AccountId: 011433970860
ContactId: c719ec1a-f0a0-481a-9a20-79b57f19303c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 916770 ms
Total Talk Time (AGENT): 329997 ms
Total Talk Time (CUSTOMER): 302855 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/c719ec1a-f0a0-481a-9a20-79b57f19303c_20250306T20:35_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, I was [PII]. Uh, I turned in a claim, uh, about a month ago and I hadn't heard anything about it.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I'm just wondering where it's what what's the procedure with it.
[AGENT][POSITIVE] OK, well, I can definitely um help you.
[CUSTOMER][NEGATIVE] They, they haven't sent me.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, I can definitely help you with your claim and provide you with an update. You said you submitted it about a month ago.
[CUSTOMER][NEUTRAL] Right, about a month ago.
[AGENT][NEUTRAL] OK, and may I have um a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] Uh, I'm on the, I'm at a golf course right now. I don't have all that with me. I know, I know my telephone number is [PII].
[CUSTOMER][NEUTRAL] [PII], but I don't have the paperwork with me.
[AGENT][NEUTRAL] OK, I can also look the policy up.
[CUSTOMER][NEUTRAL] But I've been, I've been
[CUSTOMER][NEUTRAL] OK, I'm, I've been a policy holder for since 02.
[AGENT][NEUTRAL] OK, I can look the policy up with your social as well.
[CUSTOMER][NEUTRAL] Uh, last four numbers is [PII].
[AGENT][NEUTRAL] Um, it would need to be the full social. I can also look with your first and last name, um, if you don't mind spelling it for me.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for it to come up here. Hold on one moment.
[CUSTOMER][NEUTRAL] Oh right.
[AGENT][NEUTRAL] Here it is.
[AGENT][NEUTRAL] So it just um pulls up.
[AGENT][NEUTRAL] And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] My birthday is [PII].
[CUSTOMER][NEUTRAL] My address is [PII].
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So let me take a look at the claims about a month ago.
[AGENT][NEUTRAL] Would this be for?
[AGENT][NEUTRAL] There's a claim for [PII] and [PII]. That's the date of service, but it came into [PII], um, of this year.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] That's what you're looking for? OK.
[CUSTOMER][NEUTRAL] Well, no, the one that, uh, a mail on the.
[CUSTOMER][NEUTRAL] Uh, let's see, it was on the [PII] of, uh, I thought it was on the [PII], but it might have been earlier than that. I don't know.
[CUSTOMER][NEUTRAL] I don't think it was. I think it, this was in, well, this was doctor uh.
[CUSTOMER][NEUTRAL] [PII] is, is who I, the last one was. They, they, they had sent me a letter.
[CUSTOMER][NEUTRAL] From the insurance company about they needed that needed some information so I sent it to him and.
[CUSTOMER][NEUTRAL] I sent it to him in February.
[AGENT][NEUTRAL] This is for um dermatology?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] No, a lot of all that's been taken care of, all of it in [PII]. This was in [PII]. This is [PII].
[AGENT][NEUTRAL] Is that when you submitted it or that's the date of service?
[CUSTOMER][NEUTRAL] I'm thinking he was on it.
[CUSTOMER][NEUTRAL] That's the day I mailed it.
[AGENT][NEUTRAL] OK. So the only claim that we received in
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] The only claim that we received in February received it on [PII]. Um, it just finished processing on [PII]. This is for [PII].
[AGENT][NEUTRAL] And let me see what happened with this claim.
[AGENT][NEUTRAL] OK, so this one was just a duplicate. So this has been submitted before. So let me go back to the [PII] that's, hold on one second.
[AGENT][NEUTRAL] So the claim from February.
[CUSTOMER][NEUTRAL] That was the one you're talking about.
[CUSTOMER][NEUTRAL] The one you're talking about was probably in January, but I had to wait from the insurance company to, uh, I mean the my insurance company that covered it covered it in the the uh operation.
[CUSTOMER][NEUTRAL] So it was, it was, I had to wait for it. The, the [PII] was when I mailed this thing and that, that probably was in January. It was in January where they uh where I had a, uh, where they had the surgery on the on my face.
[AGENT][NEUTRAL] OK, so this one for February was denied as a duplicate. So let me try to find the original to let you know what the
[AGENT][NEUTRAL] Outcome was.
[CUSTOMER][POSITIVE] Well, well, they, they had said that I needed I needed, uh, some more information, and I went to my dermatologist and got all the information with the insurance, my my insurance paid was and uh everything so I everything that they wanted, uh, told me they wanted.
[CUSTOMER][NEUTRAL] Um, that's what I mailed in on the [PII], but I had to wait. I had to wait for other stuff that from, from the, from the insurance that paid my, my other insurance company. I had to wait for it and see what they paid and everything. So what when I got all that and.
[CUSTOMER][POSITIVE] In February I mailed it. I mailed it right to y'all.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So all it was asking for was the explanation of benefits from primary insurance. Um, so you're saying that the explanation of benefits is what was sent in in February?
[CUSTOMER][NEUTRAL] [PII]ght.
[AGENT][NEUTRAL] Hold on one second because that was denied as a duplicate. So they're saying the explanation of benefits still wasn't received. Let me, let me see the documents. Hold on one second.
[AGENT][NEUTRAL] And it was February.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm just waiting for the documents to populate here hold on one moment.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] But this
[AGENT][NEUTRAL] OK. If you need me to, I can, um,
[AGENT][NEUTRAL] Reach out to Renaissance Dermatology to let them know what's needed. So basically this the the receipt that was received.
[AGENT][NEUTRAL] The, so it's just a receipt of payment. This is not an explanation of benefits. So that's why it's being denied as a duplicate because the original claim was asking for the explanation of benefits and this
[AGENT][NEUTRAL] This is just a receipt. It's not an explanation of benefits. This shows what you pay, um, but it doesn't show the insurance information.
[CUSTOMER][NEUTRAL] It showed the information from the insurance company, what they paid.
[CUSTOMER][NEUTRAL] The dermatologist.
[AGENT][NEUTRAL] So we
[CUSTOMER][POSITIVE] And that's what I thought they wanted.
[AGENT][NEUTRAL] Well, where it says payment receipt, this is a receipt from [PII]. The explanation of benefits is going to say explanation of benefits and then your insurance company, and then it'll say this is not a bill. It'll list all of the coding, the diagnosis codes, the procedure codes, all the charges, any adjustments, everything they paid, um, so basically what we're asking for is where they receive, where they drafted the receipt from. It just has more information on it.
[AGENT][NEUTRAL] Would you like me to give them a call?
[CUSTOMER][NEUTRAL] But what mine who, who, who you, uh, who, who you gonna call?
[AGENT][NEUTRAL] [PII] to.
[CUSTOMER][NEUTRAL] The terminologist?
[AGENT][NEUTRAL] Yes, we can either call [PII] or you can reach out to your um insurance company and just ask them for an explanation of benefits, whichever you prefer.
[CUSTOMER][NEUTRAL] You can uh you can call, you can call the insurance, uh, you can call uh [PII] or you can call, uh.
[CUSTOMER][NEUTRAL] The dermatologist Doctor [PII].
[CUSTOMER][NEUTRAL] Her her bookkeeper.
[CUSTOMER][NEUTRAL] And that's where I, she gave me, she gave me the paperwork that I sent you.
[CUSTOMER][NEUTRAL] You can call her and find out information that you need.
[CUSTOMER][NEUTRAL] But uh I thought she gave me the information, all the information that uh.
[CUSTOMER][NEUTRAL] I need it.
[CUSTOMER][NEUTRAL] I don't know anything.
[CUSTOMER][NEGATIVE] I don't know anything to them people because the insurance company paid everything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, I can definitely um reach out to them and try to see if we can get the explanation of benefits for you.
[CUSTOMER][POSITIVE] Alrighty, I thank you and that you should have that information on that paper that you're looking at.
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] The telephone number should be there.
[AGENT][NEUTRAL] Yes, hold on one moment. I'm gonna call them on the other line, OK?
[CUSTOMER][POSITIVE] OK. Well, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling Renaissance Dermatology and Aesthetics. Please listen to the following options so we can better assist you.
[CUSTOMER][NEUTRAL] Press 1 to schedule an appointment or make changes to an existing one. Press 2 for billing and our financial department. Press 3 for prior authorizations of biologics and other medication.
[CUSTOMER][NEUTRAL] Oh sorry, Honda sound dermatology and aesthetics. This is [PII]. How may I help you?
[AGENT][NEUTRAL] [PII], uh, my name is [PII]. I'm calling from American Public Life. We have a mutual patient. He's on the other line. Um, we're trying to process a claim, but we're needing the explanation of benefits, um, from his insurance, and I'm trying to see if y'all have a copy of a payment receipt was sent over, but we need the explanation of benefits.
[CUSTOMER][NEUTRAL] Alrighty let me log it.
[CUSTOMER][NEUTRAL] What's the patient's name and date of birth?
[AGENT][NEUTRAL] Um, [PII]. Date of birth is
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, what's the data service?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] So I do have an office visit for that let me see where the OB is.
[CUSTOMER][NEUTRAL] So yeah, you're looking for the Medicare EOB?
[AGENT][NEUTRAL] Um, if Medicare is primary, yes, we don't have it listed in our system, so I'm not sure who primary is.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, um, I can print this out and send it to you.
[AGENT][NEUTRAL] OK, and um yes, can you, how, how can you send it to us? Can you fax it to us?
[CUSTOMER][NEUTRAL] Is that is that what you want?
[CUSTOMER][POSITIVE] Yeah, I can fax it to you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What fax number you we send it to?
[AGENT][NEUTRAL] So it's [PII].
[CUSTOMER][NEUTRAL] And who's attention?
[AGENT][NEUTRAL] Attention claims department.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] Yeah, that's it. Thank you so much.
[CUSTOMER][NEUTRAL] OK, I'll get it printed out and send it to you.
[AGENT][POSITIVE] All right, have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye bye. Oh sure, [PII].
[AGENT][NEUTRAL] Oh, I'm sorry, what was your name? I'm sorry.
[AGENT][NEUTRAL] [PII], OK, thank you, [PII].
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] All right, bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[AGENT][POSITIVE] Hello, Mr. [PII]. Thanks so much for holding. So I um I spoke with [PII] and she has the explanation of benefits from [PII]. So she um took our fax number, she's gonna fax it over to us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, I got you.
[CUSTOMER][POSITIVE] Oh OK, OK, thank you so much.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's all, baby. Thank you. Thank you so much. OK.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] OK you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.