AccountId: 011433970860
ContactId: d4021be0-56eb-437a-a9bb-18fc5fba697f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1220189 ms
Total Talk Time (AGENT): 283723 ms
Total Talk Time (CUSTOMER): 408243 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/d4021be0-56eb-437a-a9bb-18fc5fba697f_20250114T18:33_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on our claim status.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] 1411867.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] The phone number is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And can you verify the patient's name?
[CUSTOMER][NEUTRAL] And may I know your good name?
[AGENT][NEUTRAL] My name?
[CUSTOMER][NEUTRAL] Yes, I missed out.
[AGENT][NEUTRAL] It's, it's [PII] A, first initial last name is [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Uh-huh, you're welcome. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that information and you said we're we're checking claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the date of service in charge ID?
[CUSTOMER][NEUTRAL] So, the date of service is
[CUSTOMER][NEUTRAL] [PII]. And the charge amount is $7,323.63.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Is this the emergency room or the facility charge?
[CUSTOMER][NEUTRAL] Yes, facility, emergency room, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so I'm showing that we received the requested information.
[AGENT][NEUTRAL] Um, on the [PII] this year, I processed it on the [PII] and a payment of $2,112.68 was issued, um, to the address that's on your claim form.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] Uh, may I get the claim number first?
[AGENT][NEUTRAL] That claim number is 355-02227.
[CUSTOMER][NEUTRAL] 355-027
[AGENT][NEUTRAL] 355-022-7
[CUSTOMER][NEUTRAL] OK. 227.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, sir, one moment.
[CUSTOMER][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And may I know for how much it was paid?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The check amount
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's $2,012.68.
[CUSTOMER][NEUTRAL] $2,012.68. So, it was paid for this amount?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's the payment amount.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there any patient responsibility or it was paid for this full amount?
[AGENT][NEUTRAL] Yeah, we do not determine patients responsibility um with the payment of this check, the policy maximum for this benefit has been met.
[CUSTOMER][NEUTRAL] So you have totally paid for $2,0012.68 right?
[AGENT][NEUTRAL] That's the amount of the check ID.
[CUSTOMER][NEUTRAL] For this claim alone.
[AGENT][NEUTRAL] Did you have any other questions?
[CUSTOMER][NEUTRAL] Uh, may I know if it is paid to a single check or a bulk check?
[AGENT][NEUTRAL] It's an individual check.
[CUSTOMER][NEUTRAL] OK. One moment. I got it.
[CUSTOMER][NEUTRAL] May I get the check number?
[AGENT][NEUTRAL] That number is 20.
[AGENT][NEUTRAL] 22
[AGENT][NEUTRAL] 400.
[CUSTOMER][NEUTRAL] 4008.
[AGENT][NEUTRAL] Did you get the complete number?
[CUSTOMER][NEUTRAL] The last three digits, OK. Can you please verify it? Because the last three digits was cutting in and out. So, it is 202,240.
[AGENT][NEUTRAL] Mhm. Go ahead and verify what you have.
[CUSTOMER][NEUTRAL] Yes, 202-2400.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. and the check was issued on [PII]. May I know if it is still outstanding for payment or it was cleared?
[AGENT][POSITIVE] Yeah, the [PII] was 2 days ago, so it's still outstanding.
[CUSTOMER][NEUTRAL] OK. Can you please verify me the paper address?
[AGENT][NEUTRAL] OK, what's the address on your claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's the address that it was mailed to.
[CUSTOMER][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Let me check the last 4 [PII] and it is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] I have 3 more claims. Can you please assist me with this claim status?
[AGENT][NEUTRAL] I can. You can also check your status on our online service center IV at [PII]. Would you like for me to help you set up an account to do that?
[CUSTOMER][NEUTRAL] Uh, can you please verify, uh, uh, assist me with the 3 more claims for the next time I'll look into that.
[AGENT][NEUTRAL] I can.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 02363839.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. What's the date of service and the total charge?
[CUSTOMER][NEUTRAL] Let me check for the date of service.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] The date of service is [PII]. The total charge is $23,398 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we denied it.
[AGENT][NEUTRAL] Um, the first claim was denied for a copy of the primary insurance explanation of benefits, and it looks like it was submitted two additional times denied as duplicates because the primary EOB was not attached. Um, I'll give you the information for the original claim. We'll start with the claim number and then I'll give you the received date and the process date. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] That claim number?
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] It's 348.
[AGENT][NEUTRAL] 5205.
[AGENT][NEUTRAL] Received [PII].
[AGENT][NEUTRAL] Processed [PII].
[AGENT][NEUTRAL] And the explanation of benefits was mailed to the address that you verified previously.
[CUSTOMER][NEUTRAL] OK. For this one, we have sent the explanation of benefits for the primary insurance, of the primary insurance. We have sent it through fax on [PII]. Can you please kindly check whether you was received on your end?
[AGENT][NEGATIVE] OK, I stated that we received it twice, but the EOB was not attached. It's just the itemized bill.
[AGENT][NEUTRAL] So we've not yet received the primary EOB.
[CUSTOMER][NEUTRAL] OK, but we have
[CUSTOMER][NEUTRAL] Just one moment. Let me double, we have uh attached the explanation of benefits on [PII].
[AGENT][NEGATIVE] We've not received it, ma'am.
[CUSTOMER][NEUTRAL] Just a moment. Let me take a look.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yes, we have sent, but it was not received. So I'll try to resubmit it again.
[CUSTOMER][NEUTRAL] Uh, can you please, uh, provide me the fax number?
[AGENT][NEUTRAL] OK, and we did receive the claim but we denied it as a duplicate because the primary ELB was not attached.
[AGENT][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] that's the same number for every claim for American Public Life. That's the fax number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much. So, we'll resend the explanation.
[AGENT][NEUTRAL] And I'm ready to proceed to the next policy number, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sure. Let me go ahead and get that one, sure. Thank you so much.
[AGENT][POSITIVE] Thank you, [PII].
[CUSTOMER][POSITIVE] Thank.
[CUSTOMER][NEUTRAL] One moment, my system is taking some time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The next policy number is going to be
[CUSTOMER][NEUTRAL] 1896422
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you and what's her date of service and total charge?
[CUSTOMER][NEUTRAL] I'm looking for the date of service here.
[CUSTOMER][NEUTRAL] The date of service is going to be [PII]. And the total charge is $3,923 even.
[AGENT][NEUTRAL] And when was that claim submitted?
[CUSTOMER][NEUTRAL] I mean, the explanation of benefits was sent on [PII].
[AGENT][NEUTRAL] And you said the date of service is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm not showing that claim, uh, that date of service received.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][POSITIVE] So, we'll resubmit the explanation of benefits to you again to the same fax number you have provided.
[AGENT][NEUTRAL] We need
[AGENT][NEUTRAL] We'll need the itemized bill plus the primary explanation of benefits.
[CUSTOMER][NEUTRAL] OK. Both the things together?
[AGENT][NEUTRAL] Yeah, we'll need the itemized bill to consider the benefit and then the EOB to determine what amount is payable if anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So for the claim and the UB. OK, sure.
[AGENT][NEUTRAL] Mhm. Always submit the itemized bill and the primary explanation of benefits.
[CUSTOMER][NEUTRAL] One moment, and then.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me go ahead and get the last one here.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The policy number is 2152735.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Alright, thank you for that information. What's the date of service in charge?
[CUSTOMER][NEUTRAL] The date of service.
[CUSTOMER][NEUTRAL] It is going to be [PII].
[CUSTOMER][NEUTRAL] And the total charge is $13,075 even.
[AGENT][NEUTRAL] Thank you and you said that's September?
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm not showing that claim on file for this patient.
[CUSTOMER][NEUTRAL] One moment, let me check this.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] For the additional.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Any other questions I can help out with today [PII]?
[CUSTOMER][NEUTRAL] OK. We, uh,
[CUSTOMER][NEUTRAL] Yes. Uh, we have sent to the address [PII].
[CUSTOMER][NEUTRAL] MS [PII]. Is it the correct address or can you please verify me your mailing address?
[AGENT][NEUTRAL] The correct address is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So we have sent to the incorrect address.
[CUSTOMER][NEUTRAL] So that there is no claim on file.
[CUSTOMER][NEUTRAL] OK, I need some more information.
[CUSTOMER][NEUTRAL] 248,950. May I get the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] And may I get the effective and term date of the policy?
[AGENT][NEUTRAL] Policy is currently active, the policy effective date.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much. May I know the plant type, what type of plant it is?
[AGENT][NEUTRAL] supplemental gap policy.
[CUSTOMER][NEUTRAL] Supplemental.
[AGENT][NEUTRAL] It's a it's a Medin policy.
[AGENT][NEUTRAL] M E D L I N K.
[CUSTOMER][NEUTRAL] OK. Ming secondary coverage rate.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I get the dummy filing limit?
[AGENT][NEGATIVE] To submit a claim, there's no timely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the group name and group number?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] The correct number is 16269.
[AGENT][NEUTRAL] The group name is M A I M.
[AGENT][NEUTRAL] ON
[AGENT][NEUTRAL] I D as in David, E S.
[AGENT][NEUTRAL] The second word is S H A L.
[AGENT][NEUTRAL] Oelm.
[AGENT][NEUTRAL] Academy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much. May I get the call reference number for the entire call?
[AGENT][NEUTRAL] My name and today's date?
[AGENT][NEUTRAL] And any other questions I be?
[CUSTOMER][POSITIVE] OK, thank
[CUSTOMER][POSITIVE] No, I've got all the required information. Thank you so much for your time and assistance. Have a good day. Take care. Bye for now.
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Yes, you do the same. Bye-bye.