AccountId: 011433970860
ContactId: e58316d6-df6f-4b5c-ae5c-12a42501ce95
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 423470 ms
Total Talk Time (AGENT): 171703 ms
Total Talk Time (CUSTOMER): 137154 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/e58316d6-df6f-4b5c-ae5c-12a42501ce95_20250307T14:19_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] For calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good morning. This is [PII] from Pediatric Gastroenterology. How are you?
[AGENT][POSITIVE] I'm great. How are you?
[CUSTOMER][POSITIVE] I'm doing great. It's Friday.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank [PII]
[AGENT][NEUTRAL] It's been a long week.
[CUSTOMER][NEUTRAL] Yes, yes. I'm trying to follow up on two claims that's, uh, any way that you could help me?
[AGENT][NEUTRAL] I can verify claim status. May I have a policy number?
[CUSTOMER][NEUTRAL] Uh, policy number I have 02353169ML8.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have a date of service?
[CUSTOMER][NEUTRAL] I do have [PII].
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] $400?
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well. This process under claim number 3549944. No benefits are payable. They do not have the office visit benefit.
[AGENT][NEUTRAL] This claim processed and denied on [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so this type of policy doesn't cover office copayments.
[AGENT][NEUTRAL] Let's see if this one has, this one does not have the office, but it has any treatment in the office.
[CUSTOMER][NEUTRAL] Oh, OK, perfect. So this is patient balance. Let me just transfer this to patients. OK, I have another patient that I have called before.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number is
[CUSTOMER][NEUTRAL] Um 01935546.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] And patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] And the date of service was [PII].
[AGENT][NEUTRAL] In total bill?
[CUSTOMER][NEUTRAL] Uh, the total bill was for.
[CUSTOMER][NEUTRAL] Uh, give me a second.
[CUSTOMER][NEUTRAL] I don't have that amount.
[AGENT][NEUTRAL] Let me get this pulled up.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And it was 11,500.
[CUSTOMER][NEUTRAL] 11,960.
[AGENT][NEUTRAL] This one processed under claim number 3511064. It looks like a benefit amount of $883.61 paid to the provider.
[AGENT][NEUTRAL] This claim processed on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, there was an issue with the check we never received the check, so I have called previously and they were going to reissue a check.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK. I'm not showing anything in our system as far as reprocessing. One moment. I do apologize for that. You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Just reading through the notes. One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Do you remember the date that you called? I'm not seeing anything in the notes.
[CUSTOMER][NEUTRAL] Yes, I, I call on [PII]. I have the check number is 249014 88361.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, cause I'm not seeing anything in our system. So what I'll do is.
[AGENT][NEGATIVE] Go ahead and run the, the check to verify that it has uh not cleared, stop pay and reissue.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'll go ahead and put this in right now. Today is Friday. So depending on the turnaround time, as far as finance, letting me know whether or not the check is cleared, I can get this reprocessed for you. So give me 24 to 48 hours and give us a call back and I should have an update.
[AGENT][NEUTRAL] On the.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, should I call back just saying the claim number or?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, you can call back and just let them know that you're calling in regards to policy, um.
[AGENT][NEUTRAL] 1935546 on claim number 3511064, and they should be able to see my notes that I'm entering in the system today.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, you said your name is?
[AGENT][NEUTRAL] It's [PII] Last initial is [PII] along with today's date.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you very much for your help.
[AGENT][POSITIVE] You're so welcome. Is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, [PII], thank you. You have a nice weekend.
[AGENT][POSITIVE] [PII], you're so welcome and thank you for calling American Public Life. You have a great weekend as well. Bye-bye.
[CUSTOMER][NEUTRAL] The same to you bye bye.