AccountId: 011433970860
ContactId: e8b6eb37-2396-492e-b9de-21835bfb2ead
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 732280 ms
Total Talk Time (AGENT): 243657 ms
Total Talk Time (CUSTOMER): 307991 ms
Interruptions: 8
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/e8b6eb37-2396-492e-b9de-21835bfb2ead_20250130T19:40_UTC.wav
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[CUSTOMER][NEUTRAL] It.
[AGENT][POSITIVE] Thank you for calling American. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from provider's office. I want to check the claim status.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] 022 03916.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. You're calling in for status. May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah, sure. The date of service is on [PII] and the total charge amount is $237 even.
[AGENT][NEUTRAL] Thank you. And you can also check claim status via our secured portal that is [PII]. I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Let go
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And for that claim, it does show that we received it on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 352.
[AGENT][NEUTRAL] 773-5. That claim processed and it denied that office visits are not covered under the patient's plan. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Office visits are not covered under patient's plan?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And can you please fax you will be able to provide my fax number?
[AGENT][NEUTRAL] May I have the fax number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, I will get the request submitted over for you. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And I have another patient to check, so can you please check that?
[AGENT][NEUTRAL] OK. It's, it's the same patient or a different patient?
[CUSTOMER][NEUTRAL] Mm, it's a different patient.
[AGENT][NEUTRAL] OK, may I please have that policy number?
[CUSTOMER][NEUTRAL] my
[CUSTOMER][NEUTRAL] Yeah, sure, uh, one moment, it's loading.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] Yeah, the next member ID number is uh it's 14.
[CUSTOMER][NEUTRAL] 9601, M as in Mike, L as in Lima, number 5.
[AGENT][NEUTRAL] And that policy number is 149601.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] It looks like the number is missing.
[AGENT][NEUTRAL] Some numbers.
[CUSTOMER][NEUTRAL] It's 1449061.
[CUSTOMER][NEUTRAL] And uh it has M as in Mike, L as in Lima, number 5.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The member's name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Yeah, the date of service is on [PII], and the total charge amount is $542 even.
[AGENT][POSITIVE] I'm pulling that up for you now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So for that claim it does show that we did receive it on 123-24.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was processed on [PII] of 24.
[AGENT][NEUTRAL] That claim number is 353.
[AGENT][NEUTRAL] 8042, the claim process and it denied that the policy was not active at the time of service. The term date for this policy is [PII].
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][NEUTRAL] So, uh, can you give me the effective date?
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the termination date is on [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Or [PII].
[CUSTOMER][NEUTRAL] [PII] and no longer active, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you please fax the UOB?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I have another patient to check, so can you please check that?
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, [PII]?
[AGENT][NEUTRAL] May I have that policy number?
[CUSTOMER][NEUTRAL] 023371
[CUSTOMER][NEUTRAL] 13, M as in Mike, L as in Lima, number 8.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $1,362 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that is $1,362 for this member?
[CUSTOMER][NEUTRAL] Yes, 1362.
[AGENT][POSITIVE] And I'm pulling that up for you now.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm not seeing a claim for that total bill.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No claim on file?
[AGENT][NEGATIVE] Not for the total bill, no.
[CUSTOMER][NEUTRAL] With.
[CUSTOMER][NEUTRAL] So can you please verify that the member is active for the data service or not?
[AGENT][NEUTRAL] Sure, it is showing that the member is active at the time of service.
[CUSTOMER][NEUTRAL] Mm. And can you give me the payer ID number?
[AGENT][NEUTRAL] The electronic payer ID is 60801.
[CUSTOMER][NEUTRAL] And can you uh
[CUSTOMER][NEUTRAL] Give me the mailing address.
[AGENT][NEUTRAL] Yes, the mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sorry, so can you repeat that? it's [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go.
[AGENT][NEUTRAL] You need in the city and state state again as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] And can you give me the time of filing limit?
[AGENT][NEGATIVE] There is no timely filing.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 17.
[CUSTOMER][NEUTRAL] OK. And next we move to the next question.
[AGENT][NEUTRAL] Yes, and how many do you have for me to review? Only have 2 more that I can review.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, last one, last one.
[AGENT][NEUTRAL] OK. May I please have that policy number?
[CUSTOMER][NEUTRAL] It's 02123551.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, sure. Yeah, the patient's name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Day of service and total bill?
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $542 even.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm pulling that up for you now.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that is for [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 3030. OK, thank you.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Let the correction for you.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] And for that claim, it does show that we received it on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] That claim number is 354448-7. That claim processed and denied that office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Mhm. And uh uh the claim number is 354-4487. Is that correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And can you please spella for me?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Mhm. No, and can you spell your name?
[AGENT][NEUTRAL] Yes, it is spelled [PII] Last initial of [PII] and today's date will be the call reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's uh can you repeat that? Sorry.
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Last initial of H and today's date.
[CUSTOMER][NEUTRAL] And call reference number?
[AGENT][NEUTRAL] That is the call reference.
[CUSTOMER][POSITIVE] Mhm. Yeah. OK. Thank you. Thank you so much. Have a good day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Same to you, bye.
[CUSTOMER][NEUTRAL] Uh