AccountId: 011433970860
ContactId: b5cd38e5-b7f1-4ac8-88d5-d13a2f3a6f34
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 954650 ms
Total Talk Time (AGENT): 232152 ms
Total Talk Time (CUSTOMER): 467966 ms
Interruptions: 7
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/b5cd38e5-b7f1-4ac8-88d5-d13a2f3a6f34_20250429T20:46_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for Emergency medicine physicians of Tulsa County LLC. I verify that you will be a portal and this call is made for additional information about the denial. Please note the call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] OK, I'm very sorry, but there is a lot of background noise where you're located that's making it very difficult for me to understand you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Sorry for that.
[CUSTOMER][NEUTRAL] So the provider of his name is Emergency medicine physicians of Tulsa County LLC.
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] What is your name?
[AGENT][NEUTRAL] OK, I'm very sorry, but there's someone in the background and I can only hear them.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I'm really sorry for that, uh.
[AGENT][NEUTRAL] And so [PII], did you, do you have one claim that you need additional information on the denial, is that correct?
[CUSTOMER][NEUTRAL] I do have 4 members for today.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I can help you with that and what is your callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII]. That's a direct line.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] And any, OK, so [PII], my name is [PII] and you will use my name along with today's date as your call reference number for each. Also any information that I provide will be a verification of benefits and not a guarantee of payment. And lastly, if we do have or if we have a claims on file and you need a copy of the explanation of benefits, you can print those using the claim number from our portal at [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the first policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, the policy number starts with uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 10071444.
[AGENT][NEUTRAL] OK, that's
[AGENT][NEUTRAL] OK, that's not our company's policy number [PII]. That's not an APL policy number. What number were you trying to call? I'm sorry, what company were you trying to call?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's APL.
[AGENT][NEUTRAL] OK, that's not our policy number.
[CUSTOMER][NEUTRAL] OK. Your policy number starts with A, right?
[AGENT][NEUTRAL] Start with what?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, A as in Alpha.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Could you please uh check with the patient's name?
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] If you have the claim number, do you already have the explanation of benefits?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so on the explanation of benefits, it does have the policy number.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] There is no policy number. Policy, ah.
[CUSTOMER][NEUTRAL] Only the pay member ID is there.
[AGENT][NEUTRAL] OK, so that's not an explanation of benefits from American Public Life insurance?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] How all those.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's from employees retreatta.
[AGENT][NEUTRAL] I'm sorry, I didn't understand what you said.
[CUSTOMER][NEUTRAL] In that, uh, ERA just mention that the employees will treat Trust.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. I don't know what, I don't understand what you're saying.
[AGENT][NEGATIVE] I'm not understanding.
[CUSTOMER][NEUTRAL] May I provide you with the claim number?
[AGENT][NEUTRAL] What is the claim number?
[CUSTOMER][NEUTRAL] 0104 022571788.
[AGENT][NEUTRAL] OK, that's not, that is not our claim number.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] That is not an American public life claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then shall we move on to the next member then?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the member ID is A Alpha 6008762104.
[AGENT][NEUTRAL] OK, that's also not an American public life policy number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK, I found the policy number that is 02509836.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I provide as I previously stated on any of the claims will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Data services [PII] for $406 even.
[AGENT][NEUTRAL] I'm sorry, I can't understand you. What was the date of service?
[CUSTOMER][NEUTRAL] [PII], [PII] for $406 even.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And the claim number?
[CUSTOMER][NEUTRAL] Yeah, the claim number is 3,591,040.
[AGENT][NEUTRAL] OK, and how can I help you with that claim?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, here, the claim has been got denied. Could you please help me with the denial clarification for the code 99214?
[AGENT][NEUTRAL] Yes, ma'am, the denar.
[AGENT][NEGATIVE] Office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so this code is.
[AGENT][NEUTRAL] The member supplemental policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK, so this code is not covered under the member's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So may I know the app mailing address for this?
[AGENT][NEUTRAL] The same as the claims mailing address and it would need to be put to attention appeals department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2,488,950
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. [PII], right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Thank you. And the time limit would be 180 days from the date of denial.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. And what is the next member's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, one moment. Let me pull up that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Next policy number is?
[CUSTOMER][NEUTRAL] 02509836
[AGENT][NEUTRAL] That's the one you just gave me.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 01 moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK my cell phone number is [PII].
[CUSTOMER][NEUTRAL] Yeah, same policy number, but uh I think different claim number.
[AGENT][NEUTRAL] Is it for the same patient?
[CUSTOMER][NEUTRAL] No, it's a different patient.
[AGENT][NEUTRAL] What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The last name is uh different. Yeah, one moment. Patient's name is [PII].
[AGENT][NEUTRAL] That's the very same, what's the date of birth?
[CUSTOMER][NEUTRAL] Sorry, sorry, um, the patient's name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what is the data service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Data services.
[CUSTOMER][NEUTRAL] 313 of 2025 for $440 even.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] How much was the bill amount again?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] And you said 313 of 2024?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 313 of 2025 for $440 even.
[AGENT][NEUTRAL] OK. And the claim number?
[CUSTOMER][NEUTRAL] And the claim number is 3,591,040.
[AGENT][NEUTRAL] That's the claim number for the other child that we just discussed.
[CUSTOMER][NEUTRAL] So, sorry, uh,
[CUSTOMER][NEUTRAL] I'm really sorry. It's 359-078-3.
[AGENT][NEUTRAL] OK. And how can I help you on that claim?
[CUSTOMER][NEUTRAL] Yeah, here they go uh.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Here also the code 99214 has got denied. Could you please help me with the denial of clarification on that?
[AGENT][NEUTRAL] For the same reason, office visits are not covered under the member supplemental policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] So shall we move on to the next one then?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Which is the last one, correct?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah, the last one.
[AGENT][NEUTRAL] Uh-huh. OK, what is that policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah. The policy number is 02519409.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And your patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the date of service and total bill amount please [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's [PII] for the bill amount of $374.02.
[AGENT][NEUTRAL] OK, thank you. And the claim number.
[CUSTOMER][NEUTRAL] Yeah, the claim number is 35.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 90993.
[AGENT][NEUTRAL] Mhm and that claim was denied for the same reason office visits are not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Under the member's plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 20.
[CUSTOMER][NEUTRAL] So that's it for today and uh.
[AGENT][POSITIVE] OK, well, that is all I can help you with today, [PII]. Thank you for calling APL and I hope that you have a nice day today.
[CUSTOMER][POSITIVE] Yeah, thank you so much for your great assistance. Have a great day ahead.
[AGENT][POSITIVE] You're very welcome. Uh, you too. Thank you, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.