AccountId: 011433970860
ContactId: dfb91f4f-5d28-4b78-a36c-caea6d7388eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295799 ms
Total Talk Time (AGENT): 107818 ms
Total Talk Time (CUSTOMER): 136441 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/dfb91f4f-5d28-4b78-a36c-caea6d7388eb_20250212T14:35_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider office to check the claim status.
[AGENT][POSITIVE] OK, I can verify claim status for you and I'm so sorry, your name is again?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Yes. It will be 02.
[CUSTOMER][NEUTRAL] 263-35
[CUSTOMER][NEUTRAL] 3, M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it will be [PII].
[AGENT][NEUTRAL] OK, thank you. And Ms. [PII], verify that patient's name, date of birth.
[CUSTOMER][NEUTRAL] Member name will be [PII]. Date of birth will be [PII].
[AGENT][NEUTRAL] OK, thank you. And you said you're calling to verify claim status, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Date of service will be [PII] and total bill amount on the claim will be $470.88.
[AGENT][NEUTRAL] OK, and you said the date of service was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][NEUTRAL] OK, and that amount is?
[CUSTOMER][NEUTRAL] Just a second, the balance amount will be $40 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And while I'm looking at up claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[AGENT][NEUTRAL] And the name of the provider's office?
[CUSTOMER][POSITIVE] Yes, it will be professional health.
[AGENT][NEUTRAL] OK, uh, Ms. [PII], I'm showing that claim processed as office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Uh, yes, we have, mm uh received the through EOP but uh uh insurance not cover the office visit, is that.
[AGENT][NEUTRAL] That is correct. Under the patient's policy, it does not cover office visits. So the claim was processed as office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 20
[CUSTOMER][NEUTRAL] 6661.
[CUSTOMER][NEUTRAL] And your member have another insurance apart from this? Um
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] The members and the insurance apart from the um
[CUSTOMER][NEUTRAL] American Public Life Insurance, the member of insurance?
[AGENT][NEUTRAL] Uh, you will have to contact the patient to verify if they have any other insurance. This policy they have with us is a secondary only, so they did have to have a primary.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, can you spell your name for me for documentation purpose?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] OK. Thank you so much for call assistance. And uh what will be the call reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, however, you may use my name at today's date. And Ms. [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, let me just check uh whether I have, I do have a claim number. Uh, the claim number will be the same, 022.
[CUSTOMER][NEUTRAL] 6334. OK. It's 350. Yes. The claim number is 3540591, correct?
[AGENT][NEUTRAL] No, no, that, that is the policy number.
[AGENT][NEUTRAL] Uh, the claim number
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, I do have, I just missed to see that. OK. No problem. Thank you so much, uh thank you for calling system. You help me not to do for one claim. Bye-bye. Have a great day here.
[AGENT][POSITIVE] Alright, you're welcome. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye bye.