AccountId: 011433970860
ContactId: c8ac9e72-e521-4ac5-8483-bea1992d3bb8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 497899 ms
Total Talk Time (AGENT): 186146 ms
Total Talk Time (CUSTOMER): 154023 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/c8ac9e72-e521-4ac5-8483-bea1992d3bb8_20250403T13:22_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, my name is [PII] calling from provider's office to check claim status.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have only one time today.
[AGENT][NEUTRAL] All right. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure. My policy number is
[CUSTOMER][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] 123 77.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The number's first name and last name is?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And date of birth
[CUSTOMER][NEUTRAL] [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 for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Sure. Date of service is [PII] and the bill amount is $404 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure. The provider name is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, the name of the facility, the office, sorry.
[CUSTOMER][NEUTRAL] Sure. It is Community Medical Associates.
[AGENT][NEUTRAL] Thank you, and I'm showing that we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 1689.
[AGENT][NEUTRAL] And also on [PII], the claim was denied because the benefit maximum for the date of service has been met.
[CUSTOMER][NEGATIVE] No benefit maximum has been
[CUSTOMER][NEUTRAL] Mint, OK.
[CUSTOMER][NEUTRAL] So the total amount is going to be the patients responsibility or the providers?
[AGENT][NEUTRAL] Um, that will be up to the provider because we don't determine patient responsibility here since we're not a major medical.
[CUSTOMER][NEUTRAL] OK, but upon checking on the same uh date, this is the only claim was built. There is no another claim was billed. So how this claim was denied for this reason, benefit maximum has been met on the day.
[AGENT][NEUTRAL] There wasn't another claim from your provider. There were other claims that came in for that data service.
[CUSTOMER][NEUTRAL] OK. And may I know, uh, may I know that date and when the last benefit was met?
[AGENT][NEUTRAL] The date of service is the [PII].
[CUSTOMER][NEGATIVE] But on the same day, the member doesn't have any other uh service. The only service is uh was taken for the provider, McDonald.
[AGENT][NEUTRAL] Right, but there, but more than one provider can file a claim. You weren't the only one to file a claim. So there were claims that came in before you and it was paid.
[AGENT][NEUTRAL] So when your claim
[CUSTOMER][NEUTRAL] OK. Can I get that information?
[AGENT][NEUTRAL] No, sir, we can't give you another provider's claim information. More than one provider can file a claim on the same data service, so multiple claims came in.
[AGENT][NEUTRAL] And claims were paid before your claim came in.
[CUSTOMER][NEUTRAL] OK. So, as per the member's plan, um,
[CUSTOMER][NEUTRAL] Per day, one plan, uh, sorry, one service is covered, right?
[AGENT][NEUTRAL] The benefit maximum for the data service has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And actually, we didn't receive any UOB. Can you please send the UOB to us?
[AGENT][NEUTRAL] Sure, uh, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Sure, it is [PII].
[AGENT][NEUTRAL] And should I put attention [PII]?
[CUSTOMER][NEUTRAL] So how uh
[CUSTOMER][POSITIVE] Yeah, you can.
[AGENT][NEUTRAL] And that was [PII]. I just want to confirm the fax number, please. [PII], is that correct?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, and then what question did you have?
[CUSTOMER][NEUTRAL] Yes, um, the total amount is going to be the patient's responsibility or the providers.
[AGENT][NEUTRAL] Again, we don't determine patient responsibility because we're not a major medical insurance, so that would be um whatever your policies or procedures are on outstanding or remaining balances.
[CUSTOMER][NEUTRAL] So it's up to the provider, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So like uh.
[CUSTOMER][NEUTRAL] Multiplan is not an insurance, so the payment is going to up to the providers.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm just asking, uh, I am like, yeah, I am a insurance, it's not insurance. So that's why the payment is going to the providers take off, right?
[AGENT][NEUTRAL] The insurance company is American Public Life. IMA does repricing for claims. American Public Life is not a major medical insurance company. Therefore, we do not determine patient responsibility. So that decision would be the provider or the primary insurance if they have other insurance.
[CUSTOMER][NEUTRAL] OK. And can I get the number for that primary insuran[PII]?
[AGENT][NEUTRAL] So that was just an ex that was an option. I don't know that the member has another insurance. I'm just letting you know the patient responsibility would be between the provider and if there's any other insurance.
[CUSTOMER][NEUTRAL] OK. OK. Thank you for the information. Can I get the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK. And when will we receive the EOB?
[AGENT][POSITIVE] Um, I'm sending that to you now via fax. So typically for faxes give it at least an hour. If you haven't received it by end of day today, you can definitely give us a call back and we'll be more than happy to resend it for you.
[CUSTOMER][POSITIVE] OK. Thank you for that and have a great day to you.
[AGENT][POSITIVE] Thank you, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all for now.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you have a great day.