AccountId: 011433970860
ContactId: e3a12750-fd5a-4e85-9bfe-71161ea45618
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 623840 ms
Total Talk Time (AGENT): 261135 ms
Total Talk Time (CUSTOMER): 250400 ms
Interruptions: 7
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/e3a12750-fd5a-4e85-9bfe-71161ea45618_20250515T14:57_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from provider's office to check the claim status.
[AGENT][NEUTRAL] Sure, I can assist you with that. Could you provide me with the spelling of your name and a callback number?
[CUSTOMER][NEUTRAL] My name is [PII]. It is [PII] and the callback number is [PII].
[AGENT][NEUTRAL] Thank you [PII]. Can I have the call back the policy number of the member that you're calling to verify benefits for? Let me check the status of the claim for.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 1 2nd
[CUSTOMER][NEUTRAL] Yes, Pa. It is 02286214.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII] on [PII].
[AGENT][NEUTRAL] And what is the date of service that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] [PII] and it is $1,692 even.
[AGENT][NEUTRAL] [PII]. Do you have a procedure code?
[CUSTOMER][NEUTRAL] Yeah, procedure code is 1 2nd.
[CUSTOMER][NEUTRAL] It is 43264.
[AGENT][POSITIVE] Thank you sir.
[CUSTOMER][NEUTRAL] You know you
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like this claim was received [PII]. It was processed [PII]. Is there multiple claims, multiple procedure codes?
[CUSTOMER][NEUTRAL] May I know the most recent claim?
[AGENT][NEUTRAL] Is there multiple procedure codes?
[CUSTOMER][NEUTRAL] With the anesthesiak of?
[CUSTOMER][NEUTRAL] Yeah, which, which I have provided with uh 00732, that is the anesthesia code. Uh, can I, can I get the most recent one?
[AGENT][NEUTRAL] So I'm, I'm trying to verify, so [PII], I'm trying to verify if I'm pulling up the correct claim. So is there multiple procedure lines or just one procedure line?
[CUSTOMER][NEUTRAL] I have a claim number. Can you provide?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, that's why I'm asking you to provide the, can I provide the claim number?
[AGENT][NEUTRAL] I can't provide a claim number so I know if this is the correct claim. Is there multiple procedure lines?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] How many procedure lines are listed on the claim that you submitted here to American Public Life to be processed?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah, we have submitted only two procedure codes. One is supporting code, one is main one that is 43264. Anesthesia code which I have provided now 00732.
[CUSTOMER][NEUTRAL] Modify the QG.
[AGENT][NEUTRAL] 00732.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So is this
[AGENT][NEUTRAL] Is these procedure codes combined or they're separate claims? Cause I'm not showing a claim with both of those procedure codes.
[AGENT][NEUTRAL] On the same claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is the total bill amount for the anesthesia or I'm sorry, 00732.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that is only I stated $1,692 even.
[AGENT][NEUTRAL] So there was a payment of $303.73 made on that claim.
[CUSTOMER][NEUTRAL] Yeah, I know that we have uh some query regarding that payment. Uh, we have, uh we got payment from pri uh primary, sorry, primary applied towards deductible with the load and deductible both the same, that is $1,318.90. So that the deductible amount we forwarded to secondary, which is American Public Life. So we got only received $303.73. We don't know where is the remaining amount that is.
[AGENT][NEUTRAL] Which was the maximum benefit amount.
[CUSTOMER][NEUTRAL] Yeah, it was register or a patient responsibility or what, what we need to do the remaining amount. We need to do, we need to know the clarity.
[AGENT][NEUTRAL] So this is not a primary insurance company, however, so I can't tell you that it's the patient's responsibility. I only can verify that we only made a payment of the amount that we paid.
[CUSTOMER][NEUTRAL] OK. Out of $1,318.90 we, we got received $303.73. The remaining will be adjusted, right?
[AGENT][NEUTRAL] No, I can't say that either because this is not a primary insurance company. I can only verify for the amount that we made a payment of.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] Then what about the remaining amount? What we can do? can we bill to the patient or can we adjust?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So this is not a primary insurance company again, so I can't say if it's the patient's responsibility.
[CUSTOMER][NEUTRAL] So you're saying that is patient responsibility or not?
[AGENT][NEUTRAL] No, I'm not saying that it is the patient responsibility or if it is not the patient responsibility because I have don't, I don't have the jurisdiction to tell you that because this is not a primary insurance company to sell with. We only this is a gap insurance and we only pay what went towards deductible co-pay and co-insurance until the benefit is maxed out and the members' benefits were maxed out for that date of service once the claim came here to American Public Life.
[AGENT][NEUTRAL] The members benefit per calendar day?
[AGENT][POSITIVE] It's $1000 and the benefits were maxed out.
[CUSTOMER][NEUTRAL] OK. Since
[CUSTOMER][NEUTRAL] OK. Since the benefits was met by the patient, we have, we only received the $303.73 correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So remaining will go for adjustment because it is not for patient responsibility, then, then there is an option for adjustment, right?
[AGENT][NEUTRAL] No, I didn't say that it was the patient's responsibility or if it wasn't the patient responsibility because I can't tell you that. I can only verify that we only made a payment of the amount of the.
[AGENT][NEUTRAL] 303-73 and that's all I can tell you because we're not a primary insurance company.
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] OK, what is the allowed amount for this $303.73?
[AGENT][NEUTRAL] That was the allowed amount. That was the amount, amount remaining for the date of service. The member's policy per calendar day is $1000. However, when your claim arrived.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The only benefit amount allowed was 30373.
[CUSTOMER][NEUTRAL] OK, $303 only Ida, is that correct?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] To the project.
[CUSTOMER][NEUTRAL] OK. Actually, we have received UOB in that UOB there is no allowed amount. There is no uh discount amount. There is only 3037373. Only paid amount is reflecting. There is no discount and there is no allowed amount. That's why we have called to get the clarity.
[AGENT][NEUTRAL] Now we can, the allowed amount per calendar year for these benefits per calendar day is $1000 and we made the remaining balance of the benefits that was allowed for the date of service.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] please.
[CUSTOMER][NEUTRAL] Is there any discount for this claim?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] There is no discount amount?
[AGENT][NEUTRAL] No, there is no discount amount.
[CUSTOMER][NEUTRAL] Then what about the
[CUSTOMER][NEUTRAL] What about the 1,015 and 15 and $17.17.
[AGENT][NEUTRAL] So the member's policy, as I just stated, Stella has $1000 per calendar day for benefits. There are multiple claims on file for [PII], and by the time your claim was arrived to American Public Life and was submitted here for processing.
[AGENT][NEUTRAL] The only amount remaining from that $1000 per calendar day was 303.73 benefit amount. So once that 30373 was paid towards your claim, which the actually the benefit deductible and co-pay and co-insurance towards the primary was 131,890, the only amount of benefits that was allowed to be released was 303.73 because that's all the member had available.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, one second, please.
[CUSTOMER][POSITIVE] OK. Thank you so much for the information. Can I get the call reference on your name?
[AGENT][NEUTRAL] We don't provide reference numbers, but you can use my name in today's date as a reference. It's [PII] and today's date of reference.
[CUSTOMER][NEUTRAL] What is your name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second. Can you repeat your name again?
[AGENT][NEUTRAL] [PII] and today's date of the reference.
[CUSTOMER][POSITIVE] Thank you. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day. Good bye.
[CUSTOMER][NEUTRAL] You too.