AccountId: 011433970860
ContactId: bb59044b-82e8-4726-83a7-6d811d689d47
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1427819 ms
Total Talk Time (AGENT): 287738 ms
Total Talk Time (CUSTOMER): 338855 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/bb59044b-82e8-4726-83a7-6d811d689d47_20250507T17:15_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm trying to reach the claims department.
[AGENT][NEUTRAL] This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh hi [PII], sorry, um, I just finished speaking to someone probably about 15 minutes ago regarding, I'm I'm calling from a broker and I'm calling for one of our groups. I was calling in regards to the status of a claim. She did let me know that she emailed me um all this information on this claim, but I have not received it.
[AGENT][NEUTRAL] OK. May I have your name, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And [PII], may I please have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have the policy number that you were calling in regards to?
[CUSTOMER][NEUTRAL] 26652
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Is that a group number?
[CUSTOMER][NEUTRAL] This is for the group.
[AGENT][NEUTRAL] OK, so is it for a particular member or is it just for the group itself?
[CUSTOMER][NEUTRAL] Well that's for the group itself. I can give you the member ID number. Um, give me one second.
[AGENT][NEUTRAL] Yes, I'm needing the policy number.
[CUSTOMER][NEUTRAL] 255-0760
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you're calling from the broker's office?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] May I have the broker's name, please? Or you the broker itself?
[CUSTOMER][NEUTRAL] No, so the company broker's name is you can, it may be under any solutions or South.
[CUSTOMER][NEUTRAL] South Benefits Group.
[AGENT][NEUTRAL] May I have the member's first and last name and the date of birth?
[CUSTOMER][NEUTRAL] First name is [PII], last name [PII]. Date of birth is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I can reach out to the person that you spoke with to see if she did submit that email. Could you hold just one second so I can reach out to them?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, not a problem. And if anything, I would also, if it, it may need to be resent, I would like to stay on the phone until I receive it.
[AGENT][NEUTRAL] OK, now I'm not able to stay on the phone until you receive it, but I can speak with that representative and see if she would like for me to transfer the call to her and you all can discuss that, but I'm not able to stay on the phone and wait for you to receive an email.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just hold and let me contacted agent.
[CUSTOMER][NEUTRAL] OK, that's
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I'm still here. I'm waiting for the response.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And also I wanted to know, do you know if you received anything from, I believe it says care team?
[CUSTOMER][NEUTRAL] No, I have not.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And just in case, could I verify your email address?
[CUSTOMER][NEUTRAL] Yes, so my email is [PII].
[AGENT][NEUTRAL] Let me repeat that back to you. That is [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] And just in case if I have to, you know, send this request for the supervisor to submit that, which claim or date of service were you needing that information on?
[CUSTOMER][NEUTRAL] So, the claim was in regards to, I don't have the date of service, but it is for Mid-Florida pathology.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Amount of $652.03.
[AGENT][NEUTRAL] Because she stated that it was just recent.
[AGENT][NEUTRAL] Again.
[CUSTOMER][NEUTRAL] OK, so then maybe she's she has the email in correct.
[AGENT][NEUTRAL] OK. So it's still didn't, haven't came through?
[CUSTOMER][NEGATIVE] I have not received anything.
[CUSTOMER][NEUTRAL] OK, so just to confirm, it, it was sent to
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's what I'm sending. I'm sending the email address to see if she rece if that's the one she sent it to.
[CUSTOMER][NEUTRAL] At
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that is the correct email address that she submitted it to.
[CUSTOMER][NEGATIVE] And any solutions. I'm not receiving anything. What is the email that it's coming from?
[AGENT][NEUTRAL] Hold on, I'm getting ready to see it.
[CUSTOMER][NEUTRAL] OK, let me see here. I may have received something now.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, I did receive something from care team.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I think this is in regards to one of the, I'm not sure because I'm seeing two amounts here that were submitted.
[CUSTOMER][NEUTRAL] So I'm
[CUSTOMER][NEUTRAL] I think there is another amount that is pending, so I would need a status on that one.
[CUSTOMER][NEUTRAL] Uh, let me see here.
[CUSTOMER][NEUTRAL] OK, so the one that she sent me was for
[CUSTOMER][NEUTRAL] A mid Florida pythology, uh, the other one that I am seeing here that was sent was for a garment and carbonyl DPM for the amount of $49.37.
[AGENT][NEUTRAL] OK, so, OK, the claim that you just asked me about was actually mid Florida. So now it's another claim that you're needing reviewed as well?
[CUSTOMER][NEUTRAL] Correct. The one I spoke to her about was the mid-Florida. She did confirm that a check was sent for that one. Now I'm calling for the same same employee on a different claim, and they were actually sent together.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said that one was for $49?
[CUSTOMER][NEUTRAL] And 37 cents.
[AGENT][NEUTRAL] And do you know that date of service as well?
[CUSTOMER][NEUTRAL] A date of service, I'm showing here [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm pulling the image up that we have on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because looking in our system we don't have a claim for that total amount for that data service so that's why I'm going through the images.
[AGENT][NEUTRAL] To see if we received anything for that total amount.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so for that date of service of [PII] for the total amount of the $49 we have no claim on file.
[CUSTOMER][NEUTRAL] OK, so I'm seeing the confirmation, because it was submitted on the portal and the confirmation is showing me date of [PII] and [PII], which was just last week. Would you, even then you would still be able to see those, right?
[AGENT][NEUTRAL] Yes, I pulled up the image for [PII] and I'm looking at that image now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] is for the one.
[AGENT][NEUTRAL] That you called in regards to.
[AGENT][NEUTRAL] Well, [PII] is for date of service of the [PII], which is a duplicate of the previous claim that she sent you the information on.
[AGENT][NEUTRAL] And then the one that we received on [PII].
[AGENT][NEUTRAL] Let me check that one.
[AGENT][NEUTRAL] OK, so that one you're saying the total bill charge is 4937, that is the total amount that is due.
[CUSTOMER][NEUTRAL] Let me go back to that.
[CUSTOMER][NEUTRAL] Total amount due, yes, total current charge also total current charges balance due is 4937.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But that's what they're telling her that she owes.
[AGENT][NEUTRAL] OK, but that's not the total bill charge so see when we're pulling up the total bill charge, that's not gonna be pulled up. The total charge on there is showing 298.
[CUSTOMER][NEUTRAL] OK, OK, so then.
[CUSTOMER][NEUTRAL] OK, I wasn't aware. I thought you, I gave her the same number last time and she was able to pull it up. Um, I'm giving the amount that the um patient is being charged.
[AGENT][NEUTRAL] OK, so for that one we did receive it on [PII], and that one shows that it did process and it's stating that it denied that office visits are not covered under this patient's plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, offices are not covered.
[CUSTOMER][NEUTRAL] OK, OK, is there any way that I can
[CUSTOMER][NEUTRAL] Is there any way I can get more of a detailed email, um, you know, with the actual employee's name and, and both claims one the reason why one was denied and the other reason and the other one with the with the check being sent on what date and everything, uh, the, the email that I received just has a one sentence. This is to confirm that claim number has been paid to member with check number.
[CUSTOMER][NEUTRAL] I mean, it has no member number, no employee name, no nothing. Am I able to get something more detailed?
[AGENT][NEUTRAL] Let me see if I can see what information was submitted out.
[AGENT][NEUTRAL] Because I'm not able to send anything out from this department because normally we only advise you to go on to the secured portal and you will be able to pull those up by the claim numbers that we're giving you and what you would be able to pull up is that EOB.
[AGENT][NEUTRAL] And that will have all the information listed on there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In here.
[CUSTOMER][NEUTRAL] OK, cause I'm, I'm, I am on the portal, OK, and I did go in.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, let me close this. So status on all three.
[CUSTOMER][NEUTRAL] For all 3 claims that are under this employee, it's just showing process.
[AGENT][NEUTRAL] So it
[CUSTOMER][NEUTRAL] So I don't see any denial for one.
[AGENT][NEGATIVE] It doesn't show a claim number or anything for you to be able to download download that EOB.
[CUSTOMER][NEUTRAL] Well, I don't, I don't need the EOB. I need, I need the, your decision. So one was so a claim. I see a claim number here ending in 88. It's showing me just processed, but when I spoke to the person on my, on my first phone call, she told me that this was completed and paid. I don't see that on my end.
[AGENT][NEUTRAL] OK, so that's what I'm asking. So are you
[CUSTOMER][NEUTRAL] Also, the one for the office visit.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] What I'm able to see is just the claim number, the status showing process, and the files that we submitted.
[CUSTOMER][NEUTRAL] But I, I already, I already have those files.
[AGENT][NEUTRAL] Yes, what I'm asking is once you see that claim number, are you not able to click that claim number and it pulls up that EOB?
[AGENT][NEUTRAL] And that EOB
[CUSTOMER][NEGATIVE] That I am not able to do. It does not allow me to.
[CUSTOMER][NEGATIVE] Yeah, it does not allow me to click the number.
[AGENT][NEUTRAL] OK, what I can do, I can probably reach out to the person that just submitted that to you and see if she can just submit that EOB over to you. Both of those we either give you the denial or the payment or how that claim was processed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And would that be OK for them to submit that both of those EOBs via your email?
[CUSTOMER][NEUTRAL] Um, yeah, that would be fine.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That would be fine.
[AGENT][NEUTRAL] OK, so I'm gonna reach out, go ahead.
[CUSTOMER][NEUTRAL] So and just so I'm clear because I do see I do see 3 claims and you're telling me that 1 was a duplicate, correct?
[AGENT][NEUTRAL] Yes, the one that we received on [PII] was a duplicate of the claim that was processed and paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's ending in 788.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] OK. Yes, so that would work. Thank you so much if we can if I can get another email sent over.
[AGENT][NEUTRAL] OK. And also the insured will be able to pull that information up as well via her portal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, Miss [PII]?
[CUSTOMER][POSITIVE] Uh, no, that will be all. Thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you bye.