AccountId: 011433970860
ContactId: e46ae4dd-5f40-45fc-991e-d8e7fde18018
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 954080 ms
Total Talk Time (AGENT): 291694 ms
Total Talk Time (CUSTOMER): 288025 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/e46ae4dd-5f40-45fc-991e-d8e7fde18018_20250129T13:57_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from provider's office, and I'm here to check the status of a claim.
[AGENT][NEUTRAL] Sure, I can assist you with that. Could you provide me with the spelling of your name?
[CUSTOMER][NEUTRAL] Yeah. It's uh [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can I have a callback number for you and that policy number that you're inquiring claim status for.
[CUSTOMER][NEUTRAL] OK. Um, may I say the number first?
[AGENT][NEUTRAL] Callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] I do see it is 013559352.
[AGENT][NEUTRAL] Give me that number one more time.
[CUSTOMER][NEUTRAL] 013559352.
[AGENT][NEUTRAL] That's not pulling up a policy. Could you verify the policy number that's listed on the card or a claim EOB that we sent to you?
[CUSTOMER][NEUTRAL] OK. Um, hold a minute. Let me grab the card.
[CUSTOMER][NEUTRAL] Hm, I'm sorry, I don't have the card copy in my end.
[CUSTOMER][NEUTRAL] The claim number I have, I mean the member ID I have here is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 0135593552. Um, shall we try with the member's social security number?
[AGENT][NEUTRAL] Sure, what is the social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What is this member's name?
[CUSTOMER][NEUTRAL] Name is [PII].
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It is on [PII].
[AGENT][NEUTRAL] So let me give you the correct policy number.
[CUSTOMER][NEUTRAL] Mhm. Uh, hold a minute, I'll take a note.
[CUSTOMER][POSITIVE] I'm ready now.
[AGENT][NEUTRAL] It's 1359352, 1359352, not 13559352.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK I'll take a note of it.
[CUSTOMER][NEUTRAL] Um, I'm here to check the status of a medical claim. May I see the date of service?
[AGENT][NEUTRAL] Yes, what is the data service that you're inquiring claim status for, and I'll be able to assist you.
[CUSTOMER][NEGATIVE] Yeah, it is on the date of [PII] and the claim totally billed for $126 even.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] You're right.
[AGENT][NEUTRAL] There's no claim on file for the date of service. However, the member's policy terminated [PII], and there is no active policy here at American Public Life for the member [PII].
[CUSTOMER][NEUTRAL] Mhm. Fine.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. All right. What is the termination date? It's on July?
[AGENT][NEUTRAL] [PII], the policy became effective [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Um, fine. Before that, I need one more information. What is the, um, uh, claims submitting address?
[AGENT][NEUTRAL] The claims address will be addressed to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] Um, what is the city of city, uh, OK.
[CUSTOMER][NEUTRAL] Uh, what is the ZIP code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. Can I get the payer ID for your, for the
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 0801. All right, perfect. I'm done with this one claim. Can I get a call reference number?
[AGENT][NEUTRAL] We don't provide those unfortunately, but you can use my name and today's date as a reference. It's [PII], and today's date.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Um, how can I pronounce your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII]. OK, [PII].
[CUSTOMER][NEUTRAL] Um, shall I, I do have a few more claims. Shall we move for the next one?
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][NEUTRAL] Um, let me grab it. Hold a minute.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] Got you. Here we go. Um, the member, I mean the member's ID here in my end is 02304504.
[AGENT][NEUTRAL] 2304504 so I can't check the status of a claim here you will have to contact with TBA.
[CUSTOMER][NEUTRAL] What is it? TBA.
[AGENT][NEUTRAL] Webb CPA, T as in Tom, P as in Paul, A as in Alpha, and I can give you their number.
[CUSTOMER][NEUTRAL] OK, may I know who's TP? Is there any?
[AGENT][NEUTRAL] The third party administrator.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any specific name for them, for them?
[AGENT][NEUTRAL] Web CPA.
[CUSTOMER][POSITIVE] Oh, FTP. Perfect. Can I get the number?
[AGENT][NEUTRAL] 18669759458 that's 18669759458 and that is web TPA.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. OK, we just keep it and move for the next one.
[AGENT][NEUTRAL] How many clients do you have?
[CUSTOMER][NEUTRAL] 5 more.
[AGENT][NEUTRAL] What is the next policy number?
[CUSTOMER][NEUTRAL] I do see it is 02100257.
[AGENT][NEUTRAL] And what is this member's name and date of birth?
[CUSTOMER][NEUTRAL] Just a minute.
[CUSTOMER][NEUTRAL] The name here is [PII]. The date of birth is on [PII].
[AGENT][NEUTRAL] What is the data service that you're inquiring about?
[CUSTOMER][NEUTRAL] Uh, on the date of, uh, let me check.
[CUSTOMER][NEUTRAL] It is on [PII]. The claim to billed for $181.
[AGENT][NEUTRAL] And what was the the the policy number that you provided me?
[CUSTOMER][NEUTRAL] It is 021 00257.
[AGENT][NEUTRAL] So her policy number is [PII]. It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, it is [PII], right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Oh, for all this kind of, uh, this, this kind of patients, we don't have the copy of member's ID card and all the member IDs uh seems different in, in my end.
[AGENT][NEUTRAL] Mhm. This policy became effective [PII] and it was terminated [PII]. There was no payment made on your claim because the policy does not cover any services that's not a sickness.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] The claim was received [PII]. It was processed [PII].
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Mhm. Um, could you please repeat the denied reason the policy does not cover?
[AGENT][NEGATIVE] The policy does not provide coverage for services that's not considered a sickness.
[CUSTOMER][NEUTRAL] What is sickness? Could you please spell it?
[AGENT][NEUTRAL] A sickness is something that a diagnosis for a sickness like a cold. The diagnosis here is not for sickness.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm. All right. Um.
[CUSTOMER][NEUTRAL] Oh fine. um, could you please hold a minute?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But while checking on the diagnosis, there is no um sickness flu has been mentioned.
[AGENT][NEUTRAL] Right, there is no sickness. There's a member went to the doctor for screening.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And screenings are not covered here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm done and the reference number remains the same, right? Shall like the date.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. All right I'm pulling up to the next one.
[CUSTOMER][NEUTRAL] Fine. Uh, before that, um, in our end, I didn't receive the copy of.
[AGENT][NEUTRAL] 34
[AGENT][NEUTRAL] 01929 is the claim number 3401929 is the claim number.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um, I'm sorry, I, I missed it somewhere.
[AGENT][NEUTRAL] What is the fax number that you would like this information to be sent over to?
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[CUSTOMER][NEUTRAL] Um, and the attention of [PII] that's my name in the subject field mention the member's name.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I place you on a brief hold?
[CUSTOMER][NEUTRAL] Sure, go ahead, waiting.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What is the next policy number that you're requiring checking the status of the claim for?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, I'm speaking by, yeah, yeah, I'm in line. I'm speaking by muted. I'm sorry. Um, the policy number in mind is um
[CUSTOMER][NEUTRAL] 021 00257.
[AGENT][NEUTRAL] OK, so you, I need that number again.
[CUSTOMER][NEUTRAL] Or that you provided?
[AGENT][NEUTRAL] The number that you just provided me to look up a status of a claim for the next the next customer.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think that policy number is 226-5956.
[AGENT][NEUTRAL] So I gave you that information for that claim. Is there another claim for the same member?
[CUSTOMER][NEUTRAL] Um, let me check.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, um.
[CUSTOMER][NEUTRAL] I don't see any claim on the same data services.
[AGENT][NEUTRAL] Alright, so is there.
[CUSTOMER][NEUTRAL] Is there anything on your end?
[AGENT][NEUTRAL] No, you, I just.
[AGENT][NEUTRAL] So you told me that you needed the status of a claim for [PII]. I gave you the status of the claim and I sent you a copy of the EOB as well. So you told me that you had multiple individuals to check the status of a claim for. So when I came back on the phone, I asked you what was the policy of the next insured that you would like to check the status of a claim for, and you gave me this one for [PII] again, so I asked you, was there a second claim that you would like to check the status of for [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um, fine. Um, what is the other way to get the copy of UB?
[AGENT][NEUTRAL] I sent a copy of the EOB to you by fax.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Fine, we just, can we move to the next one?
[AGENT][NEUTRAL] Yes, after this one I'm gonna have to send you back to the queue.
[AGENT][NEUTRAL] What is your policy number?
[CUSTOMER][NEUTRAL] OK. For
[CUSTOMER][NEUTRAL] Let me, uh, let me grab it.
[CUSTOMER][NEUTRAL] The next policy number here is 02340540.
[AGENT][NEUTRAL] This is a web TPA policy as well. You will have to contact them to check the status of a claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, I'm done. Uh, uh, uh, how many claims do you have on a single call?
[AGENT][NEUTRAL] Um, it's actually supposed to just be one.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's up to you. We shall we move for the next or we just wrap up the call.
[AGENT][NEUTRAL] No, I'm gonna transfer you to the queue for someone else to get you. Hold one moment.
[CUSTOMER][NEUTRAL] Fine.
[CUSTOMER][NEUTRAL] OK.