AccountId: 011433970860
ContactId: cae1718d-3ccf-4ff7-8bc5-1243c05ee6b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1265550 ms
Total Talk Time (AGENT): 244192 ms
Total Talk Time (CUSTOMER): 661090 ms
Interruptions: 12
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/cae1718d-3ccf-4ff7-8bc5-1243c05ee6b3_20250421T19:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] calling from products office to check on client status. How are you doing today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Yeah, I'm great. Thank you for asking.
[AGENT][NEUTRAL] Hey [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The policy number of the patient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] His policy number was um
[CUSTOMER][NEUTRAL] Um, it's uh R as in Romeo, X as in X-ray, O as in Oscar, 2108285.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Um, our numbers don't have letters in them. It's just strictly numbers. They have a different number or last name.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Remember last name was um.
[CUSTOMER][NEUTRAL] 40, it's K as in Kilo, Hotel Oscar Romeo India Alpha Tango Yankee.
[CUSTOMER][POSITIVE] It's very well.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Did you say [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, I'm not pulling up that name. Do you have a group number?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 012001.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, I, I'm not pulling anything up under that. You have a social security number for the patient?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, I don't have the social number.
[CUSTOMER][NEUTRAL] Uh, I'll repeat the first name. So it's uh,
[AGENT][NEGATIVE] Not able to locate it.
[CUSTOMER][NEUTRAL] Hmm, I'm sorry?
[AGENT][NEUTRAL] Um, I didn't find anything under [PII]. I just use [PII].
[CUSTOMER][NEUTRAL] Flow.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah, I wasn't able to pull anything up under that name.
[CUSTOMER][NEUTRAL] Mhm. Uh, could I with date of birth?
[AGENT][NEUTRAL] Uh, we can't look my date of birth.
[CUSTOMER][NEUTRAL] OK. One moment. I'll check the medical records on.
[CUSTOMER][NEUTRAL] I'll let you know.
[CUSTOMER][NEUTRAL] And yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have any other information on it? I can only look by name, social, or group.
[CUSTOMER][NEUTRAL] Yeah, I'll check.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, I have medical. In medical record patient name was, uh, uh, last name is [PII] and last, uh, first name was [PII], and I have address, uh, also.
[AGENT][NEUTRAL] I, I'm not able to find anything with the information you provided.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah, actually, I have another claim. Uh, could you please help me with that?
[AGENT][NEUTRAL] OK, do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, give me one moment. I'll pull up the account and the like. Just give me one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Why
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, hello?
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah, I'm ready with the member ID 7709W150084.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Um, our, our numbers don't have any letters in them. Do you have the last name?
[CUSTOMER][NEUTRAL] Her last name is [PII].
[CUSTOMER][NEUTRAL] [PII]. And first name is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not pulling anything up under that name. Do you have a group number?
[CUSTOMER][NEUTRAL] 02640.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] I'm not pulling anything up under that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have any other numbers to try?
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Uh, I want I have, um, I don't have a different policy number.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, I have, uh, uh, I have one.
[AGENT][NEUTRAL] You have any other different pet policies to try somebody else information. OK, go ahead.
[CUSTOMER][NEUTRAL] Yeah, I wait. I have one more, uh, just one more.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] you say.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, my ID was 002513755.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Um, OK. What was that number again?
[CUSTOMER][NEUTRAL] Member ID, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 002513755.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I'm pulling up a totally different name. What's the birthday?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, um, yeah, it's not.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You don't, I don't have that information, so that must not be our policy number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's not your policy number?
[CUSTOMER][NEUTRAL] Uh, is this American Public Life, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But you're unable to pull the patient with the member ID and patient name, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, if you don't mind, could you please, uh, help me with this, is this correct?
[CUSTOMER][NEUTRAL] one or is this anything it's handled by another one. Could you please help me with that?
[AGENT][NEUTRAL] Help you with a different number.
[CUSTOMER][NEUTRAL] Uh, mhm.
[AGENT][NEUTRAL] OK. What's the number?
[CUSTOMER][NEUTRAL] Uh, actually, I don't have another one. Could you please help me with that? Uh, is this correct department or, uh, this number is, uh, forward to another one. Could you please let me know which one is correct?
[AGENT][NEUTRAL] I, I'm sorry, I don't understand. What are you saying?
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Mhm, no, I think that uh.
[AGENT][NEUTRAL] I can't find anything, any information you've provided, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, give me one moment.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh hello? Hello? Yeah. Yes, uh, give me one moment. I will transfer to my supervisor. Just, uh, could you please one minute.
[AGENT][NEUTRAL] Yes, do you have any other information?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, hi [PII] here from provider's office. Could you please help me with your first name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII]. So as I can see the
[CUSTOMER][NEUTRAL] Claim details. So, however, the primary has made the payment. So, and the primary insurances cross over the claim to your insurance. However, are you able to pull the facility?
[AGENT][NEUTRAL] No, I, I, I pulled by the policy number that he provided and the name and the group ID and I can't locate anything. Do you have other information you can provide?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'll, I'll, I'll give you the information. Hold on. So do you have the NPI correct NPI?
[AGENT][NEGATIVE] I, I can't locate anything in our system with the information that's been provided, so I, I'm not even able to look at claims or anything.
[CUSTOMER][NEUTRAL] OK, so, OK, so sorry for that. OK, I'll do one thing. I'll just give you, uh, the NPA of the provider. So we'll go by one by one, OK? OK.
[AGENT][NEUTRAL] I can't look by NPI. I can't look by NI MPI. I can only search by name, social security number, policy number, and group ID.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, hold on. I'll just help you with the policy ID of the claim, just a minute. It's American Public Life and the policy ID would be 002513755.
[CUSTOMER][NEUTRAL] So it's American Public Life, right?
[AGENT][NEUTRAL] Right, and I, and the name that.
[AGENT][NEUTRAL] Yes, but the name that he gave me with this number and the date of birth are completely different from what I have in our system.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'll help you again. So the patient's first name would be [PII]. That's [PII]
[CUSTOMER][NEUTRAL] And the last name would be
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I don't have this patient name. I have no claims on file.
[CUSTOMER][NEUTRAL] OK, just a minute. Let me check in the system.
[CUSTOMER][NEUTRAL] Did we bill the claim to your insured, so you're unable to find the patient itself, right? OK, just a minute. Just give me 30 seconds more so that I can check for the information of the claim and get back to you. Just a minute.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And by any chance, could you please help me with the mailing address, the claim mailing address?
[AGENT][NEUTRAL] Uh, claim mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Great. So as you stated, like you're unable to find the patient, I'll just check in the clearing house just a minute. So did we, uh, send the claim or not? Just a minute more.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yeah, thank you for holding the line. Just checking for the information so that uh it will be a good initiative like can I place your call on hold for a minute?
[AGENT][NEGATIVE] OK, we've been on the call 15 minutes and all policy numbers you've given me is incorrect. I can't find anything in our system.
[CUSTOMER][POSITIVE] OK, I do got it.
[CUSTOMER][POSITIVE] So sorry for that. Let me check for the SSN number. Hold on just a minute, ma'am.
[CUSTOMER][NEUTRAL] So is there any possibility that I can check with the MRN number?
[AGENT][NEUTRAL] With the what?
[CUSTOMER][NEUTRAL] MRN number?
[AGENT][NEUTRAL] The only, the only information that I can locate a patient by is the policy number, the name, social security number, and the group number.
[AGENT][NEUTRAL] Or group name.
[CUSTOMER][NEUTRAL] So with the help of the name, you're unable to find it, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just a minute.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, just checking for the information.
[AGENT][NEUTRAL] OK, yeah, I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can you just take our claims information and then look on your end when we get off the call?
[AGENT][NEGATIVE] Cause I'm, I'm not able to locate any.
[CUSTOMER][NEUTRAL] No, however, I'm checking.
[CUSTOMER][NEUTRAL] However, I'm checking the clearing house. It states like the claim was approved and uh processed. So,
[CUSTOMER][NEUTRAL] And the member ID?
[AGENT][NEUTRAL] You have a claim number?
[CUSTOMER][NEUTRAL] Just a minute. I, I just need to reconfirm the member ID again. It's 00.
[CUSTOMER][NEUTRAL] 002513755.
[AGENT][NEUTRAL] Yes, that's what I'm looking under.
[CUSTOMER][NEUTRAL] 3755, right?
[AGENT][NEUTRAL] I have no claims on file and the number, name and date of birth are different.
[CUSTOMER][NEUTRAL] Yes, we have this.
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] And you also don't, so do you have the patient? forgot about the date of birth. So do you have this patient?
[AGENT][NEUTRAL] No, we don't.
[CUSTOMER][NEUTRAL] OK, so you don't have the patient as well, right?
[AGENT][POSITIVE] Correct. Yes, that's what I explained, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there any other information that you need from me?
[CUSTOMER][NEUTRAL] Yeah, just a minute more.
[CUSTOMER][NEUTRAL] OK, I'll do one thing. As you stated, like there is no claim on file, so sorry, as you are not able to uh identify the patient as there is no patient, right under this insurance.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] So I'll do one thing. I'll just check the details once again.
[CUSTOMER][NEUTRAL] And as you, as you stated like it's an American Public Life Insurance, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But you should have a patient because the insured date of birth is [PII].
[AGENT][NEUTRAL] I don't, can't look by date of birth unless you provide the correct policy ID and name, and that's, I can't find anything under that.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, OK. So as you stated like with the name, so with the help of this name, reach [PII], are you not able to find the member?
[AGENT][NEUTRAL] No, I cannot.
[AGENT][NEUTRAL] So I don't, I don't know what else we're trying to verify. Do you need our fax number? You can try to send it to us again.
[CUSTOMER][NEUTRAL] No, we don't need the fax number.
[AGENT][NEUTRAL] OK. What else can I provide for you?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, I'll do one thing. I'll just, no, we have billed the claim to your insurance, but however, I'm unable to get the policy ID as you stated like it's incorrect. So I'm not able to rectify like how the clearing houses passed the claim.
[CUSTOMER][NEGATIVE] And you're unable to find the patient.
[AGENT][NEUTRAL] I contact the medical provider.
[AGENT][NEUTRAL] If they can help.
[CUSTOMER][NEUTRAL] Uh, so is there any possibility, so is there any possibility that I can help you, help you with the last four digits of the SSN number? No. OK, no issues. I'll do one thing. I'll collect all the information of the claim and give you a call back, OK.
[AGENT][NEUTRAL] I can look by the full social security number. Do you have that?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] So is there any possibility where like you put me back in queue?
[AGENT][NEUTRAL] No, you'll just have to call back.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK, just help me with the call reference number.
[AGENT][NEUTRAL] It's my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] Today's date is [PII], right?
[AGENT][POSITIVE] [PII], yes, that's correct.
[CUSTOMER][NEUTRAL] [PII], today's date.
[AGENT][NEUTRAL] It's
[CUSTOMER][POSITIVE] OK, great. I'll do one thing. I'll just check the information and give you a call back, OK? Thank you so much. Bye-bye.
[AGENT][POSITIVE] OK, thank you.