AccountId: 011433970860
ContactId: ade1de8e-d5c6-401a-ba0a-1b3b22824cb5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 793969 ms
Total Talk Time (AGENT): 171452 ms
Total Talk Time (CUSTOMER): 302467 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/ade1de8e-d5c6-401a-ba0a-1b3b22824cb5_20250515T15:14_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] calling for the property check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. So may I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, I can check on a claim for you. You said your name was [PII]?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] [PII], OK, uh, can I get a good call back number from you in case we're just, uh, disconnected please?
[CUSTOMER][NEUTRAL] It's [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Uh yeah, I do have the policy number. Is policy number is 52 Y as in Yankee 618513F as in Foxtrot.
[AGENT][NEUTRAL] OK, so that's not one of our policy numbers, [PII]. Um, that's a bit too long. Do you maybe have their uh social? I could search for them that way.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] OK. I do have the social, just a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what was the name for the member?
[CUSTOMER][NEUTRAL] Yeah, the member's name, first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] It looks like
[AGENT][NEUTRAL] OK, so I did not get a result with that social, uh, [PII], the only other way I can search if you wouldn't mind spelling out the first and last name for me please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, it's [PII], and the last name is spelled as [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, I don't have anyone with that name in our system, [PII].
[CUSTOMER][NEUTRAL] OK, so what will be the call reference number? OK, but we have received the copy of, OK, but we have received the copy of you from you guys.
[AGENT][NEUTRAL] That would be my
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] Um, is it American Public Life because again I don't have anyone with that name in our system.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, just a second. We are now insured.
[CUSTOMER][NEUTRAL] Yeah, it's American Public Life. Yeah, it's your name, uh.
[AGENT][NEUTRAL] Do you have that claim number?
[CUSTOMER][NEUTRAL] Give me a minute. Just a minute, [PII], just a minute. I need to find it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, I don't know, but it's, it's not, uh, your UP.
[AGENT][NEUTRAL] OK, all right. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, yeah, I do have more 4 claims on the file. Could you please help me with that?
[AGENT][NEUTRAL] Yes, um, let's see, give me just a moment.
[CUSTOMER][NEUTRAL] bye bye.
[CUSTOMER][NEUTRAL] Yeah, I'll, uh, the call reference number will be your name and today's date.
[AGENT][NEUTRAL] Uh, my first name, last initial and today's date, um, and so my name is spelled [PII], and then I'm ready for that policy number when you are.
[CUSTOMER][NEUTRAL] Yeah, the policy number will be.
[CUSTOMER][NEUTRAL] OK, just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the policy number is 14, sorry, it's 1341.
[CUSTOMER][NEUTRAL] 910.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] The member's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[AGENT][NEUTRAL] OK, [PII] and then uh what was that bill amount please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] $63 even.
[AGENT][NEUTRAL] 63. OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] What was the uh tax ID for this provider, [PII]?
[CUSTOMER][NEUTRAL] The tax ID is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, I do have one claim on file for the state of service from that provider, uh, for $17.49. Is that the amount after major medical paid?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so for this claim, [PII], uh, all of the payable benefits were applied to this policy's deductible.
[CUSTOMER][NEUTRAL] OK, just a second. And when you guys received the claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, one moment, let me get that.
[AGENT][NEUTRAL] This claim was received [PII], and it did process on [PII].
[CUSTOMER][NEUTRAL] And what's the claim number?
[AGENT][NEUTRAL] That is 358-850-2.
[CUSTOMER][NEUTRAL] Which
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK, do you follow the Medicare guidelines?
[AGENT][NEUTRAL] Major medical guidelines.
[AGENT][NEUTRAL] This is a secondary medical policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you follow the major medical guidelines.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, just a second, give me a minute.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] OK. Uh, so, after the primary paid the amount and the amount was processed towards by the primary to the co-insurance. So you guys don't cover the co-insurance in your guidelines.
[AGENT][NEUTRAL] It was covered, [PII], the amount that we paid the amount payable went towards their deductible for this plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Could you please tell me what's the annual deductible amount for the member?
[AGENT][NEUTRAL] That's $500.
[CUSTOMER][NEUTRAL] And how much the patient met?
[AGENT][NEUTRAL] Uh, for the entire year.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Uh, let's see, they did meet their deductible for this year.
[CUSTOMER][NEUTRAL] They made the $500.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, perfect. And was it in-network deductable or out-network deductible?
[AGENT][NEUTRAL] This policy doesn't have a network, um, it just pays as long as major medical pays this policy can, so it's not affiliated with any sort of network.
[CUSTOMER][NEUTRAL] OK. Could you please verify me the patient's account number?
[AGENT][NEUTRAL] Um, what was that? I'm sorry?
[CUSTOMER][NEUTRAL] Could you please verify me the patient's account number?
[AGENT][NEUTRAL] Their account number?
[CUSTOMER][NEUTRAL] Patient, yeah, the account number of the patient. Could you please verify?
[AGENT][NEUTRAL] That was the policy number that you gave me.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, now I'm talking about the account number of the patient. It's V as in Victor number. Do you have any?
[AGENT][NEUTRAL] From the provider?
[CUSTOMER][NEUTRAL] Uh, no, uh, in the claim form is there, there is a patient's account number, means there are a few numbers and in the middle of the number there is V as in Victor alphabet, and then again the few numbers.
[AGENT][NEUTRAL] They don't have an account number with us besides the policy number.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, perfect. Could you please uh verify to which address the UB was mailed to means, to which address you guys mailed the copy of UB the pay to address.
[AGENT][NEUTRAL] Um, for this, the EOB.
[CUSTOMER][NEUTRAL] Yeah, could you please verify me the pay to address, payments, mailing address?
[AGENT][NEUTRAL] I don't know if we didn't send a payment to this uh provider, but if you need a copy of the EOB I can fax one to you.
[CUSTOMER][NEUTRAL] Uh, yeah, I need the copy of you but I'm asking about your, could you please verify the pay to address.
[AGENT][NEUTRAL] We didn't send a payment, uh, to this, for this claim.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, I got it. You, you didn't send the payment, but you have the pay to address on your file. So could you please verify the pay to address to me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Do you have any pay to address?
[CUSTOMER][NEUTRAL] Are you there [PII]?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah.