AccountId: 011433970860
ContactId: b0801686-53ab-4ec6-8359-ebee0ac12c94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 500089 ms
Total Talk Time (AGENT): 194362 ms
Total Talk Time (CUSTOMER): 213087 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/b0801686-53ab-4ec6-8359-ebee0ac12c94_20250529T12:46_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII], this is [PII]. I'm calling from provider's office looking for the claim status.
[AGENT][NEUTRAL] I can verify claim status. May I have a policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's going to be 025123777.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII] with no extension.
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. One moment.
[AGENT][NEUTRAL] I have a data service.
[CUSTOMER][NEUTRAL] It's for [PII] with the total charge of $1,576 even that is 1576.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well. One moment.
[CUSTOMER][NEUTRAL] You you may visit our website.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] May I have a CPT code that's billed on that claim?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, it's uh totally 5 CPD codes are building service. Uh, it's 99214993969612790739 and [PII].
[AGENT][POSITIVE] Thank you. One moment, I'll get this pulled up.
[AGENT][NEUTRAL] So it looks like this processed under claim number 356-569-7.
[AGENT][NEUTRAL] And I'll get this pulled up.
[AGENT][NEUTRAL] It looks like you paid a benefit amount of $50 to the provider.
[AGENT][NEUTRAL] Looks like you paid the $9,921,450.
[AGENT][NEGATIVE] And nothing else was paid on this claim.
[CUSTOMER][NEUTRAL] OK. Uh, may I know the reason, uh, why the other claims, other procedure codes was not Bay? Can I know the reason?
[AGENT][NEUTRAL] OK, one moment, I'll pull it up.
[AGENT][NEUTRAL] OK. Wellness screenings are not covered under the policy. So it looks like the lines for wellness was not covered.
[AGENT][NEUTRAL] Which was for 99396.
[AGENT][NEUTRAL] And 961-27.
[AGENT][NEUTRAL] And 4 lines.
[AGENT][NEUTRAL] 90739 and 90471 vaccines and immunizations are not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK. Thank you so much. And it is process the member responsible, right, for the uh rest of the amount.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, fine. Thank you so much for the information. Can I get the process date of this claim and can I get the payment information?
[AGENT][NEUTRAL] The claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm sorry, what other information?
[CUSTOMER][NEUTRAL] Um, can I get the, uh, mode of the payment uh for the $50? Is a check or EFT?
[AGENT][NEUTRAL] Yes, it was a single check.
[AGENT][NEUTRAL] Let me get the check number, one moment.
[CUSTOMER][NEUTRAL] Mhm. OK. Can I get the chip?
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] 202-8631
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you so much. Can you please verify the address for me? It is [PII], yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This one to Community Medical Associates, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, it's, uh, can I get it one more time? It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Mhm. OK, fine. Thank you so much for.
[AGENT][NEUTRAL] Let me pull up the actual client image.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you need the zip code?
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Community Medical Associates, [PII].
[CUSTOMER][NEUTRAL] OK, uh, thank you so much for this information, but, uh, unfortunately, the, uh, I pay to address is, uh, incurrect for this one. Is it possible to, uh, stop the check and, uh, reissue the new check? Is it possible?
[AGENT][NEUTRAL] OK, the check is processed to the address that's on the bill.
[CUSTOMER][NEUTRAL] Yeah, uh, that is the incorrect address for this one. So we don't receive the payment for this one. So that's why I'm asking for. That is the incorrect address and the correct address is um [PII]. So that's why I'm asking for. You need the divid form to update this information?
[AGENT][NEUTRAL] Yes, we would need a W9 form.
[CUSTOMER][NEUTRAL] OK. Uh, what will be the, uh, tax, tax ID to update this information?
[AGENT][NEUTRAL] You would have to use your federal tax ID number. I can give you a fax number to submit it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You know, I'm asking for.
[CUSTOMER][NEUTRAL] Yeah, yeah, fax number I'm asking for. Yeah.
[AGENT][NEUTRAL] It's [PII] attention claims.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much for this information. And also, is it possible to send this uh copy of your through the fax?
[AGENT][NEUTRAL] Yes, that is correct. And you, can you please repeat the new mailing address?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure. It is going to be [PII], [PII].
[AGENT][NEUTRAL] OK, I'll get this added into our system.
[AGENT][NEUTRAL] And then once they receive that W9, they'll update that. They'll run a check status tracer and if the check has not been processed, they can stop paying reissue.
[CUSTOMER][NEUTRAL] Oh I don't
[CUSTOMER][POSITIVE] OK, thank you so much for the information. And can I get this copy of your for this one, for this claim?
[AGENT][NEUTRAL] Yes, yes, may I have your fax number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[CUSTOMER][NEUTRAL] 289
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'll fax it over to [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for this information. Can I get the reference number for today's call?
[AGENT][NEUTRAL] It will be my name which is [PII] Last initial is [PII] along with today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much, Ms. [PII]. Have a wonderful rest of your day. Bye-bye.
[AGENT][POSITIVE] [PII], you're so welcome and thank you for calling American Public Life. Have a great day. Bye-bye.