AccountId: 011433970860
ContactId: b72f3cb8-0564-4628-b4c5-d4bc2e79580b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 438100 ms
Total Talk Time (AGENT): 184524 ms
Total Talk Time (CUSTOMER): 120525 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/b72f3cb8-0564-4628-b4c5-d4bc2e79580b_20250129T15:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, uh, my name is [PII] calling from provider's office today for status of the claim.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] Yes, I can help you with that, [PII]. And what is your callback number, please?
[CUSTOMER][NEUTRAL] That is [PII] direct line.
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Yes, that is going to be D delta 43,302,090.
[AGENT][NEUTRAL] OK, thank you, [PII], but that is not an APL policy number, that is a 90 degree benefit number. Does the member also have a policy with APL?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, they don't have that.
[AGENT][NEUTRAL] OK, what number did you call today, [PII] to reach me?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] OK, so that is American Public Life's phone number.
[AGENT][NEUTRAL] Do you have any other information on the member to see if they also have a policy with APL?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Since you have our phone number?
[CUSTOMER][NEUTRAL] Specially I think that 90 degree benefit plan that this uh phone numbers they provided.
[AGENT][NEUTRAL] What is the, let me see before I transfer you to 90 Degree Benefits to make sure that they do not have a policy with APL. What is the last name?
[CUSTOMER][NEUTRAL] Yes, last name is [PII].
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] That is
[AGENT][NEUTRAL] I'm sorry, what is the name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], correct?
[AGENT][NEUTRAL] And [PII], is that [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I it.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What state does he live in?
[CUSTOMER][NEUTRAL] In that.
[AGENT][NEUTRAL] With you having our phone number?
[AGENT][NEUTRAL] Do you not have a copy of his ID card um sorry, [PII]?
[CUSTOMER][NEUTRAL] Yes, yes, I have the ID card copy. They got they got, uh, multi plan.
[CUSTOMER][NEUTRAL] Also with the MetLife 90 degree.
[AGENT][NEUTRAL] OK, so what is, first off, any information provided would be a verification of benefits and not a guarantee of payment. What is his date of birth?
[CUSTOMER][NEUTRAL] So the [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] don't know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I have located a policy also with APL. Um, what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $289 even.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we did receive a claim on the policy we have for this member for that data service and that bill amount. Just one moment, I'll provide you that information.
[AGENT][NEUTRAL] OK, so the policy number for APL is 02474924.
[AGENT][NEUTRAL] And one moment, please.
[AGENT][NEUTRAL] The claim was received by APL on [PII], processed on [PII].
[AGENT][NEUTRAL] The claim number is 353-7706.
[AGENT][NEUTRAL] This claim was denied. It states the policy provides no benefits for charges made by a doctor for inpatient visits.
[CUSTOMER][NEUTRAL] What it means?
[AGENT][NEUTRAL] Means it is not covered inpatient doctor's visits are not covered under this member's plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, but the, the CPT code bill is 99233. It's a hospital subsequent.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] That is correct, and it is not covered under this member's plan.
[CUSTOMER][NEUTRAL] Being
[CUSTOMER][NEUTRAL] So is it a patient responsibility on the plane?
[AGENT][NEUTRAL] We do not determine patients do not determine patient responsibility, saying that would be up to the provider.
[CUSTOMER][NEUTRAL] If it is not so.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, you can print it from our portal at secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] OK. Thank you so much. How do you spell your name?
[AGENT][NEUTRAL] [PII] and my name along with today's date will be your call reference number.
[CUSTOMER][NEUTRAL] I see. When does the claim process from [PII]/7 right, [PII]?
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] No, sir, I don't believe that's the correct date. Let me go back to that screen and I'll give you that information again. One moment.
[AGENT][NEUTRAL] This claim was received on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right then, thank you so much. Hope you have a very wonderful day. Thank you. Bye.
[AGENT][POSITIVE] Yes. Yes, sir. I hope you have a nice day too, [PII], and thank you again for calling APL if that's all I can help you with today.