AccountId: 011433970860
ContactId: cbc713b2-2654-4a95-9e0e-7a51cec16de2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 824789 ms
Total Talk Time (AGENT): 275602 ms
Total Talk Time (CUSTOMER): 277947 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/cbc713b2-2654-4a95-9e0e-7a51cec16de2_20241231T15:23_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider's office checking on claims.
[AGENT][NEUTRAL] OK. Did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Oh, [PII]. OK. Thank you. And [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Mhm. And mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] Mhm it's [PII].
[CUSTOMER][NEUTRAL] [PII] is a direct line.
[AGENT][NEUTRAL] Thank you. And how many claims?
[CUSTOMER][NEUTRAL] And your name is [PII]. mhm mhm.
[AGENT][NEUTRAL] [PII] and my name and today's date [PII] will also be your call reference number.
[AGENT][NEUTRAL] And how many times?
[CUSTOMER][POSITIVE] Oh OK, yeah, I got it. Thank you.
[AGENT][NEUTRAL] Uh-huh. How many claims?
[CUSTOMER][NEUTRAL] I do have 555 planes for a member, single member.
[AGENT][NEUTRAL] OK, 5 different dates of service for 1 member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you. And any information that I provide for you today, [PII], on any of the claims will be a verification of benefits and not a guarantee of payment. What is your patient's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Policy number is AC 0527.
[AGENT][NEUTRAL] OK, now that is not an American public life policy number. What company were you trying to reach, [PII]?
[CUSTOMER][NEUTRAL] American Public Life mhm uh.
[AGENT][NEUTRAL] OK, that's not a valid number.
[CUSTOMER][NEUTRAL] OK. Let me check the postcard for the patient. Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII], the, I have the policy number is exactly what I sent you on the card as well.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] AC 0527.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is the name of the insurance company on that ID card itself?
[CUSTOMER][NEUTRAL] American Public Life Insurance Company.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That is
[CUSTOMER][NEUTRAL] APL.
[AGENT][NEUTRAL] A.
[CUSTOMER][NEUTRAL] Do you want, can you verify with the patient?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is not a valid number for our company. I don't know why, I mean, on the ID card.
[AGENT][NEUTRAL] AC 0527.
[CUSTOMER][NEUTRAL] Can you verify
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir. Not for American, maybe American Republic, but not American public life.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, it's the, I do have the patient ID card here with me. It's American Public Life Insurance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do have as a group number if you want the group number for the patient name or date of birth if you can verify with them.
[AGENT][NEUTRAL] What is the group number?
[CUSTOMER][NEUTRAL] Group number 5485.
[AGENT][NEUTRAL] What is the last name of the patient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Last name of the patient is [PII]
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, there is no one under what is showing as the place of employment? What is the name of that group?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Family of lake physician.
[AGENT][NEUTRAL] OK. That, I'm not sure what type of
[CUSTOMER][NEUTRAL] You want to know the provider where I.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Are you able to find, locate the patient?
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. I don't know what that, what is her date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, there is this policy, I located a policy for that member with that name, but it is not the policy number that you gave me, and this policy is not active. It has not been active with APL since [PII].
[CUSTOMER][NEUTRAL] Patient policies is not do you, you do look at the patient with the information.
[AGENT][NEGATIVE] Not with that policy number that you gave me, no.
[AGENT][NEUTRAL] I looked it up under that group, but again, what type of policy is this?
[CUSTOMER][NEUTRAL] OK, but
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me check something.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] There is one policy that is active with our company. Again, it is not that number that you gave me. This is a cancer policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, but the, the same cancer policy, the, the policy number is AC 057.
[AGENT][NEUTRAL] 98, that is the old policy number, yes. The newer policy number issued is 83401.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] OK. Date of service, first date of service I have is [PII].
[AGENT][NEUTRAL] Mhm. Total.
[CUSTOMER][NEUTRAL] Bill amount $484.
[CUSTOMER][NEUTRAL] 484.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And [PII] is the date of service?
[CUSTOMER][NEUTRAL] Yeah, [PII] this year.
[AGENT][NEUTRAL] There is no claim on file.
[AGENT][NEUTRAL] Yes, there is no claim on file.
[AGENT][NEUTRAL] For the state of service.
[CUSTOMER][NEUTRAL] No claim on file for this data service could you?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Mhm. Could you please verify the patient effective dates?
[AGENT][NEUTRAL] 10, this again, this is a cancer policy and effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To present, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do have these medical claims. Will this medical claim be covered under the cancer policy or not?
[AGENT][NEUTRAL] This is a cancer policy, not medical claims.
[CUSTOMER][NEUTRAL] OK, so the medical claims will not be covered under the cancer policy.
[AGENT][NEUTRAL] No, sir. Uh, I mean, this, again, it's a cancer policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's another day of service?
[CUSTOMER][NEUTRAL] OK. Could you also
[CUSTOMER][NEUTRAL] Mhm. Another date of service I have is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bill amount $484.
[AGENT][NEUTRAL] Yes, sure, no claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and the what timely filing limit for the claims.
[AGENT][NEGATIVE] Uh, there is no timely filing.
[CUSTOMER][NEUTRAL] OK. And the claim mailing address?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do, could you
[CUSTOMER][NEUTRAL] OK, [PII], could you repeat the from [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, thank you, [PII]. Could you also please provide me the new order that you said.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Updated policy number.
[AGENT][NEUTRAL] 83401. And again, this is for cancer coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you, [PII]. I do need more data service. Could you please check that? Do they also not on file or not?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The OK, next date of service is [PII] bill amount for $84.
[AGENT][NEUTRAL] Not on file.
[CUSTOMER][NEUTRAL] [PII] bill amount for $84.
[AGENT][NEUTRAL] How much was the bill's amount for 102?
[CUSTOMER][NEUTRAL] 484.
[AGENT][NEUTRAL] 40, same thing, 484?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] $48484.
[AGENT][NEUTRAL] That's OK, that's the same billed amount as the other dates of service and that is also the bill amount for 12, no claim on file.
[CUSTOMER][NEUTRAL] Yeah. Yeah. Mhm.
[CUSTOMER][NEUTRAL] OK, and the last date of service [PII] build amount $195.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Actually
[AGENT][NEUTRAL] No claim on file.
[CUSTOMER][NEUTRAL] OK, [PII], no problem. Mhm.
[CUSTOMER][NEUTRAL] OK, and the reference number will be your name and today's date, right?
[AGENT][POSITIVE] Yes, sir that is correct.
[AGENT][NEUTRAL] And for future reference, um, also, [PII], once claims have been filed and processed with APO, we do have a portal that you can check claim status in, and that portal website is secured. [PII].
[CUSTOMER][NEUTRAL] OK, would any
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And uh yeah, can I know the initial to your last name?
[AGENT][NEUTRAL] S
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. That's all the information I needed from you today. Hope you do have a great day and, and a great year ahead.
[AGENT][NEUTRAL] OK, well.
[AGENT][POSITIVE] Uh, I hope you do too, [PII]. Thank you very much. And if that is all I can help you with, thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] Uh-huh. Yes, you're very welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Hello