AccountId: 011433970860
ContactId: badd739a-7eba-4012-9581-b414bee95da9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 435200 ms
Total Talk Time (AGENT): 149773 ms
Total Talk Time (CUSTOMER): 203163 ms
Interruptions: 3
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/badd739a-7eba-4012-9581-b414bee95da9_20250314T18:26_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] Oh
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Broader's office to check on a claim status.
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] [PII] to answer directly.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I please have a policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It is 01963639.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], with the date of birth of [PII].
[AGENT][NEUTRAL] And you're calling in for status of claim. May I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Sure, it's on [PII] with the total amount of $576.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I mean.
[AGENT][NEUTRAL] And I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] Oh you for it.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And for that claim, it does show that we received it on 129-22.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 323.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1146, that claim process and it denied that office visits are not covered under the patient's plan and also it denied that the calendar year max had been met for that member.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Con
[CUSTOMER][NEUTRAL] OK. How much office is it can be covered for calendar year?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is there any limit for the calendar air or uh offices it is not covered for the patient?
[AGENT][NEUTRAL] OK, as I previously stated, office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][POSITIVE] OK, thank you so much for that information. And could you please send the explanation of benefit copy of the fax?
[AGENT][NEUTRAL] May I have the fax number, please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's 585-440.
[CUSTOMER][NEUTRAL] 9493. [PII]
[AGENT][NEUTRAL] Into the attention
[AGENT][NEUTRAL] OK, I will get that submitted over to you. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I do have uh two more claims for the same patient on different date of service. [PII].
[AGENT][NEUTRAL] May I have the next date of service?
[AGENT][NEUTRAL] Total bill.
[CUSTOMER][NEUTRAL] $184.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And for that claim, we did receive it on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] Claim number 3289304 claim processed and denied office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Could you please repeat the claim number?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Claim number is 32893004.
[CUSTOMER][POSITIVE] OK, thank you so much for that. And could you please also send the EOV via fax, same fax number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. May I have the next date of service and total bill?
[CUSTOMER][NEUTRAL] Sure. It's on.
[CUSTOMER][NEUTRAL] [PII] with the total bill amount of $184.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] to be
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For that claim, we did receive it on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] What.
[AGENT][NEUTRAL] Claim number 3373062 claim processed and denied, office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information as well. And could you please send the UB the same fax number?
[AGENT][NEUTRAL] OK, I will get that request submitted over to you and is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Nothing else and then they will receive the fax?
[AGENT][NEUTRAL] It can take up to 24 to 48 hours, but with this being a Friday, it could be by Monday.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Monday.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Are you still there?
[CUSTOMER][NEUTRAL] Is there is any new report? Yes, I'm still there. Is there is a new portal to pull the explanation of benefit copy?
[AGENT][NEGATIVE] With this policy being termed, you wouldn't be able to access the portal.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You just told me
[CUSTOMER][NEUTRAL] OK, there is any other way to receive and fax on this day, today?
[AGENT][NEUTRAL] It will be submitted via fax and it can take up to 24 to 48 hours. Uh EOB was already submitted out once this claim was processed previously.
[CUSTOMER][NEUTRAL] OK. It's completely fine. Could you please spell out your name?
[AGENT][NEUTRAL] Yes, it is spelled [PII]
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII] last [PII] and today's date will be the call reference.
[CUSTOMER][POSITIVE] Thank you so much for providing the information, [PII]. A wonderful day. Bye bye now.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Lifetime and have a great day as well.