AccountId: 011433970860
ContactId: d26ba5ad-c6f2-4b67-b4b7-2abc7e33019b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 504929 ms
Total Talk Time (AGENT): 120852 ms
Total Talk Time (CUSTOMER): 187198 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/d26ba5ad-c6f2-4b67-b4b7-2abc7e33019b_20250303T16:43_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, uh, can you please help me with the claim status?
[AGENT][NEUTRAL] OK, what's your name?
[CUSTOMER][NEUTRAL] My name is [PII] and I'm from provider's office Ms Hospital.
[AGENT][NEUTRAL] OK, you said your name is [PII]?
[CUSTOMER][NEUTRAL] O
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK, and you're checking claim status, we can help with the claim status. What's the policy number?
[CUSTOMER][NEUTRAL] Policy number is gonna be 023299-990.
[AGENT][NEUTRAL] And what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure. Uh, it's gonna be [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] uh after that right?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You can.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Correspondent.
[CUSTOMER][NEUTRAL] Fla
[CUSTOMER][NEUTRAL] Terminator or not.
[AGENT][NEUTRAL] [PII], can you verify the patient's name and date of birth for me?
[CUSTOMER][NEUTRAL] Sure. Uh patient's first name is [PII] and the last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And what's the data service [PII]?
[CUSTOMER][NEUTRAL] Date of service is [PII] until [PII].
[AGENT][NEUTRAL] [PII] through [PII].
[CUSTOMER][NEUTRAL] [PII] until [PII].
[AGENT][NEUTRAL] [PII]. OK, and the amount?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Total charges for $2,748.50.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mo
[AGENT][NEUTRAL] And you said the patient's name is [PII] with the date of birth of [PII], correct?
[CUSTOMER][NEUTRAL] Um, she's the mother, uh, but I do have another claim for, uh, the mother, but, uh, I just want to get the information but for the baby's claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm not showing anyone else on this policy.
[AGENT][NEUTRAL] I'm showing that this policy is an individual policy.
[CUSTOMER][NEUTRAL] OK, um, OK, so would you please, uh, check and let me know, uh, um, lastly, uh, claim and the date of service would be the same, and, uh, the total charge is gonna be $1,602 even.
[AGENT][NEUTRAL] Is this for the dependent child?
[CUSTOMER][NEUTRAL] Um, previously was for the dependent child, uh, and the 1602 is for the same patient, I see.
[AGENT][NEUTRAL] OK, but the dependent child is not covered under the policy.
[CUSTOMER][NEUTRAL] OK I mean.
[AGENT][NEUTRAL] They're not on this policy.
[CUSTOMER][NEUTRAL] Sure, sure, uh, and I just want to get that mother's claim information. So can you please check?
[AGENT][NEUTRAL] Oh, the OK, so I'm gonna keep for you. The second data service you gave me is for [PII].
[CUSTOMER][NEUTRAL] Yes, for the last week.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me that date again, please.
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] And give me the total charge again please.
[CUSTOMER][NEUTRAL] Really
[CUSTOMER][NEUTRAL] 1602
[AGENT][NEUTRAL] OK, and the first date of service you gave me was for the dependent child, correct?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] That's not on the policy, OK.
[AGENT][NEUTRAL] And this is for a hospital charge or professional charge?
[CUSTOMER][NEGATIVE] It's unprofession.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And is this a medical claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so the policy number that you gave me is for a dental policy. I do not show they have a medical policy with American Public Life.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, but I do see that like, uh, um, hospital claim was also just.
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] I'd have the same policy number for the medical too.
[CUSTOMER][NEUTRAL] And uh UB claim was uh processed and applied the patient's responsibility.
[AGENT][NEUTRAL] Yeah, so the
[AGENT][NEUTRAL] Processed by whom?
[CUSTOMER][NEUTRAL] Um, yeah, by APL only.
[AGENT][NEUTRAL] And where do you have a claim number of the process claim?
[CUSTOMER][NEUTRAL] Yes, it's 353-10008.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, and so you have the explanation of benefits, so what information did you need on it?
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] OK. Um, so, uh, for the PS 1160 to claim, I just want the explanation of benefits because I didn't receive any um information for that. Only I have the uh hospital billing claim, not the physician.
[AGENT][NEUTRAL] OK, so this medical claim was submitted under a dental policy, which is they do not have a medical plan, so we denied it saying that this is a dental only policy. There are no medical benefits. So there is no medical policy for this patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. So you are asking us to submit uh the claim again, right? With the medical, medical policy.
[AGENT][NEUTRAL] No, I'm saying that they do not have a medical policy for you to submit the claim, so their medical coverage could be through a different carrier other than American Public Life.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So do you have that information that like uh patient has any other insurance information?
[AGENT][NEUTRAL] You'll have to check with the patient for that information. I to see who their medical carrier is. We do not have that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 28
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] OK. Anything else?
[CUSTOMER][NEUTRAL] And uh would you please help me with the call reference number?
[AGENT][NEUTRAL] It's gonna be my name in today's date, [PII].
[AGENT][NEUTRAL] Oh [PII] first initial last name is [PII]. Anything else, [PII]?
[CUSTOMER][POSITIVE] Uh, I'm good with this, [PII]. Thank you for helping, and have a nice day.
[AGENT][POSITIVE] Alright, thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] Yeah bye for now.