AccountId: 011433970860
ContactId: de78f716-0693-49cb-a20e-03bfbb6762a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 900570 ms
Total Talk Time (AGENT): 276484 ms
Total Talk Time (CUSTOMER): 247048 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/de78f716-0693-49cb-a20e-03bfbb6762a2_20250606T17:29_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII], this is [PII] here calling you from provider office.
[AGENT][POSITIVE] Hi [PII], how are you doing today?
[CUSTOMER][POSITIVE] I'm doing great, yeah, what about you?
[AGENT][POSITIVE] I'm doing well. And how may I assist you today?
[CUSTOMER][NEUTRAL] I just want to know the claim status, yeah.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's uh the contact number will be [PII] and extension is [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] That's gonna be 01116669.
[AGENT][NEUTRAL] Thank you, hold on one moment, one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The member's full name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] The total amount will be.
[CUSTOMER][NEUTRAL] $381.92.
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] And that will be [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And this is for [PII], correct?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] The provider name is I mean mm.
[CUSTOMER][NEUTRAL] You need the provider address, right?
[AGENT][NEUTRAL] I'm asking for the name of the facility.
[CUSTOMER][NEUTRAL] The name of the facility will be the Cano Health LLC. The address is [PII].
[AGENT][NEUTRAL] Thank you. And I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 7165.
[AGENT][NEUTRAL] And on [PII], the claim, uh, we paid out on the claim to the provider, a total of $25.
[CUSTOMER][NEUTRAL] OK, the claim has been paid.
[AGENT][NEUTRAL] Yes, that's correct. A total of $25.
[CUSTOMER][NEUTRAL] OK, and can you provide me the check number here?
[AGENT][NEUTRAL] Yes, the check number is 204.
[AGENT][NEUTRAL] 756 7.
[AGENT][NEUTRAL] It was a single check?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] That's it. Yes, everything I'm giving you is complete. That's the whole check number.
[CUSTOMER][NEUTRAL] And can you provide me the issue date here?
[AGENT][NEUTRAL] The check was issued on [PII].
[AGENT][POSITIVE] And it is still outstanding?
[AGENT][NEUTRAL] It was mailed to 9
[CUSTOMER][NEUTRAL] It's not cleared yet.
[AGENT][POSITIVE] No, it's still outstanding. It has not been cleared.
[AGENT][NEUTRAL] We mailed it to 90
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah, you say
[AGENT][NEUTRAL] Thank you. We mailed it to [PII]. Is that the correct address?
[CUSTOMER][NEUTRAL] The address is [PII], right?
[AGENT][NEUTRAL] OK, so yes, that's the correct address. And um if you have not, if you do not receive the check by [PII], then you can give us a call back and we can check on the check and reissue it for you if needed.
[CUSTOMER][NEUTRAL] Yeah, OK then, no problem, uh, I know, and, uh, I know what will be the call reference number I do have one more claim here.
[AGENT][NEUTRAL] The call reference number for the entire call will be my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] [PII], am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, just give me a second, let me pull up another claim here.
[AGENT][NEUTRAL] Is it for the same member or a different member?
[CUSTOMER][NEUTRAL] By the way, have I
[CUSTOMER][NEUTRAL] Uh, it's for the different member.
[AGENT][NEUTRAL] OK, let me note this one. Hold on one moment.
[AGENT][POSITIVE] All right, I'm ready for the next number whenever you're ready.
[CUSTOMER][NEUTRAL] The member ID will be 1224148 M.
[CUSTOMER][NEUTRAL] As in mango, L as in Lima, and number 8.
[AGENT][NEUTRAL] Thank you. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The first name will be.
[CUSTOMER][NEUTRAL] [PII], last name [PII], date of birth [PII].
[AGENT][NEUTRAL] Thank you for that. And again, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] The date of service will be [PII]. Bill amount $381.92.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] [PII], yeah, right.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so it wouldn't be on this policy because this policy terminated [PII]. So let me see what was active on your data service. Hold on one second.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Could possibly be this one. OK, so the policy number that you provided um was effective from [PII]. So this wasn't active on your data service. There was a policy, um, 1891717 that was effective from [PII]. Go ahead.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can you tell me the effective and the term date once again here?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] To [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so, uh, you want, you mean to say that for my date of service there is a
[CUSTOMER][NEUTRAL] OK, so [PII]. And after that?
[AGENT][NEUTRAL] OK, so what I just gave you was the effective and termination date of the policy that you gave me. I'm getting ready to give you the active policy. Hold on, allow me to speak, please. I'm getting ready to give you the active policy number that was active on your data service and then I'm gonna check and see if there's a claim there.
[CUSTOMER][NEUTRAL] So this was.
[CUSTOMER][NEUTRAL] OK, provide me the active policy.
[AGENT][NEUTRAL] Hold on one moment, sir. It's coming up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The policy number is 1891717.
[CUSTOMER][NEUTRAL] 1891717 OK.
[AGENT][NEUTRAL] And I'm checking now to see if there's a claim on file for your date of service.
[CUSTOMER][NEUTRAL] And what is the effect on the term date for this policy?
[AGENT][NEUTRAL] Hold on one moment. I'm checking for your claim. I can go back and give you the effective dates. Hold on one second.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And again, the date of service is [PII].
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yes, my date of service is this [PII].
[AGENT][NEUTRAL] OK, so there's no claim on file.
[AGENT][NEUTRAL] On the policy that was active for your data service.
[AGENT][NEGATIVE] Um, however, there's no timely.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] And what is the effect on the term date under this policy ID?
[AGENT][NEUTRAL] This policy was effective from [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and [PII] and what is the timely filing limit?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] No TFL.
[CUSTOMER][NEUTRAL] For claims admission.
[AGENT][NEUTRAL] There is no timely filing limit as long as the policy is active, you can file the claim active on the data service. You can file the claim at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] So the ID, the new ID is, I will repeat that once again, 1891717, right? Pardon?
[AGENT][NEUTRAL] It's not the new policy number, it's just the policy that was active on your date of service.
[CUSTOMER][NEUTRAL] Uh, yeah. And the payer ID will be, just give me a second, that will be 00010, right?
[AGENT][NEUTRAL] No, our payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801. OK, just give me a second let me check here 60801.
[CUSTOMER][NEUTRAL] So, we have to submit the claim electronically.
[AGENT][NEUTRAL] That's up to you. You can fax it, you can mail it, or you can send it electronically.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the insurance name will be uh the American Public Life, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Just give me under this payer ID I can't find that. Just like 60801.
[AGENT][NEUTRAL] Yes, that's our only payer ID for APO.
[CUSTOMER][NEUTRAL] What is the ZIP code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Under the [PII], I have the PR ID of 00010.
[AGENT][NEGATIVE] OK, that's incorrect.
[CUSTOMER][NEGATIVE] That's incorrect, yeah, just give me a second.
[CUSTOMER][NEUTRAL] Check if I do have other claims for American.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] Hello, pardon, then I'm done with the claim here.
[AGENT][NEUTRAL] All right. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No thank you and have a great day. Bye-bye.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[AGENT][NEUTRAL] Hm.