AccountId: 011433970860
ContactId: ed153045-829d-4738-9502-0c2911c9513b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 538900 ms
Total Talk Time (AGENT): 168789 ms
Total Talk Time (CUSTOMER): 207630 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/ed153045-829d-4738-9502-0c2911c9513b_20250414T18:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office, PH University Medical Group, and I'm calling in reference to a claim, please.
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then the policy number.
[CUSTOMER][NEUTRAL] Uh, I have 025486550.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] This is going to be for [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. You're calling in for status. May I please have a date of service and total bill?
[CUSTOMER][NEUTRAL] Uh, 25 of $25 we bill $17.
[AGENT][POSITIVE] Thank you, I'm pulling that information up for you now.
[CUSTOMER][POSITIVE] I appreciate it, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And you can also check claim status via our secured portal that is [PII] and it does look like we received that claim on [PII].
[AGENT][NEUTRAL] It was processed on 35 of 25.
[AGENT][NEGATIVE] It is showing that we denied it requesting the primary EOB.
[CUSTOMER][NEUTRAL] So you show that the patient has another insurance, a primary insurance?
[AGENT][NEUTRAL] Yes, we're just their supplemental.
[CUSTOMER][NEUTRAL] Oh, you're always just a supplemental. OK. Uh, thank you for that. And can I ask you for one more, um,
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I see. I know this. I don't have, I have a claim number, but it starts with a D, and I think this is on the wellness side.
[CUSTOMER][NEUTRAL] Uh, let me pull this one up and tell you the claim number.
[AGENT][NEUTRAL] Is it for this member?
[CUSTOMER][POSITIVE] No, we're talking about a different member. I'm so sorry. I apologize.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I'm finished. You said, OK, and so thank you for that patient. Can you help me with another one?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. This is the one I was stating that uh I have a claim number of D for [PII], 437731864.
[AGENT][NEUTRAL] OK, our claim number doesn't start with a D.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, is, are you saying that that's their policy number for benefit in the car?
[CUSTOMER][NEUTRAL] All right. Is there a
[CUSTOMER][NEUTRAL] That's their right, that's their policy number, but I think maybe it's on the wellness side maybe.
[AGENT][NEUTRAL] Yes. A lot of times, they normally handle the wellness and we would handle the medical if they have a policy with us.
[CUSTOMER][NEUTRAL] Do you know the phone number for the wellness?
[AGENT][NEUTRAL] Let me check that for you.
[AGENT][NEUTRAL] And you say it's benefit in a car?
[CUSTOMER][NEUTRAL] They, the patient, we don't have a car. The patient just said this is their claim num this is their policy number and they requested us to file some claims, some bills to this particular claim number.
[AGENT][NEUTRAL] OK, may I have the patient's first and last name, please?
[CUSTOMER][NEUTRAL] Sure. The first name is spelled [PII]
[CUSTOMER][NEUTRAL] Um, [PII]
[AGENT][NEUTRAL] Is [PII] together?
[CUSTOMER][NEUTRAL] I think so.
[AGENT][NEUTRAL] And may I have the date of birth?
[CUSTOMER][NEUTRAL] Actually, her date of birth is [PII].
[AGENT][NEUTRAL] OK, I did pull that member's policy up with us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get that
[AGENT][NEUTRAL] Number for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So does she have any coverage on the medical side?
[CUSTOMER][NEUTRAL] The mega on your side on APL side?
[AGENT][NEUTRAL] Now, with this policy, it is an indemnity policy. She will have benefits, but it just varies off of which benefit are you needing me to pull up.
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] Yes, is it for inpatient, outpatient or an office setting?
[CUSTOMER][NEUTRAL] Opposite him.
[AGENT][NEUTRAL] Let me pull that up for you.
[AGENT][NEUTRAL] And would you like the policy number for us as well?
[CUSTOMER][POSITIVE] Please, thank you. I really do appreciate your help. Mhm. Yes, ma'am.
[AGENT][NEUTRAL] You're welcome. For us that policy number would be 02.
[AGENT][NEUTRAL] 58.
[AGENT][NEUTRAL] 8272.
[CUSTOMER][NEUTRAL] Alright, that was 02588272, correct?
[AGENT][NEUTRAL] Yes, yes, and it is showing the effective date of [PII].
[CUSTOMER][NEUTRAL] And do
[CUSTOMER][NEUTRAL] Hm, these are [PII] dates of service. So did she have coverage prior to the [PII]?
[AGENT][NEUTRAL] Let me check that.
[AGENT][NEUTRAL] So prior to that I'm not seeing that we had her listed in our system at that time. She had no coverage.
[CUSTOMER][POSITIVE] OK, alright then, thanks, alright, and right, I'm ready for the phone number for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that will possibly mean.
[CUSTOMER][NEUTRAL] Oh, before, before we leave, you see.
[AGENT][NEGATIVE] She wouldn't have coverage with benefit in a card either.
[CUSTOMER][NEUTRAL] OK, back OK.
[AGENT][NEUTRAL] But I'll I'll still give you that number so you can go ahead and check with them. Are you ready for the number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I am go ahead mhm.
[AGENT][NEUTRAL] It is 1-800.
[AGENT][NEUTRAL] 833.
[AGENT][NEUTRAL] 4296.
[CUSTOMER][NEUTRAL] Alright, 8008334296, but she had no coverage in 2024 with APL.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and if I need to submit 2025 bills to APL, is there a group number for this uh policy?
[AGENT][NEUTRAL] Let me get that for you and first it will have to go to benefit and a card and then it should cross over to us, but let me give you the group number are you ready for that?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am, go ahead.
[AGENT][NEUTRAL] It is 70056.
[CUSTOMER][NEUTRAL] OK. And the address?
[AGENT][NEUTRAL] The mailing address.
[CUSTOMER][NEUTRAL] You said it's got to go to benefit in a car. Mhm.
[AGENT][NEUTRAL] Yes, the mailing address for them is [PII].
[CUSTOMER][NEUTRAL] Go ahead. Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] With the zip code of [PII].
[CUSTOMER][NEUTRAL] Alright, so that is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Alright, I appreciate your help. I hope you have a good day.
[AGENT][POSITIVE] You're welcome and thank you so much for calling American Public Life, [PII]. You have a great day as well.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.