AccountId: 011433970860
ContactId: f305ed02-9f8d-43a7-8b0f-fc25ef071d19
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1864829 ms
Total Talk Time (AGENT): 282302 ms
Total Talk Time (CUSTOMER): 464216 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/f305ed02-9f8d-43a7-8b0f-fc25ef071d19_20250410T20:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh well yes hello [PII], this is [PII] from within Health Provider Services. I'm calling in regards to visit claims.
[CUSTOMER][NEUTRAL] Um, actually I'm calling in regards to the payment.
[AGENT][NEUTRAL] A claims payment?
[CUSTOMER][NEUTRAL] Uh huh, right, because since, um, actually, uh, I already follow up uh followed up this claim last, uh, I mean yesterday, and I wasn't able to ask if uh did the, I mean, did the payer already cashed the payment or where did they send the payment?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can check on the payment for you. And for my notes, can you spell your first name for me please and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh yeah, sure. Um, for my name, um, that will be, first name, that will be [PII] [PII] It [PII], [PII], and for my initial last name, that will be [PII]. And for my contact number, that will be [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] OK, hold on, let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, insurance information and for American Public Life. Yes, that will be 023343778.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And the patient's name, that will be [PII].
[CUSTOMER][NEUTRAL] Her date of birth, um [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service of the claim number for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Um, actually, there is a multiple date of service for this one. And let's proceed to [PII].
[CUSTOMER][NEUTRAL] Um, uh, uh, well, actually, uh, one of your representatives, uh, already sent us a complete remit.
[CUSTOMER][NEUTRAL] Via fax
[CUSTOMER][NEUTRAL] And uh I'm not sure if um it was already cash or, or where did you send the payment.
[AGENT][NEUTRAL] Right, I understand that.
[AGENT][NEUTRAL] I understand the question. I'm asking you for the data service so that I can pull the claim and get the check number to see what happened with the check. So what's the data service for the, the claim that you like me to check on?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, hold on. [PII].
[CUSTOMER][NEUTRAL] Hold on for a moment.
[AGENT][NEUTRAL] And what's the total bill? OK.
[CUSTOMER][NEUTRAL] [PII], um.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Main one.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hold on, I'm still looking for.
[AGENT][NEUTRAL] Are you
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] The dates that you're saying, am I supposed to be writing this down? Are these the dates that you're wanting me to check?
[CUSTOMER][NEUTRAL] Oh no, no, no, I'm so sorry, um, that would be [PII] for [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Holden.
[AGENT][POSITIVE] OK, take your time.
[CUSTOMER][NEUTRAL] Uh, yes, um, for 2200 bills.
[AGENT][NEUTRAL] Right, and [PII], is it OK if I place you on just a brief hold while I locate the claim?
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. Um, so the claim number um is 358.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 3916.
[CUSTOMER][NEUTRAL] 3916. Mhm.
[AGENT][NEUTRAL] Mhm. The check number is 2036696.
[AGENT][NEUTRAL] And it was issued, it was a single check.
[CUSTOMER][NEUTRAL] Oh, no, no. Um, it's 203-6688.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And what is the claim number that goes with that check that you have?
[CUSTOMER][NEUTRAL] Um, for the claim number 3583916.
[AGENT][NEUTRAL] That's the correct claim number, but that's not the correct check number.
[AGENT][NEUTRAL] Can you provide the check number that you just gave me?
[CUSTOMER][NEUTRAL] But I
[CUSTOMER][NEUTRAL] Uh yes. Um, it's 203-6688 because actually this is uh the um check number that was attached in the um EOB.
[AGENT][NEUTRAL] Can we
[AGENT][NEUTRAL] OK, give me just a moment. Hold on one second. And what was the claim number that that went with?
[CUSTOMER][NEUTRAL] Um, for claim number 3583916.
[AGENT][NEUTRAL] OK, hold on one moment, OK?
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, am I tripping?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] [PII].
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] Alright, thank you so much for holding. I apologize for that wait. Um, so yes, there's two claims that are 661 and 16, so I apologize for that confusion, but yes, you're correct. And your um check number 2036688 was just issued on [PII]. Um, it was mailed to [PII].
[CUSTOMER][NEUTRAL] Oh hold on, it was mailed to.
[CUSTOMER][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK. Uh, it was mailed, uh, again, it was mailed to [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Um, is this a cash?
[CUSTOMER][NEUTRAL] Payment
[AGENT][NEUTRAL] It was a it was a single check in the amount of $291.51 is a cash, I'm sorry, check payment.
[CUSTOMER][NEUTRAL] OK, sure, sure.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, do you have any, uh, a check payment for this one?
[AGENT][NEUTRAL] Yes, that's the information we just went over.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] Hold on for a moment.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] OK. Um, I just wanted to provide those, um, date of service that was um already processed and paid, and I just wanted to ask if where did the payment goes or where, where did you mail the payment?
[CUSTOMER][NEUTRAL] Is that OK?
[AGENT][NEUTRAL] OK, and what's the date of service?
[CUSTOMER][NEUTRAL] Oh yeah, sure, um, we're done with [PII], let's proceed to [PII] for 2200 bill.
[CUSTOMER][NEUTRAL] [PII] for 2200 bill.
[CUSTOMER][NEUTRAL] [PII] for 1100 bill.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] for 1100 build, [PII] for 1100 build, [PII] for 1100 build. [PII] for 1100 build.
[AGENT][NEUTRAL] I'm sorry, hold on, please. Can you, can you slow down, please? [PII] for 1100.
[CUSTOMER][NEUTRAL] Oh yeah, sure.
[CUSTOMER][NEUTRAL] Uh huh, [PII] for 1100.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] After [PII], it's [PII], then [PII] for 1100 bills.
[CUSTOMER][NEUTRAL] And [PII] for 1100 bill.
[CUSTOMER][NEUTRAL] And [PII] for 1100 bill.
[CUSTOMER][NEUTRAL] [PII] for 1100 bill.
[CUSTOMER][NEUTRAL] [PII] for 1100 bill.
[CUSTOMER][NEUTRAL] [PII] for 1100 bills.
[CUSTOMER][NEUTRAL] [PII] for 1100 build, [PII] for 1100 build.
[CUSTOMER][NEUTRAL] And lastly [PII] for 1100 bills.
[AGENT][NEUTRAL] OK, and is it alright if I place you on a brief hold while I go through these dates?
[CUSTOMER][POSITIVE] Oh yeah, sure, thank you.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Sorry about that. Um, thank you so much for holding. I apologize for the wait. There are a few of the claims that were denied, so I'll give you those claim numbers first. It's all for the the same denial reason.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm so sorry. Well, um, as per one of your representatives yesterday, um, the claim was paid.
[AGENT][NEUTRAL] So you gave me several dates of service and the total bill. So I went through each of those dates of service and I got the claim number and the outcome of each of the claims. All of these claims were not paid, majority of them were. The ones we're going to start with first are the ones that were denied because they were all the same denial reason, and then I'll go through the ones that were paid and the check information.
[AGENT][NEUTRAL] Are you ready?
[CUSTOMER][NEUTRAL] OK, um, for the denial?
[AGENT][NEUTRAL] So, uh, data service, [PII].
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. Yes?
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 3979.
[AGENT][NEUTRAL] From [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 3976.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] From [PII], the claim number is 358.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 3981.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 358
[AGENT][NEUTRAL] 3977.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Um, 20243583984.
[AGENT][NEGATIVE] And they were all denied because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, denied because, I'm so sorry, can you repeat?
[AGENT][POSITIVE] Sure, the outpatient benefit.
[AGENT][NEUTRAL] For the calendar year?
[CUSTOMER][NEUTRAL] The outpatient.
[CUSTOMER][POSITIVE] Benefits for the calendar year.
[AGENT][NEUTRAL] Has been met.
[CUSTOMER][NEUTRAL] Has been met, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's MET.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so what do we need to do for this claim to be reprocessed?
[AGENT][NEUTRAL] So
[AGENT][NEGATIVE] There's nothing you can do. Once the max has been made, there's no payments that can be made after the max. So, for those claims that were denied, the max has been met, so there's nothing you can do on those.
[CUSTOMER][NEUTRAL] OK, hold on for a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] [PII], uh.
[AGENT][NEUTRAL] Are you ready for the paid claims?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, hold on, hold on for a moment.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] hold on [PII], um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], [PII], [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and lastly, [PII]. OK. So it was the [PII].
[CUSTOMER][POSITIVE] Oh yes, yes please thank you.
[AGENT][NEUTRAL] OK, you ready for the pay claims?
[CUSTOMER][NEUTRAL] Oh well, um, yes, um, actually there, um, all I need is that if all the paid claims was sent or was mailed to [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, perfect. That's all. Thank you so much. Well, I think that uh I, I mean that is all I need for this one. So lastly, um, [PII], can I have the reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number.
[AGENT][NEUTRAL] Excuse me, you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK and now.
[CUSTOMER][NEUTRAL] Uh, your name is [PII] and the date today, it's uh [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK perfect thank you so much for that. So I think we're all set here. Thank you for your time and have a great day and I I appreciate you today.
[AGENT][POSITIVE] Thank you, [PII]. You're welcome. Well, thanks for calling APL and I hope you have a great day as well. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.