AccountId: 011433970860
ContactId: cacffce5-32bf-4691-b33d-9242da3ed6c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 544020 ms
Total Talk Time (AGENT): 147433 ms
Total Talk Time (CUSTOMER): 245489 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/cacffce5-32bf-4691-b33d-9242da3ed6c2_20250616T20:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, good afternoon. This is [PII] from um
[CUSTOMER][NEUTRAL] Baptist Hospital. How are you?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][POSITIVE] Good thanks. I'm calling to check on the status of a claim, please.
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Yes. 1,458,880.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yes, um, [PII]. And I'm sorry, I'm sorry, your name said [PII], you said?
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][POSITIVE] Oh, I'm sorry. Here we go. OK. Thank you.
[CUSTOMER][NEUTRAL] Um, yes, [PII], the, the date of service is [PII], and the amount is $5100. We had a balance of $1,3377 from you guys.
[AGENT][NEUTRAL] OK. I'm pulling the information up for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So for the date of service of [PII], total we charge 5100, no claim is listed on file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Are you sure? I was told that you guys pay the check and the check. We did not, we did not find the check, so you guys will, here's the claim number, Tarika they gave me. So I'm looking for a new check because the previous check, it's um 2, wait a minute, the claim number.
[AGENT][NEUTRAL] May I have it?
[CUSTOMER][NEUTRAL] 22 Claim number 3549089.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I did pull this claim up.
[AGENT][NEUTRAL] And it looks like it has been reprocessed.
[AGENT][NEUTRAL] Where this policy was not active at that time of service.
[AGENT][NEUTRAL] It is showing that the term date, go ahead.
[CUSTOMER][NEUTRAL] Oh, that's weird. So I was, yeah.
[CUSTOMER][NEUTRAL] Um, I was told that, now I'm confused. I was told that you guys paid a check for, uh, in the amount check number 2029122.
[CUSTOMER][NEUTRAL] Um, check number, uh, check amount.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 25, that's it. That's the claim number 254. And you said that the check was sent uh in the amount of 1377, which is the balance that I'm showing on 22125, and we didn't get the check and I was told that by Tory that they were gonna stop payment on the check.
[CUSTOMER][NEUTRAL] I spoke to her on [PII] last month.
[CUSTOMER][NEUTRAL] Um, they were gonna stop payment on the check and reissue a new check.
[AGENT][NEUTRAL] OK, so I do see that the check that claim and that check has been reviewed, but when looking at this member's policy, this participant was not active at that time of service. This participant term date was [PII].
[AGENT][NEGATIVE] So there was actually no money that could have been paid out on this member.
[CUSTOMER][NEUTRAL] Hm. That's weird. So all this information that I'm getting is not correct. Um, are you sure? Let me look, make sure.
[AGENT][NEUTRAL] I do see the
[CUSTOMER][NEUTRAL] Yeah, I was wondering if there's another um policy number, hold on.
[AGENT][NEGATIVE] I do see that the member that claim that you're talking about was processed and it was paid, but that claim has now been reviewed and it shows that that that payment was not supposed to have been issued out. This member was not active, so no other payment will be made on this claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. All right, well, um, um, so you're saying that, you're saying that the policy was terminated from [PII]?
[AGENT][NEUTRAL] Yes, the term date for that member is [PII].
[CUSTOMER][NEUTRAL] Wow. OK. What is the, I'm gonna put a note because as I said that, you know, nobody told me that until now. So when I didn't see the check when you guys told me that um.
[CUSTOMER][NEUTRAL] That um
[CUSTOMER][NEGATIVE] The check was mailed and I didn't see it, so I said, oh, they said, I told them we didn't get. So was that, was, and was that check really paid? Then, so it, so was the first check, I wonder if that's the reason why we didn't get it because it was never really paid, cause
[AGENT][NEUTRAL] This first check was issued out.
[AGENT][NEUTRAL] And it was issued out on [PII]. So after speaking, after you spoke with that examiner, they then reviewed it and then it was reprocessed and you should receive an EOB which it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII] that was issued out to the provider and that will show that that claim was denied that the policy was not active at the time of service.
[CUSTOMER][NEUTRAL] And what was the full effective date from when to when? From when to [PII]?
[AGENT][NEUTRAL] It shows
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, because I see a claim that you guys paid for.
[CUSTOMER][NEUTRAL] Uh, data service, [PII]. You guys paid a claim, so I just wanted to make sure, um.
[AGENT][POSITIVE] Yes, even if that claim was paid, even though it was 130 or 22, we may not have received the drop date until after that. So as of right now, this member turned 112 of 22.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEGATIVE] OK. All right, great. No problem then. I just wanted to, you know, nobody told me that before, you know. They just told me that they paid the check that when I told them we didn't get the check, and they said, um, when I, when I look on the date and see that we didn't get the check, I said something is wrong, you know, we should have gotten the check. So then they say that the last thing they told me, oh, we'll just reissue we'll stop payment then reissue. And I said, OK. All right, no problem. Um, great. um perfect. Uh.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And there's no other policy numbers, right, um, [PII]?
[AGENT][NEUTRAL] For that time frame, there was no active policy number.
[CUSTOMER][POSITIVE] No other problem.
[CUSTOMER][POSITIVE] OK. All right. Great. Thank you so much. I appreciate your call, your time today.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You're so welcome and thank you so much for calling American Public Life, [PII]. Have a great day.
[CUSTOMER][POSITIVE] OK, have a good day.
[CUSTOMER][POSITIVE] Yes, thank you too. OK. Bye-bye. Bye-bye.
[AGENT][NEUTRAL] Bye bye.