AccountId: 011433970860
ContactId: c9ef84ad-79bf-4406-90ff-94bd9210171d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 733809 ms
Total Talk Time (AGENT): 298419 ms
Total Talk Time (CUSTOMER): 241789 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/c9ef84ad-79bf-4406-90ff-94bd9210171d_20250620T17:57_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from Pros office. How are you doing today?
[AGENT][POSITIVE] I'm good, [PII]. How are you today?
[CUSTOMER][NEUTRAL] Yeah, I'm fine. Thank you for asking. Can you please spell out your name for documentation, please?
[AGENT][NEUTRAL] How can I help you?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Am I right?
[AGENT][NEUTRAL] The last letter [PII]
[CUSTOMER][NEUTRAL] Yeah, I see like
[CUSTOMER][NEUTRAL] [PII] thank you so much. Uh, uh, I see, may I know the claim status actually claim was adjusted. It was declined. Can you please assist me for that?
[AGENT][NEUTRAL] OK, [PII], you're wanting claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that and what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, what are the last four numbers again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Yeah, one claim only.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah. Um, remember, D for Delta 43302156.
[AGENT][NEUTRAL] OK, now that, did you say D was the first thing you said?
[CUSTOMER][NEUTRAL] Yes, and uh uh first letter is D for Delta 43302156.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you, but [PII], that is not an APO policy number. That is an IMA or 90 degree benefit number. Were you trying to reach 90 Degree benefits or American Public Life?
[CUSTOMER][NEUTRAL] Actually, I don't know. I, I was checking this number only. So, uh the insurance company number.
[CUSTOMER][NEUTRAL] So I have dialed this number. Can you please forward this uh uh proper uh representative.
[AGENT][NEUTRAL] Uh, what is the policy?
[AGENT][NEUTRAL] You should, I cannot, no, sir, that's another company's number. I can't look up information with that the number that you gave me. If the member has a policy number with APL, they should have that on the ID card also.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah, I'm looking for ID card also, but I, I'm not getting the information in the ID card.
[CUSTOMER][NEUTRAL] So that's why I'm calling you.
[AGENT][NEUTRAL] What number did you call [PII] to reach me on today?
[CUSTOMER][NEUTRAL] Uh, it's uh [PII], actually I caller number.
[CUSTOMER][NEUTRAL] Uh, this number only, actually, I will just me, please.
[CUSTOMER][NEUTRAL] Yeah, it's uh
[CUSTOMER][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], so you should have another number. Yes, it is, um, and that is a 90 degree, yes, that is correct, but that is not our policy number that you just provided for me. Do you have the member's full social security number?
[CUSTOMER][NEUTRAL] This is the American public.
[CUSTOMER][NEUTRAL] This is American, American Public Life.
[CUSTOMER][NEUTRAL] No, actually, I don't have social security number.
[AGENT][NEUTRAL] I can, OK, I can try by the name, [PII]. If the name is, if I'm not able to locate it, then you would have to just get the correct policy number to call us back. What is the last name of the patient?
[CUSTOMER][NEUTRAL] Yeah. Last name is [PII], [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you're gonna need to spell all of that again slower because I'm not understanding you, [PII]. What is the first name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. First name is [PII].
[AGENT][NEUTRAL] OK, and the last name?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] just
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What state does the patient live in?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What state? Yes, what state does [PII] live in?
[CUSTOMER][NEUTRAL] Could you please do it again?
[CUSTOMER][NEUTRAL] [PII], yes, you're asking straight, right?
[AGENT][POSITIVE] That is correct. That is what I'm asking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then are you checking?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And any information that I provide for you, [PII] will be a verification of benefits and not a guarantee of payment. Are you trying to check on some type of medical claim?
[AGENT][NEUTRAL] For this number?
[CUSTOMER][NEUTRAL] Yes, my name. Yes, medical. I'm looking for this one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is the patient's date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, so the correct policy number that you should have Jack for APL is 2502125.
[CUSTOMER][NEUTRAL] 12 5, lastly, all right?
[AGENT][NEUTRAL] Right, and what is the date of service and total bill amount please for her?
[CUSTOMER][NEUTRAL] Yeah, that data services. [PII]. Total bill amount is $1,763 even.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, this claim has been received more than once. The most recent one received was denied as a duplicate of previously submitted expenses. Are you needing the original claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so the original claim was received [PII].
[AGENT][NEGATIVE] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number.
[CUSTOMER][NEGATIVE] Oh, it was denied.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] On those dates that I just gave you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the claim number is.
[CUSTOMER][NEUTRAL] Yeah, uh, [PII].
[CUSTOMER][NEUTRAL] Yeah, please go ahead.
[AGENT][NEUTRAL] The claim number is 350.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] 350
[AGENT][NEUTRAL] Mhm. 5274. Again, it's 350-5274.
[CUSTOMER][NEUTRAL] 2, yeah.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] And the reason for the denial on this claim?
[AGENT][NEUTRAL] States covered diagnostic benefits are limited to one, an MRI.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] To a CT scan.
[CUSTOMER][NEUTRAL] Uh, could you please repeat again? Our diagnosis limited?
[AGENT][NEUTRAL] And then the
[AGENT][NEUTRAL] OK. I'm gonna read the paragraph to you.
[AGENT][NEUTRAL] Covered diagnostic benefits.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] are limited to, mhm.
[CUSTOMER][POSITIVE] Benefits, OK.
[CUSTOMER][NEUTRAL] Limited to
[AGENT][NEUTRAL] MRI.
[CUSTOMER][NEUTRAL] MRI.
[AGENT][NEUTRAL] CT scan?
[CUSTOMER][NEUTRAL] 3G
[AGENT][NEUTRAL] C as in Charlie. T as in Tango, CAT scan.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And colonoscopy.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Colonoscopy.
[CUSTOMER][NEUTRAL] Askpay, am I right?
[AGENT][NEUTRAL] Colonoscopy, C O L O N O S C O P Y.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] E Y
[AGENT][NEUTRAL] After that, it says other.
[AGENT][NEUTRAL] Diagnostic testing.
[CUSTOMER][NEUTRAL] Rode.
[CUSTOMER][NEUTRAL] Dusting, OK.
[AGENT][NEGATIVE] Is not covered.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Under this policy.
[CUSTOMER][NEUTRAL] Under this policy.
[AGENT][NEUTRAL] Therefore,
[CUSTOMER][NEUTRAL] So I'm therefore,
[AGENT][NEGATIVE] No benefits.
[AGENT][NEUTRAL] Are payable.
[CUSTOMER][NEGATIVE] No benefits.
[AGENT][NEGATIVE] No benefits are payable for this date of service.
[CUSTOMER][NEUTRAL] For this date of service.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits with those remarks on it, you should be able to print it.
[AGENT][NEUTRAL] [PII] from our portal by using that claim number if you go to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So I need to, uh, so I'm looking for, uh, this, OK. Uh, may I know the reason for this claim for billing or uh
[CUSTOMER][NEUTRAL] To, uh, may I know, may, may I have to send the billing team for this claim?
[AGENT][NEUTRAL] Uh, I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Uh, I'm looking for, uh, the claim is going to be billing or uh
[CUSTOMER][NEGATIVE] denied.
[AGENT][NEUTRAL] The claim was denied, [PII], and I just read you the denial remark.
[AGENT][NEGATIVE] As to why it was denied.
[CUSTOMER][POSITIVE] Yeah. Thank you so much. Ma'am.
[CUSTOMER][NEUTRAL] Yeah. May I have the call reference number, please?
[AGENT][NEUTRAL] Yes, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] Yeah, your name.
[CUSTOMER][POSITIVE] Uh, great date. All right.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] My name is [PII], yes, sir, and I spelled it for you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, yes. Uh I got.
[CUSTOMER][NEUTRAL] Anything else as of now, I need to add for this claim?
[AGENT][NEUTRAL] That is all the information for this claim.
[CUSTOMER][NEUTRAL] OK. OK. OK, [PII], thanks for giving the proper information for this claim.
[AGENT][POSITIVE] OK. Well, you're welcome. Yes, and is there anything else that I can help you with today, [PII]?
[CUSTOMER][POSITIVE] No, no, actually, as of now you're giving proper information for this claim, a great weekend.
[AGENT][POSITIVE] OK. Well, I hope you have a nice weekend as well and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you so much, sir.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.