AccountId: 011433970860
ContactId: f187dccc-1763-4c96-95d9-a70167a51732
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1902130 ms
Total Talk Time (AGENT): 472842 ms
Total Talk Time (CUSTOMER): 498519 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/f187dccc-1763-4c96-95d9-a70167a51732_20250415T13:54_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, [PII], I think I might have pressed the wrong um option I need. I should have pressed 3 for hospital.
[AGENT][NEUTRAL] OK. You have a hospital indemnity plan?
[CUSTOMER][NEUTRAL] Well, actually I'm from the um hospital from [PII] downtown and I was calling to get information about this uh particular plan and for a service date of [PII].
[AGENT][NEUTRAL] OK, may I have your name and a policy number?
[CUSTOMER][NEUTRAL] Um, yes, I'm [PII] and the policy number is T031158.
[AGENT][NEUTRAL] OK, that is
[CUSTOMER][NEUTRAL] And the patient is
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] That is not our policy number. Can I have the first and last name of the patient?
[CUSTOMER][NEUTRAL] Um, yes, this patient's, uh, first name is [PII].
[CUSTOMER][NEUTRAL] And last name is [PII]
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] Patient's date of birth I have it as um [PII].
[AGENT][POSITIVE] Thank you and may I have a good call back number for you, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that did not pull up. Do you by chance have the group number or his social security number?
[CUSTOMER][NEUTRAL] Uh, yes, and you know what, the group that T number was actually his group number. I'm sorry.
[AGENT][NEUTRAL] OK, cause that
[CUSTOMER][NEUTRAL] So the group number is it still didn't pull up anything as a group number?
[AGENT][NEUTRAL] No, ma'am, that would not be our group number.
[CUSTOMER][NEUTRAL] OK, um, so I have the patient's social security number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And I do, I, yes, ma'am.
[AGENT][NEUTRAL] OK, that didn't pull up anything.
[CUSTOMER][NEUTRAL] And why you
[CUSTOMER][NEUTRAL] They pull up, OK, and the reason I'm calling is because we have like um 10 patients um that was registered with um benefits in the card and we haven't received any payments so I was truly calling to see if this is um a legitimate, you know, plan and also to get status, but like I said, I have 10 patients so I can give you another um patient's information just to see if you if you pull up anything.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, patient's name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, member ID number I have it is 02481710.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And his date of birth?
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that information and that is the correct policy number for Mr. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so can you tell me what type of um insurance this is?
[AGENT][NEUTRAL] This is a hospital indemnity plan. It's a limited benefit plan. It's not a major medical.
[CUSTOMER][NEUTRAL] So it's limited, OK, um, can I take a date of service for this patient, please?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's on [PII].
[AGENT][NEUTRAL] OK. May I have the total bill amount?
[CUSTOMER][NEUTRAL] Bill amount is $27,797.15.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is this web, um, is this just the, the website, is it a um self-registered website or?
[AGENT][NEUTRAL] Yes, ma'am. You register.
[CUSTOMER][NEUTRAL] Or do I have to? OK. All right.
[AGENT][NEUTRAL] Yes, just register as a provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] OK, so it looks like this claim processed under claim number 3534824.
[AGENT][NEUTRAL] Pay to the provider on [PII].
[AGENT][NEUTRAL] And it looks like the benefit amount was $1900 to Saint Francis.
[CUSTOMER][NEUTRAL] $1900 you said?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, do you have the patience responsibility?
[AGENT][NEUTRAL] If there's any remaining balance, it becomes patient's responsibility.
[CUSTOMER][NEUTRAL] OK, just wanna make sure, do you have the uh check number check date?
[AGENT][NEUTRAL] Yes, yes, ma'am. The check number is 201.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 7091. And check date is [PII].
[CUSTOMER][NEUTRAL] OK, so it's 6.
[CUSTOMER][NEUTRAL] Um, how many claims can you check?
[AGENT][NEUTRAL] 10.
[CUSTOMER][NEUTRAL] On one call.
[AGENT][NEUTRAL] I can do up to 10.
[CUSTOMER][POSITIVE] And, OK, so it might be my, my lucky day. OK. So, um, let's try.
[AGENT][NEUTRAL] OK, one moment, let me close this one out.
[CUSTOMER][NEUTRAL] Um, [PII], OK, I'm sorry, sorry.
[AGENT][NEUTRAL] One moment. No, you're, you're fine.
[CUSTOMER][NEUTRAL] Oh, I'm, I'm sorry. Another thing, do you show what the uh check was cashed?
[AGENT][NEUTRAL] I would have to send it over to the finance department to verify that.
[CUSTOMER][NEUTRAL] OK, um, if you haven't closed it out, could you please, because we don't see we have it.
[AGENT][NEUTRAL] Would, would you like to send it over?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. I'm ready for your next one.
[CUSTOMER][NEUTRAL] OK, um, next one, the, I don't have the patient ID number. I have it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that would not be our policy number? I can do a name search.
[CUSTOMER][NEUTRAL] OK, name search is [PII].
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And there are several. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So, [PII]'s policy number is 02446644.
[AGENT][NEUTRAL] And his data service?
[CUSTOMER][NEUTRAL] Um, the first day of service for [PII] is.
[CUSTOMER][NEUTRAL] It is on [PII].
[AGENT][NEUTRAL] In total bill amount?
[CUSTOMER][NEUTRAL] Yes, um, total bill amount is $976.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK. This looks like your ER visit.
[AGENT][NEUTRAL] This one processed under claim number.
[AGENT][NEUTRAL] 350-1323. No benefits were payable because
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The maximum for this data service was met.
[AGENT][NEUTRAL] So that
[CUSTOMER][NEUTRAL] So next.
[AGENT][NEUTRAL] That claim processed on.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] Where did it go? It processed on 9-4-24.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So my um
[CUSTOMER][NEUTRAL] My next data service for the same patient.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] It's on [PII].
[AGENT][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. And total bill?
[CUSTOMER][NEUTRAL] $1,873
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's probably the same for the data service.
[CUSTOMER][NEUTRAL] 12,000.
[AGENT][NEUTRAL] Can you give me a CPT code on that one?
[CUSTOMER][NEUTRAL] Yes, ma'am, let's see.
[CUSTOMER][NEUTRAL] Alright, um, we have the Higgs code of 73,610.
[CUSTOMER][NEUTRAL] It's an ER visit.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, and that's right for radiology.
[AGENT][NEUTRAL] OK, put this one up.
[AGENT][NEUTRAL] So this one is radiology Associates, but it's only billed for $37.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, yeah, and the only claim I'm showing for that particular data services for that particular bill is for that bill amount.
[CUSTOMER][NEUTRAL] But OK, so no, so no claim on file for.
[CUSTOMER][NEUTRAL] For the data service of 5:31.
[AGENT][NEUTRAL] Not with that total. Let me see if the other ones are with that provider.
[AGENT][NEUTRAL] No, that's a totally different provider. So, no, that actual bill amount is not on file.
[CUSTOMER][NEUTRAL] 905. OK, alright, so let me.
[CUSTOMER][NEUTRAL] We go to the next one.
[CUSTOMER][NEUTRAL] Um, the next day the service for is 6-14-2024.
[AGENT][NEUTRAL] In total bill amount?
[CUSTOMER][NEUTRAL] I'm sorry, that's, that's the one that's the first one you gave me for um [PII], the, um, let me see.
[CUSTOMER][NEUTRAL] Actually, the data service is 2:15 of 2025.
[AGENT][NEUTRAL] OK, and the total bill amount?
[CUSTOMER][NEUTRAL] Um, $8,085.49.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And that data service with that bill amount is not on file, not showing we have received one moment make sure there's no other.
[AGENT][NEUTRAL] Policies out here.
[AGENT][NEUTRAL] OK, and there is not.
[CUSTOMER][NEUTRAL] OK, and I do see where actually the last claim was billed on even though that's the date of service, I don't show that the bill actually went out until the [PII], so it's a strong possibility that it's not on file.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] That 3.
[CUSTOMER][NEUTRAL] My next one is for a different patient.
[AGENT][NEUTRAL] OK, one moment, I'll close this one out.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Next policy number?
[CUSTOMER][NEUTRAL] Um, I don't have the policy. Well, I don't know if this policy number or not, but I have it as D 47668526.
[AGENT][NEUTRAL] No, ma'am. Our policy starts with 0102 or never would it be. So we'll do a member search on this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, social is [PII].
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient, uh, let me spell it, it's [PII]
[CUSTOMER][NEUTRAL] And last name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you. OK, let me put this in because the social didn't pull up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII] is the last name?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] That one did not pull up at all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So no, I was gonna say no coverage.
[CUSTOMER][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] And we, I think I tried to pay the thing, yeah, that was paid. Um, the next one is.
[CUSTOMER][NEUTRAL] well, social security number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Date of birth is [PII] and patient's name is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK. And that's [PII]?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what would be the date of service on this one for [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let's see [PII].
[AGENT][NEUTRAL] And total bill amount?
[CUSTOMER][NEUTRAL] $1,977.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that would be under policy number 02516735.
[AGENT][NEUTRAL] OK, so it looks like an ER visit it processed under claim number 3511197.
[AGENT][NEGATIVE] It looks like it denied for eligibility.
[AGENT][NEUTRAL] And it looks like this policy.
[AGENT][NEUTRAL] Looks like this policy is no longer active as of [PII]. So this claim denied for eligibility on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And then I have uh.
[CUSTOMER][NEUTRAL] Yeah, I don't have the policy number, so I have the member's on social.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, let me close up, [PII].
[CUSTOMER][NEUTRAL] It's 249. OK, sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, 249.
[CUSTOMER][NEUTRAL] 617-825
[AGENT][NEUTRAL] OK. Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Policy number is 02453668.
[AGENT][NEUTRAL] May I have a date of service?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] In total bill amount?
[CUSTOMER][NEUTRAL] $5,292.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This one processed under claim number 3541193.
[AGENT][NEGATIVE] No benefits were payable. The max was met for this data service.
[AGENT][NEUTRAL] This claim processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have another data service for this one?
[CUSTOMER][NEUTRAL] Alright, I have
[CUSTOMER][NEUTRAL] No, not this one, and I just have 2 more.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, this one, you probably like ready to pull up cause it's showing.
[CUSTOMER][NEGATIVE] This, this is truly not a valid social security number. Do you definitely have to have the social security number?
[AGENT][NEUTRAL] Or a name search.
[CUSTOMER][NEUTRAL] OK, so we'll, we'll try the name, um, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So, let's, let's try.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] No, let's see.
[AGENT][NEUTRAL] And what would be the data service on this one?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So the policy number on this one would be
[AGENT][NEUTRAL] 02486386.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the total bill for [PII]?
[CUSTOMER][NEUTRAL] $1,264.
[AGENT][NEUTRAL] OK, so this one processed under claim number 349-5110.
[AGENT][NEGATIVE] No benefits were payable because
[AGENT][NEUTRAL] The provider provides no benefits for charges made by a doctor and an inpatient visit.
[CUSTOMER][NEUTRAL] I'm sorry, say that again now.
[AGENT][NEGATIVE] The the the policy provides no benefits for charges made by a doctor for inpatient visits. So it looks like the place of service was not covered on this one.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, cause it's showing hospital, we we we facility.
[AGENT][NEUTRAL] Yes, and
[CUSTOMER][NEUTRAL] Saint Francis Hospital.
[AGENT][NEUTRAL] And that's how this one was.
[AGENT][NEUTRAL] How it was this, did they go from the ER to the inpatient?
[CUSTOMER][NEUTRAL] Oh, no, I just show ER charges.
[AGENT][NEUTRAL] And that's what I'm looking at this one.
[CUSTOMER][NEUTRAL] Or ERVs that I mean.
[AGENT][POSITIVE] Yeah, that's what I'm looking at this one as well.
[CUSTOMER][NEUTRAL] And they were discharged at home.
[AGENT][NEUTRAL] I can write this one up and send it over for a review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me send this one over for review.
[AGENT][NEUTRAL] So normal turnaround time on review is anywhere from 7 to 10 business days. It doesn't necessarily take as long, but you can call back for update status on this one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me get this one together one moment.
[AGENT][NEUTRAL] OK, got that one in.
[CUSTOMER][NEUTRAL] Alright and the last one.
[CUSTOMER][NEUTRAL] Um, social is [PII].
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] OK, that did not pull up. [PII]?
[CUSTOMER][NEUTRAL] [PII], yes ma'am.
[AGENT][NEUTRAL] And [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And social [PII].
[AGENT][NEUTRAL] Yes, and it did not pull up under that one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would he be a dependent under someone?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it's possible because he's [PII].
[AGENT][NEUTRAL] Because I'm not
[CUSTOMER][NEUTRAL] But I don't show
[AGENT][NEUTRAL] I'm not pulling him up by his name or by his so.
[AGENT][NEGATIVE] It's not pulling up anything.
[CUSTOMER][NEUTRAL] Yeah, and I don't see a guarantor, just, just him.
[CUSTOMER][NEUTRAL] As the patient.
[AGENT][NEUTRAL] And there's no group number, correct?
[CUSTOMER][NEUTRAL] No group number.
[AGENT][NEUTRAL] OK, because I don't, I've done a name search and social.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] OK, I just say because there's no coverage. Alright, that was my last one. I appreciate your help and the information you provided.
[AGENT][POSITIVE] [PII], you're so welcome. You're welcome and thank you for calling American Public Life, [PII]. Have a great day.
[CUSTOMER][POSITIVE] Alright, thank
[CUSTOMER][NEUTRAL] You too. Bye-bye.