AccountId: 011433970860
ContactId: ebc55a2a-d2e5-4505-ad7c-1c1ee3a1962e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 483679 ms
Total Talk Time (AGENT): 122656 ms
Total Talk Time (CUSTOMER): 140082 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/ebc55a2a-d2e5-4505-ad7c-1c1ee3a1962e_20250428T18:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], I have an agent on the back line that's inquiring about an insurance policy. She's wanting to see what's going on um with these claims that were submitted in. I'm thinking she's just checking to see.
[CUSTOMER][NEUTRAL] If we sent EOBs and if we denied them because she's aware that the person is no longer active, but she's trying to see specifically what's going on with that claim status.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, we can definitely double check that. Did you get a policy?
[CUSTOMER][NEUTRAL] I did. It's 241-422-0.
[CUSTOMER][NEUTRAL] And you're speaking with Ms. [PII], and she's with NAS.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And I did verify [PII]'s information as well too.
[AGENT][POSITIVE] Alright perfect thank you so much you can go ahead and send her on over.
[CUSTOMER][NEUTRAL] Um, the callback number is the number that's gonna be transferred over, um, the [PII], so just to let you know that is the same thing too.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I got that jotted down. Thank you.
[CUSTOMER][POSITIVE] Thank you, have a good day. Here she goes.
[AGENT][NEUTRAL] You too.
[AGENT][NEUTRAL] Hi, this is [PII] with American Public Life. How are you doing today?
[CUSTOMER][NEUTRAL] Hi, good, and you?
[AGENT][NEUTRAL] I'm good, thanks. So I understand that we need to check on some claims for an insured, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, so I've got [PII]'s information up here. Do we have a date of service for checking on?
[CUSTOMER][NEUTRAL] But, uh, let me see if I have one,
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm I will.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Actually,
[CUSTOMER][NEUTRAL] Actually, no, I don't think.
[CUSTOMER][NEUTRAL] I don't have one the person who submitted the claim didn't save it and she's no longer with us, so.
[CUSTOMER][NEUTRAL] I don't have it.
[AGENT][NEUTRAL] OK, do you have a claim number or anything if you don't have the data service?
[CUSTOMER][NEUTRAL] Let me see if I have something.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I don't, uh.
[CUSTOMER][NEUTRAL] I don't have a claim number. I know that NAS when they spoke with you guys on [PII], there was a um.
[CUSTOMER][NEUTRAL] It was a length of processing, but I don't have a claim number or or a date of service. All I have is the policy number.
[AGENT][NEUTRAL] OK, [PII] at [PII]. It was in process.
[AGENT][NEUTRAL] Let me, I'm just pulling up the last claim that was submitted under [PII] here.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So the last claim that was submitted.
[AGENT][NEUTRAL] Uh, there was no itemized receipt or anything received for the charges. We received a claim form, but we didn't receive anything else. So the last claim submitted for our.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] They've been missing the item in my bill.
[AGENT][NEUTRAL] Yeah, it doesn't have any itemized charges.
[CUSTOMER][NEUTRAL] OK, so you need to, so I can resubmit it with the itemized bill and the EOB.
[AGENT][POSITIVE] Mhm. Correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would you happen to have the claim number so I can when I submit it again, I can have the claim number on the email?
[AGENT][NEUTRAL] The claim number is gonna be 358.
[AGENT][NEUTRAL] 792 3.
[CUSTOMER][NEUTRAL] OK. 358-7823. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you need
[CUSTOMER][NEUTRAL] And is it the only cream that she has or does she have another one open?
[AGENT][NEUTRAL] That's the only one that I see that um was recent needing additional information on it, yes.
[CUSTOMER][NEUTRAL] OK, and does she have one that's that was previously closed or denied?
[AGENT][NEUTRAL] She has some from March, but I didn't think those would be applicable since she said the call was after April. There were some submitted in March.
[CUSTOMER][NEUTRAL] And what is the status of those, please?
[AGENT][NEUTRAL] Let me just pull that up here.
[AGENT][NEGATIVE] First one was denied showing that services were rendered after termination. The data service was 33 of 25.
[AGENT][NEUTRAL] Patient's policy terminated in January.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like it's the uh the same for the other one that was submitted in March.
[CUSTOMER][NEUTRAL] OK, no problem, so.
[CUSTOMER][NEUTRAL] OK, no problem, so I will get the invoices for the one of of April.
[CUSTOMER][NEUTRAL] Let me see what it says. Does that form have a date of service or no? No, I don't think so, right?
[AGENT][NEUTRAL] Hm.
[AGENT][NEGATIVE] No, it doesn't show a date of service. So if the date of service is after [PII], it would be denied.
[CUSTOMER][NEGATIVE] Yeah, I wouldn't be with you guys.
[CUSTOMER][NEUTRAL] Yeah, OK, no problem. Let me get that information and if it's if it's um.
[AGENT][NEUTRAL] OK, sounds
[CUSTOMER][NEUTRAL] It was before January. I'll submit it. If not, I'll let you know to close it. OK.
[AGENT][POSITIVE] All right, sounds good.
[CUSTOMER][POSITIVE] OK. Thank you for your help.
[AGENT][POSITIVE] Thank you. Uh bye-bye.