AccountId: 011433970860
ContactId: cf5695d7-cd5e-406d-85c0-b093d418b8b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1330579 ms
Total Talk Time (AGENT): 342821 ms
Total Talk Time (CUSTOMER): 424977 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/cf5695d7-cd5e-406d-85c0-b093d418b8b3_20250604T14:58_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, this is [PII] calling from Skin and Cancer Associates. How are you doing today?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][POSITIVE] I'm also doing good. Thank you for asking. And I'm calling to check the claim status.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] Yes, before I proceed with that, please be informed that this call has been recorded for quality and training purpose. Would you like us to continue the recording?
[AGENT][NEUTRAL] Yes, may I please have the callback number.
[CUSTOMER][NEUTRAL] Yes, my good callback number is [PII].
[AGENT][NEUTRAL] And the policy number please?
[CUSTOMER][NEUTRAL] Yes, the policy number is
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] That's not the policy number that is our electronic payer ID.
[CUSTOMER][NEUTRAL] Sorry. Uh, but as for our records, we see that the claim was billed with that same number.
[CUSTOMER][NEUTRAL] Can you check with the group number?
[AGENT][NEUTRAL] Do you have the card on file?
[CUSTOMER][NEUTRAL] No, we don't have the card for this number.
[AGENT][NEUTRAL] May I please have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes. Member's first name is
[CUSTOMER][NEUTRAL] It is [PII]
[CUSTOMER][NEUTRAL] And the last name is [PII].
[AGENT][NEUTRAL] Could you spell both for me please?
[CUSTOMER][NEUTRAL] Yes, first name, [PII], it is [PII], and the last name, [PII], [PII] is [PII].
[AGENT][NEUTRAL] And may I please have the date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm not finding a member by that name in our system.
[CUSTOMER][NEUTRAL] Uh, can you check with the group by your group number?
[AGENT][POSITIVE] OK, you're more than welcome. Give me that group number please.
[CUSTOMER][NEUTRAL] Yes. It is 17886.
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what was the spelling of the last name again?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] OK, so actually the member does have a different last name.
[CUSTOMER][NEUTRAL] Different last name?
[AGENT][NEUTRAL] Yes, so you have to get that from that member. So, the date of birth was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you're calling in for status. May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] and the total bill amount is $468 even.
[AGENT][POSITIVE] Thank you, and you can also check claim status via our secured portal that is [PII] and I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for the data service of 9424-468 no claim is on file.
[AGENT][NEUTRAL] And would you like the correct policy number?
[CUSTOMER][NEUTRAL] Yes, I want the correct policy number.
[AGENT][NEUTRAL] The policy number is 02.
[AGENT][NEUTRAL] 28
[AGENT][NEUTRAL] 18
[CUSTOMER][NEUTRAL] Please wait for a moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Sorry, can you please repeat it from the starting once again?
[AGENT][NEUTRAL] OK, this would be my last time repeating it. That number again is 02.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 28
[AGENT][NEUTRAL] 1872.
[CUSTOMER][NEUTRAL] OK, thank you. And may I, can you please verify the mailing address and the payer ID which we have billed to initially?
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that electronic payer ID would be the 60801.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, and can I get the, can I get the call reference for this member?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, the call reference would be my first name [PII], last initial of [PII] in today's state, and are you needing me to spell my first name for you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It is spelled [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for that.
[CUSTOMER][NEUTRAL] And I do also have other claims to check the status. Can you please help me with that?
[AGENT][NEUTRAL] Is it a different member or the same member?
[CUSTOMER][NEUTRAL] For the different member?
[AGENT][NEUTRAL] May I please have that policy number?
[CUSTOMER][NEUTRAL] Yes, please wait for a moment.
[CUSTOMER][NEUTRAL] OK. Oh my God. Uh, yes, for this member also, we have billed with this payer ID.
[CUSTOMER][NEUTRAL] Can you please check with the patient's name and date of birth? For this number, we don't have group number also.
[AGENT][NEUTRAL] You said you do or you don't have the group number?
[CUSTOMER][NEUTRAL] We don't have.
[AGENT][NEUTRAL] May I have the member's first and last name please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, member's first name is [PII]. It is [PII], and the last name is [PII]. It is [PII].
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Yeah. Can I go with the date of birth?
[AGENT][NEUTRAL] I'm pulling the member's name up.
[CUSTOMER][NEUTRAL] OK, please.
[AGENT][NEUTRAL] And the spelling of the last name is [PII].
[CUSTOMER][NEUTRAL] No, there is no [PII] in between. It is [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Date of birth please.
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] and the total bill amount is $359 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I did pull that claim up for you and it does look like we did receive that claim twice.
[AGENT][NEUTRAL] And I'm getting both of those claims information for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the first date of receipt was [PII] of 25.
[AGENT][NEUTRAL] That claim number is 355.
[AGENT][NEUTRAL] 3996.
[AGENT][NEUTRAL] The claim was processed on [PII].
[AGENT][NEUTRAL] That claim denied that office visits are not covered under the patient's plan.
[AGENT][NEUTRAL] Then we did receive it again.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] With that claim number.
[AGENT][NEUTRAL] 358
[AGENT][NEUTRAL] 0638. That claim denied as a duplicate of the previous submitted claim.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, Salu?
[CUSTOMER][NEUTRAL] Uh, so, uh, as per our records, we see that we received the, the duplicate, uh, EOB, the claim which is denied as duplicate. We received that EOB, but we did not receive the EOB which is denied as office visits are not covered. So, can you please send us the EOB of previous claim?
[AGENT][NEUTRAL] May I have a fax number because you can also pull it up via the secured portal as well. May I have that fax number?
[CUSTOMER][NEUTRAL] To our fax number.
[CUSTOMER][NEUTRAL] Yes. Our fax number is [PII].
[AGENT][NEUTRAL] Attention.
[CUSTOMER][NEUTRAL] And my attention would be my name, [PII]
[CUSTOMER][NEUTRAL] And my last name initial [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I will get the request submitted over to you. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Yes, I do have.
[CUSTOMER][NEUTRAL] More 4 claims to check the status. Can you please help me with that?
[AGENT][NEUTRAL] I do have the option to check 3 more.
[AGENT][NEUTRAL] And may I have the next one, please?
[CUSTOMER][NEUTRAL] Yes. The next policy um ID is
[CUSTOMER][NEUTRAL] Yes, the next member's policy number is 1,154,050.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, Patient first name is [PII]. My last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Data service and total bill.
[CUSTOMER][NEUTRAL] Uh, date of service is [PII] and the total bill amount is $536 even.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] I'm pulling that up for you now.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So for that claim, it does show that we did receive it on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 355.
[AGENT][NEUTRAL] 92
[AGENT][NEUTRAL] 02.
[AGENT][NEUTRAL] The claim process and denied that the policy was not active at the time of service. The term date for this policy is [PII].
[CUSTOMER][NEUTRAL] Term date is on [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. So, do you have any other active insurance information?
[AGENT][NEUTRAL] You have to check with the policy holder.
[CUSTOMER][NEUTRAL] We have to check with the policyholder. Oh, thank you. Thank you, [PII]. Thank you for that. Uh, so as we do not have any information on our records, can you please send us the UV through our fax number?
[AGENT][NEUTRAL] Yes, and it's the same fax number as given before?
[CUSTOMER][POSITIVE] Yes, that is right.
[AGENT][NEUTRAL] OK, I will get that request as well. May I have the next policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The next member's policy number is 01659528 M as in Mary, L as in Lima.
[CUSTOMER][NEUTRAL] And number 8
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, patient's first name is [PII] and the last name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Data service and total bill.
[CUSTOMER][NEUTRAL] Yes, it is [PII] and the total bill amount is $346 even.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] And I'm pulling that up for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it does show that we did receive that claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 357-064-7.
[AGENT][NEUTRAL] It shows that the maximum per calendar office visits has been met.
[CUSTOMER][NEUTRAL] Uh, how many visits are covered for this member in a calendar year?
[AGENT][NEUTRAL] For this member policy, verification of coverage does not guarantee the payment of the claim. It does show that the member has a total of 4 office visits.
[CUSTOMER][NEUTRAL] 4 office visits.
[CUSTOMER][NEUTRAL] OK. Uh, but we don't see any payment from the payer for this member. Is this
[AGENT][NEUTRAL] The member may have other office visits, not referring to your office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, was the 4 digits were covered for this member?
[AGENT][NEUTRAL] As I previously stated, their claim denied that the office visit Max had been met.
[CUSTOMER][NEUTRAL] OK. So, as for you, this, uh, for this number, the 4 digits were covered under the different providers, right?
[AGENT][NEUTRAL] As I previously advised, they have already been met. I can't disclose any other information but the denial for that claim.
[CUSTOMER][NEUTRAL] OK. So can you please send us the UV through our fax number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, please
[AGENT][NEUTRAL] Next policy, please.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, the next policy number is 008199917.
[AGENT][NEUTRAL] That's too many numbers for our policy.
[CUSTOMER][NEUTRAL] Sorry, I did not get that.
[AGENT][NEUTRAL] That is too many numbers for our policy number.
[CUSTOMER][NEGATIVE] It's too many numbers.
[AGENT][NEUTRAL] You said it was 008199917.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That is too many numbers for our policy number.
[CUSTOMER][NEUTRAL] OK. So, but as per our record, we see that only that number. Uh, can you please check with the patient's name and date of birth?
[AGENT][NEUTRAL] May I have that, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, but I'm needing you to spell the first and last name please.
[CUSTOMER][NEUTRAL] Yes. The first name is [PII].
[CUSTOMER][NEUTRAL] And the last name is [PII]. It is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And for the name of [PII] that member is not listed in our system.
[CUSTOMER][NEUTRAL] Not listed in your system?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you. Take care. Thank you for your information.
[AGENT][POSITIVE] You're welcome, and I do wanna thank you so much Sou for calling American Public Life. You have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you and bye for now. Have a nice day.
[AGENT][NEUTRAL] Same to you bye bye.