AccountId: 011433970860
ContactId: adc55ec1-fc06-4729-9aff-33aec62ce535
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553289 ms
Total Talk Time (AGENT): 191361 ms
Total Talk Time (CUSTOMER): 213633 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/adc55ec1-fc06-4729-9aff-33aec62ce535_20250311T17:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good, good afternoon. My name is [PII]. I'm calling regarding a claim status, please.
[AGENT][NEUTRAL] And you said your name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I please have a callback number?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Yes, policy number is.
[CUSTOMER][NEUTRAL] 01852
[CUSTOMER][NEUTRAL] 31 I'm sorry 130 M as in Mary, L as in Louis 8.
[AGENT][NEUTRAL] So the policy number is 01852130.
[CUSTOMER][POSITIVE] 13. Yes. Correct.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, her name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And you're calling in for status. Now I the service and total bill.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, the first one will be [PII].
[CUSTOMER][NEUTRAL] And bill amount was $5,946.
[AGENT][NEUTRAL] And you have another data service for this member?
[CUSTOMER][NEUTRAL] Yes, I have 4 29 2024.
[CUSTOMER][NEUTRAL] The first one is for $233.
[CUSTOMER][NEUTRAL] And the same date of service, another one for um build amount.
[CUSTOMER][NEUTRAL] $5,946.
[CUSTOMER][NEUTRAL] Yeah, I think it's just those 3.
[AGENT][NEUTRAL] So you have a 429 for the same total as the 321?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I think I have another one.
[CUSTOMER][NEUTRAL] Huh
[CUSTOMER][NEUTRAL] Wow, I have 2 more for the same patient, I'm sorry.
[AGENT][NEUTRAL] it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have also [PII].
[CUSTOMER][NEUTRAL] Let me check the balance. [PII].
[CUSTOMER][NEUTRAL] For $5,946.
[CUSTOMER][NEUTRAL] I also have um.
[CUSTOMER][NEUTRAL] Let's see what is this I think this one, this one was paid.
[CUSTOMER][POSITIVE] And the correct way.
[CUSTOMER][NEUTRAL] Um, I think this one was paid, so no, just those.
[CUSTOMER][NEUTRAL] 34, just those 4.
[AGENT][NEUTRAL] And that is 321 of 24 for 5946. I'm pulling that up for you now and you can also check claim status via our secured portal at [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, I'm not even seeing a claim that was submitted in from the provider for the database of 321-24.
[CUSTOMER][NEUTRAL] OK, it's
[CUSTOMER][NEUTRAL] You don't have it.
[AGENT][NEUTRAL] No claim is submitted in from the provider.
[CUSTOMER][NEUTRAL] I wish I could talk.
[CUSTOMER][NEUTRAL] OK, I have, um, I have a note saying that we send it on [PII] and also on [PII]. Uh, I'm just trying to make sure if it was elect electronically.
[AGENT][NEUTRAL] We don't have any submission for that date of service.
[CUSTOMER][NEUTRAL] No, OK, not on file.
[CUSTOMER][NEUTRAL] OK, can we check on [PII]?
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Yes, I'm going down the dates of service for you.
[CUSTOMER][POSITIVE] Thank you, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Now what you can do now for the date of [PII], it looks like let me pull that one back up.
[AGENT][NEUTRAL] You can either submit that either via the secured portal, fax or mail for the date of service of the [PII].
[CUSTOMER][NEUTRAL] Can I please have, can I please have the uh fax number?
[AGENT][NEUTRAL] Yes, let me get you the fax number. Are you ready?
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] It is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942-3 and that is attention claim department.
[CUSTOMER][NEUTRAL] Claims department?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And for the date of service of [PII], it does like we have that claim on file we received that one on 210 [PII].
[AGENT][NEUTRAL] It was processed on [PII]. That claim processed and it denied that office visits are not covered under the patient's plan. Are you ready for that claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] It is 356.
[AGENT][NEUTRAL] 2906.
[CUSTOMER][NEUTRAL] 3562906
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] And for the date of service of 429 total bill 5,946.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is showing that no claim is on file.
[AGENT][NEUTRAL] From the provider
[CUSTOMER][NEUTRAL] No gray one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII].
[AGENT][NEUTRAL] And that one is the 5,946 as well?
[CUSTOMER][NEUTRAL] Yes, 5,946.
[AGENT][NEUTRAL] So for that one, it does show that we received that one as well on [PII]. It was processed on [PII]. That claim number is 356.
[AGENT][NEUTRAL] 2889. That claim processed and it made a payment in the amount of $1,033.72. Would you like that check number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I think we're fine with that one. Let me check if I have another one. This payment commercials, I think it's Sky view.
[CUSTOMER][NEUTRAL] Can you check um [PII]?
[CUSTOMER][NEUTRAL] [PII] bill, the amount is uh again 5,946.
[AGENT][NEUTRAL] OK. And with this one, this would be the last one that I can check for this call.
[CUSTOMER][POSITIVE] Oh OK alright I understand thank you.
[AGENT][POSITIVE] You're welcome. I'm pulling that up for you now.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] It is showing no claim on file.
[CUSTOMER][NEUTRAL] No claim on file.
[CUSTOMER][NEUTRAL] OK my dear, can I please have a call reference number?
[AGENT][NEUTRAL] Yes, the call reference will be my first name, [PII], which is spelled [PII]
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Last initial of [PII] and today's date.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Today's day. OK, [PII], thank you so much for your help. Um, how many claims, um, per call it's allowed?
[AGENT][NEUTRAL] 5 planes.
[CUSTOMER][POSITIVE] 5 payments. Perfect. All right, my dear, have a good day. Thank you bye bye.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] You're welcome thank you for calling American Public Life. Have a great day, [PII].
[CUSTOMER][NEUTRAL] You too bye.