AccountId: 011433970860
ContactId: f5876813-e8d0-49a9-9dc5-ec4459bd27bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 700380 ms
Total Talk Time (AGENT): 261206 ms
Total Talk Time (CUSTOMER): 198468 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/f5876813-e8d0-49a9-9dc5-ec4459bd27bc_20250428T19:26_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII]. I'm calling from the provider's office to check on our claim status. I don't have the claim number. Could you please assist me?
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] OK, the member's policy number it's
[CUSTOMER][NEUTRAL] 02369839 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], date of birth, [PII].
[AGENT][NEUTRAL] What is the last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Did you say [PII]? Hey, that's not, OK, that's not the last name that we have on file for this number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Uh, I'm so sorry.
[CUSTOMER][NEUTRAL] I'm so sorry, it's [PII]
[AGENT][NEUTRAL] That's
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount please?
[CUSTOMER][NEUTRAL] Sure date of service it's [PII] for $37 even.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, you said [PII] for $37 is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK. Now, we do not have a claim on file on this policy for this member, but this policy number you gave me was not active for your data service.
[AGENT][NEUTRAL] Let me see if she has another.
[CUSTOMER][NEUTRAL] Uh yes, ma'am. I do.
[CUSTOMER][NEUTRAL] Uh, actually, I just verify that. Uh, I don't have the information. This was received and processed and I do have the claim number. And I do have that information that this
[AGENT][NEUTRAL] Yes, ma'am, but you have the wrong policy number.
[AGENT][NEGATIVE] But you have the wrong policy number.
[CUSTOMER][NEUTRAL] Oh, OK, yeah.
[CUSTOMER][NEUTRAL] I can provide the policy number, sorry, it's 025182772. Is that right?
[AGENT][NEUTRAL] OK, so let me, that one is correct, but let me get that information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the claim number that you have?
[CUSTOMER][NEUTRAL] Oh, sure. The claim number I have, it's
[CUSTOMER][NEUTRAL] Just a moment. Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The claim number I have it's 83,569,480.
[AGENT][NEUTRAL] OK, now that's not an APL claim number.
[AGENT][NEGATIVE] I don't know what company that is for, but that's not for American Public Life.
[CUSTOMER][NEUTRAL] 83.
[CUSTOMER][NEUTRAL] Uh, actually, uh, I just want to verify that I just get the claim status. It was denied as outpatient benefit for the member for the calendar has met. I just want to verify the patient responsibility. That's why I reached out.
[AGENT][NEUTRAL] OK, but now again the claim number you're giving me is not APL's claim number.
[CUSTOMER][NEUTRAL] Uh, can able to verify using the member's date of birth, sorry, date of service in the bill amount.
[AGENT][NEUTRAL] I'm searching for a claim for that billed amount, but I have not seen one for, that's the total bill amount $37.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That was the amount that was billed to her primary insurance?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so for [PII] there is no claim on file for that bill amount.
[CUSTOMER][NEUTRAL] No claim on file.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, actually, previously I just spoke today to [PII]. Is there anyone [PII] in your office?
[AGENT][NEGATIVE] There is an [PII], but the date of service that you're giving me and the billed amount of $37 is not on file. And that claim number that you just gave me is not one that [PII] would have given you because that's not our company's.
[CUSTOMER][NEUTRAL] Ah
[AGENT][NEUTRAL] Information.
[CUSTOMER][NEUTRAL] Um, but, but I just spoke to [PII].
[CUSTOMER][NEUTRAL] For [PII], she gave me those information. Can you able to transfer me to [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what claim number did [PII], what claim number did she give you? because that's not the claim number that she, she, you said 83,569,480?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] No ma'am, that's not a valid number for us. Give me just a moment and let me see what.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so the, the claim numbers that you and [PII] discussed are not for this data service.
[AGENT][NEUTRAL] Did you talk about another data service because they are not for [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, I just spoke about this.
[AGENT][NEUTRAL] Yes, ma'am. And I'm looking at the note.
[CUSTOMER][NEUTRAL] She only gave me those information.
[AGENT][POSITIVE] But you got the OK.
[AGENT][NEUTRAL] So the claim number that you all discussed,
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It is not 835-69480. That's not a valid number for us.
[CUSTOMER][NEUTRAL] I don't know, ma'am. She only gave me that.
[AGENT][NEUTRAL] Maybe you misheard what she said?
[CUSTOMER][NEUTRAL] No, ma'am. I'm sure what she said. I was just taking the note while she was providing.
[AGENT][NEUTRAL] OK, and I'm sure.
[AGENT][NEUTRAL] Yes, ma'am. And I'm sorry about that, and I'm sure that there's not a claim on file for $38.
[AGENT][NEUTRAL] $37. I'm sorry for that date, $37 for [PII]. No claim on file.
[CUSTOMER][NEUTRAL] 37.
[CUSTOMER][NEUTRAL] OK, so no claim on file. That's what you're stating, right?
[AGENT][POSITIVE] For that bill amount. Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK, can you please provide me the correct mailing address to submit the claim?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII].
[CUSTOMER][NEUTRAL] Actually, ma'am, uh, I can, sorry for the interruption. I can see that we have received an EOP as [PII] said it was denied for outpatient benefit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so again, you need to provide me, you have the explanation of benefits. I need the correct build information because what you're providing for me and I, the EOB will also have that claim number on there.
[CUSTOMER][NEUTRAL] OK, let me check that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The claim number it's 3583127.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what does it show as the billed amount on that claim on that explanation of benefits?
[CUSTOMER][NEUTRAL] 37.
[AGENT][NEUTRAL] OK. And what does it show as the data service?
[CUSTOMER][NEUTRAL] 37.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number?
[AGENT][NEUTRAL] It's also on that explanation of benefits.
[CUSTOMER][NEUTRAL] Let me check 02.
[CUSTOMER][NEUTRAL] Just a moment. 025182772.
[AGENT][NEUTRAL] OK, give me one moment. I'm gonna go out of this policy and go back into this policy. One moment.
[AGENT][NEUTRAL] OK. So after refreshing this policy,
[AGENT][NEUTRAL] On claim number ending in 27, that was denied as a duplicate of previously submitted expenses.
[AGENT][NEUTRAL] Claim 3583127.
[CUSTOMER][NEUTRAL] But in the UBI.
[AGENT][NEUTRAL] The night is a duplicate.
[AGENT][NEUTRAL] And what is the other claim number again that you have?
[CUSTOMER][NEUTRAL] But I can see that the UV states it's outpatient benefit treatment, but you're stating something different.
[AGENT][NEUTRAL] I'm reading the explanation. I'm looking at the explanation of benefits.
[CUSTOMER][NEUTRAL] Sure