AccountId: 011433970860
ContactId: ed3863ec-a97e-42da-806b-dee6e83c9afb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341309 ms
Total Talk Time (AGENT): 128781 ms
Total Talk Time (CUSTOMER): 149963 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/ed3863ec-a97e-42da-806b-dee6e83c9afb_20250415T13:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi [PII], my name is [PII]. I'm calling from provider's office and I'm looking for claims.
[AGENT][NEUTRAL] I can verify claim status. [PII], may I have a policy number?
[CUSTOMER][NEUTRAL] For sure the policy number will be.
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] It'll be 01575689 M as Mike L 8.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] Sure that'll be [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Patient's name will be [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have a date of service?
[CUSTOMER][NEUTRAL] Data service will be in [PII].
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] That will be $68,996 even.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well. One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like this claim processed under claim number 3341196 and it denied as max benefit was met.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] This claim
[CUSTOMER][NEUTRAL] Mex benefit.
[AGENT][NEUTRAL] Yes, this plan has an outpatient per calendar day benefit.
[CUSTOMER][NEUTRAL] And uh actually there is um multiple CBT was built on this claim um only.
[CUSTOMER][NEUTRAL] How many CD have you received for this, uh, on this claim?
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] How many CPD codes or the digit codes have you received on the claim?
[AGENT][NEUTRAL] One moment, I'll get the actual claim pulled up, one moment.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK. It looks like there are 20 lines on this outpatient claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Just give me a second, just give me a second.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] There are 7 CPT codes built on here.
[CUSTOMER][NEUTRAL] Uh yes, so, so my question is, uh, I just said that the, the claim is denied for max benefit, right, um, but yeah, but that is for which CBT. There are multiple CBT that be on the claim.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] That is for the entire claim. This policy has an outpatient benefit. So there was a claim that was submitted for the same date of service prior to this claim being received, which matched the benefit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, uh, that means, uh, uh, you have also received the same claim, uh, I mean, uh, one more claim on the data service, right?
[AGENT][NEUTRAL] The benefit only allows $500 per day.
[AGENT][NEUTRAL] So a different claim came in and matched that benefit prior to this facility claim being received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That means uh there's one more claim that was below the same day, right?
[AGENT][NEUTRAL] For the same date of service, that is correct.
[CUSTOMER][NEUTRAL] That's that's.
[CUSTOMER][NEUTRAL] Yes, that's why, um, the $500 benefits have max.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And that was built by the same provider or from different provider?
[AGENT][NEUTRAL] This is a different provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much. And could you please spell your name?
[AGENT][NEUTRAL] [PII] [PII]
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] [PII], you're welcome.
[CUSTOMER][POSITIVE] OK, thanks so much for helping me. Yeah, and could you please provide the reference number for our conversation.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] The reference number will be my name, which is [PII]. Last initial is [PII] along with today's date. [PII], is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Um, no, thank you so much, and, uh, uh, I just want to confirm one more thing that, uh, if, if, if you submitted an appeal, uh, to the APL insurance, so what will the mailing address?
[AGENT][NEUTRAL] The mailing address for an appeal is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so do the same as um for the claims mailing address, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you so much. And what is the timely final limit to submit it, uh, uh, submit on the field.
[AGENT][NEUTRAL] 180 days.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you so much have a great day.
[AGENT][POSITIVE] You're so welcome, [PII], and thank you for calling American Public Life. Have a great day. Bye-bye.