AccountId: 011433970860
ContactId: c6f92f0c-1c0b-44ea-aff7-1d436378d406
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 846969 ms
Total Talk Time (AGENT): 206788 ms
Total Talk Time (CUSTOMER): 114269 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/c6f92f0c-1c0b-44ea-aff7-1d436378d406_20250603T12:33_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII]. I had a couple of claims that I wanted to ask about, please.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claims and [PII], are you calling from a provider's office?
[CUSTOMER][NEUTRAL] Facility
[AGENT][NEUTRAL] OK. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, it is [PII].
[AGENT][NEUTRAL] And the member's policy number?
[CUSTOMER][NEUTRAL] Um, the first one is D47680067.
[AGENT][NEUTRAL] OK, so the D numbers are for 90 degree benefits. Do you have a copy of the ID card available?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see, I'm not sure if I do.
[AGENT][NEUTRAL] I can also look the policies up with the full social.
[CUSTOMER][NEUTRAL] Um, I have a social.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hold on one moment, I'm just waiting for the policies to populate here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the member's first and last name?
[CUSTOMER][NEUTRAL] [PII] 22365.
[AGENT][NEUTRAL] OK, can you spell the first and last name for me?
[CUSTOMER][POSITIVE] [PII] for the first [PII]
[AGENT][NEUTRAL] And you said [PII] for the first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, [PII] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Nothing came up with the social. I'm gonna look with the name.
[AGENT][NEUTRAL] So the first name is [PII] and the last name is [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm just asking to make sure because I, I'm not showing a policy with that name either or the social.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you sure it's American Public Life?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] No, I'm not sure. I just know it's under benefits on a card.
[AGENT][NEUTRAL] Oh, OK. Um, because, well, I was gonna say, OK, so that the number that you gave, that's for 90 degree benefits, but 90 Degree benefits works with a lot of different insurance companies, um.
[AGENT][NEUTRAL] You want to check the other one or were they all for this person?
[CUSTOMER][NEUTRAL] Um, no, I have a 2 for a different patient.
[AGENT][NEUTRAL] You want to try those or do you have the numbers for them as well?
[CUSTOMER][NEUTRAL] It's the numbers also.
[AGENT][NEUTRAL] You want me to try with their name and social?
[CUSTOMER][NEUTRAL] We can that's fine.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm ready whenever you are.
[CUSTOMER][NEUTRAL] Um, it's what, what do you want first? the social.
[AGENT][NEUTRAL] I mean, you can give it both to me.
[CUSTOMER][NEUTRAL] OK, um, the social is [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, now I do see one for [PII], and this is medical, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify his date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Um, it's 422 of 25, and it's for $4,115.91.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK, I mean, I have another data service for him too.
[AGENT][NEUTRAL] OK, and what's the second one?
[CUSTOMER][NEUTRAL] Um, 423 25 and that's for 186 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And 91 cents. OK, that's this one.
[AGENT][NEUTRAL] And that was [PII] for 186?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so the first one, [PII], um, I'm showing that we received that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 8213.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And on [PII], 0, I'm sorry, it flipped. So [PII] it was received. [PII], it was um processed and it was denied because the calendar year max for diagnostic testing um has been met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me see the 2nd 1.
[AGENT][NEUTRAL] The second one, it's the same, received on [PII].
[AGENT][NEUTRAL] Denied on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 8215.
[AGENT][NEUTRAL] And let me see what this one, hold on one moment.
[AGENT][NEGATIVE] Um, this one was denied because it's not a covered diagnostic test.
[CUSTOMER][NEUTRAL] OK, um, is there any way I can get those EOBs? Would that be a problem?
[AGENT][NEUTRAL] Yes, no, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] And should I put attention [PII]?
[CUSTOMER][POSITIVE] Yes, that's fine thank you.
[AGENT][NEUTRAL] You're welcome. And it was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, and do you mind if I place you on just a brief hold while I send this over to you?
[CUSTOMER][POSITIVE] Yeah, that's fine thank you.
[AGENT][NEUTRAL] You're welcome, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I've sent both um explanation of benefits over to you via fax. So you should be receiving those shortly. Um, if you haven't received them by end of day today, just give us a call and we'll be more than happy to resend it for you.
[CUSTOMER][POSITIVE] OK thank you I appreciate that.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, just a reference number please.
[AGENT][NEUTRAL] Alright, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, thank you again I appreciate all your time.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye.