AccountId: 011433970860
ContactId: d28fc29d-7fb0-4d7b-a749-b7bb53db73cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375940 ms
Total Talk Time (AGENT): 86580 ms
Total Talk Time (CUSTOMER): 201552 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/d28fc29d-7fb0-4d7b-a749-b7bb53db73cd_20250114T19:02_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] Hey, this is [PII] with the care team. How are you doing today?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][POSITIVE] Hey, I'm doing wonderful. I do have an insured on the line, um, who is, um, needing to speak to somebody today about a claim that was denied.
[AGENT][NEUTRAL] OK. May I have the policy number?
[CUSTOMER][NEUTRAL] Yes, I'm looking at policy number 1463092.
[AGENT][NEUTRAL] And the caller?
[CUSTOMER][NEUTRAL] Um, it's Miss [PII], the insured part one.
[AGENT][NEUTRAL] OK, and may I have the callback number?
[CUSTOMER][NEUTRAL] Yes, absolutely it is um the [PII] that she's calling from.
[AGENT][NEUTRAL] And what and what was the claim number again?
[CUSTOMER][NEUTRAL] Yes, it's for her husband claim number 3541035.
[AGENT][NEUTRAL] OK. So what question did she have on this client?
[CUSTOMER][NEUTRAL] Um, yeah, so she, um, stated that she spoke to somebody in December and they spent like an hour on the phone with her an examiner and somebody from the hospital and that this, um, claim here was from a hospital, not from an office visit, and so she can't understand why it's being denied for an office visit, um, because it was like for.
[CUSTOMER][NEUTRAL] A procedure done in the hospital?
[AGENT][NEUTRAL] I'm pulling that image up as well.
[AGENT][NEUTRAL] OK, you're more than welcome to transfer because what we received in this is an office visit, so denied correctly.
[CUSTOMER][POSITIVE] OK perfect I will um send her to you, Ms. [PII], and I'll introduce you when we join. Is that OK?
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][POSITIVE] Thank you so much. 1 2nd.
[CUSTOMER][POSITIVE] Hi Ms. [PII], are you still there with us today? Yes ma'am. Hey, thank you so much for your patience. I do have Miss [PII] on the line with us she's one of our examiners and she's gonna be able to talk to you about that claim, OK? All right, thank you so much ma'am. You have a blessed day. Thank you you too take care. All right.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hi, yes, my name is [PII] and you're needing assistance on a claim for your spouse?
[CUSTOMER][POSITIVE] Yes ma'am. Good good afternoon. How are you?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][POSITIVE] Very good, man. Thank you. Do you have the policy number or you need it?
[AGENT][NEUTRAL] Yes, I have the policy number.
[CUSTOMER][NEUTRAL] OK, I, I'm, I'm not sure if there's a note in there because I just came back from out of the country from December and I'm just looking at all the mail and I see that the claim was denied from my husband. It wasn't an office visit. It was an abdominal ultrasound.
[CUSTOMER][NEUTRAL] And even the day I spoke to the rep, I have Cleveland Clinic rep.
[CUSTOMER][NEUTRAL] On the phone because Cleveland Clinic calls to verify and they have me on the phone. In fact, I didn't even have the new card because I gave Cleveland Clinic the wrong PO box, not knowing it was the new one was Oklahoma or something.
[CUSTOMER][NEGATIVE] But I came back now and I see that it said office visits are not covered. It was never an office visit. It was an abdominal ultrasound.
[CUSTOMER][NEUTRAL] And I just want to use the gap, the 1000 to pay it off.
[AGENT][NEUTRAL] OK, and this is for the data service of 3:15 or 24?
[CUSTOMER][NEGATIVE] To be honest, I don't know the day of the service anymore because I mean my husband goes and comes he's already I'm searching him he's already out of the country and I'm telling him to look at his uh account from Cleveland Clinic because all this was done on that day.
[AGENT][NEUTRAL] OK, so the, the claim that I was.
[CUSTOMER][NEUTRAL] It wasn't an opposite.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEGATIVE] The claim that I was told to look at it is for the date of service of [PII] where we denied it as an office visit is not covered, and after looking at the image that we received in, it is an office visit.
[CUSTOMER][NEUTRAL] Is it with Dari Wiggle or for abdominal ultrasound because abdominal, because I'm meanractitioner, I know what office visit is. If it is office visit, it's [PII], which is his primary, but this is for abdominal.
[AGENT][NEUTRAL] That's the claim that we received.
[CUSTOMER][NEGATIVE] Um, I have to send it back because this one is for $927 for abdominal ultrasound, so it's not for office visit, I know, and I spoke to the lady that day.
[AGENT][NEUTRAL] OK, so we don't have that claim if that's the date of service that you're saying was denied for office visits not covered.
[CUSTOMER][NEUTRAL] OK. I, I mean, I have, so you guys will still be able to pay for last year.
[CUSTOMER][NEUTRAL] Because I don't know if he rolls over.
[AGENT][NEUTRAL] As long as the policy was active at that time of service, the claim can be received.
[CUSTOMER][NEUTRAL] It was, I mean, it was, it was active.
[AGENT][NEUTRAL] Yes, I'm just saying that as long as it was active at the time, we will, we will accept claims.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much for your patience.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] No, no. No, no. Thank you.
[AGENT][POSITIVE] Well I do wanna thank you for calling American Public Life. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.