial is [PII] along with today's date.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank you so much, uh, [PII], and thank you so much for assistance and uh you have a great day.
[AGENT][POSITIVE] You're so welcome, [PII], and thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] You too thank you bye bye.