AccountId: 011433970860
ContactId: f995aac9-6a27-4c14-8236-e21f457c4ae2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1072140 ms
Total Talk Time (AGENT): 302088 ms
Total Talk Time (CUSTOMER): 404198 ms
Interruptions: 6
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/f995aac9-6a27-4c14-8236-e21f457c4ae2_20250109T20:00_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Very good afternoon. My name is [PII] and initial to my last name is [PII], and I'm calling from the provider's office to discuss on a claim. And before we proceed with this call, I would like to inform you this call is being recorded for quality and training purposes. Is that OK with you?
[AGENT][NEUTRAL] Yes, that is fine. And could you please spell your first name for me?
[CUSTOMER][NEUTRAL] Absolutely my name is [PII] spelled as [PII] is my last name initial. And give me one moment here. Yes, can I know your name as well?
[AGENT][NEUTRAL] And I do, what is your callback number?
[CUSTOMER][NEUTRAL] Sure it is [PII] extension would be [PII].
[AGENT][NEUTRAL] Thank you. And you said that you're needing additional information regarding a, a claim, is that correct?
[CUSTOMER][NEUTRAL] Yes, um, can you also let me know your name once again?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] First initial to last name [PII]. You will use my name and.
[AGENT][NEUTRAL] Today's date for your call reference number if you need one. And uh do you, how many do you, you said you only have one claim that you're needing status information about?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Absolutely mhm.
[CUSTOMER][NEUTRAL] Uh, give me one moment, let me check for that here.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Here I go with the details now. Uh, this is American Public Life, and I have total.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so for American Health I just have.
[AGENT][NEUTRAL] American Public Life is who I'm with.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yes, American Public Life, uh, yes, uh, for American Public Life. I have only, I guess 1 to 2 claims. I don't find any much claims here.
[AGENT][NEUTRAL] How many?
[CUSTOMER][NEUTRAL] Oh, no, not one, it's total 4 claims here.
[AGENT][NEUTRAL] 4. Is that correct?
[CUSTOMER][POSITIVE] Yes. Yes, yes.
[AGENT][NEUTRAL] OK, so I can help, uh, and is it for 4 different numbers, 4 different patients or 1 patient and 4 dates of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, for that, as you can see, it's just one patient.
[AGENT][NEUTRAL] OK, 1 member and 4 dates of service for that member. Is that correct?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Actually 2 members, uh, yeah, only 2 members.
[AGENT][NEUTRAL] OK, and each of them have 2?
[CUSTOMER][NEUTRAL] Because, because the thing is I can only see the patient's name. Uh-huh. I just have the patient's name here. I don't know about that, how many claims does the patient have. So for that, I'm opening the account. First account, I have it for the patient and it have only one account.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] So the rest of the 3 years for different patient mhm.
[AGENT][NEUTRAL] Mhm. OK, so you will use my name and today's date as your call reference number for each one that I check. Also any information that I provide for you today on any of the claims will be a verification of benefits and not a guarantee of payments. And lastly, if you need a copy of any of the explanation of benefits.
[CUSTOMER][NEUTRAL] Sure, sure, sure.
[AGENT][NEUTRAL] You can print them from our portal by going to secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] Policy number for the first patient, it is going to be 02475232.
[AGENT][NEUTRAL] Say that again, please?
[CUSTOMER][NEUTRAL] 02475232.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Do you already have the claim numbers?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um, give me one moment here.
[AGENT][NEUTRAL] That you're needing additional information regarding it?
[CUSTOMER][NEUTRAL] Yes, I do have a claim here, but I'm not having, give me one moment.
[AGENT][NEUTRAL] OK, and what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] The total date of
[CUSTOMER][NEUTRAL] OK, first of all, the dealt service is [PII]. Charge amount is $540 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the client number?
[CUSTOMER][NEUTRAL] Claim number I'm not pulling out here. Give me one moment. I'm opening the UB here.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, no, I don't find any claim number on that year. Can you help me with the claim number as well?
[AGENT][NEUTRAL] One moment to verify that we have the claim on file.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And also let me know first of all, what is the receipt date and the process date.
[AGENT][NEUTRAL] Again, let me verify first that we even have received this claim.
[AGENT][NEUTRAL] For this number for this data service and if so, I will provide you that information.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] And it's still trying to load the information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's taking time to get the information?
[AGENT][NEUTRAL] It is.
[CUSTOMER][POSITIVE] Oh sure it's OK you can take your time.
[AGENT][NEUTRAL] OK, I do not show that we have received a claim for a total billed amount of $540 for this member for this data service.
[CUSTOMER][NEUTRAL] The data service is [PII], right?
[AGENT][NEUTRAL] 43 2024, 4540 is the billed amount, is that correct?
[CUSTOMER][NEUTRAL] Yes, and you're not having.
[CUSTOMER][NEUTRAL] 540 yes you're right, um, give me one moment. How is that possible?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Can you check for the billed amount 136?
[AGENT][NEUTRAL] OK, so for the billed amount of 136, we did receive a claim.
[CUSTOMER][NEUTRAL] OK, and you don't have any claim for uh $540 right?
[AGENT][POSITIVE] No, that is correct.
[CUSTOMER][NEUTRAL] Actually, give me one moment. I have an UB where we have received a claim for $536 and that the $50 I mean the payment which has been paid, it is $50.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] That is for the total bill amount on the 136. That is correct.
[CUSTOMER][NEUTRAL] Not a possibility that you haven't received it. Give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] With the type
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] contact.
[CUSTOMER][NEUTRAL] 99203 is changed to 99213, which is $136. OK. Uh, you didn't find any details regarding the CVV code [PII] or [PII]?
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] As I stated, we don't have a claim on file for the member for the data service 43-2024 in the amount of $540.
[CUSTOMER][NEUTRAL] Nope.
[CUSTOMER][NEUTRAL] Mm, OK, give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Let's do one thing. Let's, let's, let's, let's take patient now. Uh, I'll talk this about about this claim to my supervisor anyways, let's move forward for the next one.
[AGENT][NEUTRAL] OK, um, it's going to take us, take me a couple of minutes because I have to make notes on each claim that I took for you as well.
[CUSTOMER][NEUTRAL] Sure, sure, yeah, yeah, sure.
[AGENT][NEUTRAL] So, I will let you know um of you when we get, when I'm finished with my portion and we can move to the next one.
[AGENT][NEUTRAL] OK, and the next um member's policy number, please?
[CUSTOMER][NEUTRAL] It is um gonna be L as in Lima, H as in Henry, P as in Peter 191, go ahead.
[AGENT][NEUTRAL] OK, that
[AGENT][NEUTRAL] I was gonna say that's not a policy number for our company, for American Public Life.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Hold on, give me one moment, uh.
[CUSTOMER][NEUTRAL] Yes you're right, this member ID not belong to you.
[CUSTOMER][NEUTRAL] Um, let me check.
[CUSTOMER][NEUTRAL] Yes, it does not belongs to you. Uh,
[CUSTOMER][NEUTRAL] Mm, OK, so let me do one thing let me find this one here.
[CUSTOMER][NEUTRAL] OK, can I know your payer ID number?
[AGENT][NEUTRAL] 6. Well, it depends. It, that would depend on the type of plan a member has.
[CUSTOMER][NEUTRAL] Uh, can you find the member by the name and the date of birth?
[AGENT][NEUTRAL] I, I can't search by date of birth, no. What is the last I can try by the name?
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Do you have the last 4 of the social?
[CUSTOMER][NEUTRAL] Yes, I do have it. It is going to be [PII].
[AGENT][NEUTRAL] OK, do you have the full social?
[CUSTOMER][NEGATIVE] Full social I won't be able to provide you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But let me check if I can find anything.
[AGENT][NEUTRAL] This may take, I say this may take a while because that's a very common name.
[AGENT][NEGATIVE] And I can't search by only the last 4.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Of the social.
[CUSTOMER][NEUTRAL] Mhm, I know.
[CUSTOMER][NEUTRAL] I'm also trying to check if I have anything here.
[CUSTOMER][NEUTRAL] Uh, uh-huh, OK, Metropolitan.
[AGENT][NEUTRAL] Well, what state does he live in?
[CUSTOMER][NEUTRAL] Can I
[CUSTOMER][NEUTRAL] I lived in uh.
[CUSTOMER][NEUTRAL] Oh, OK, wait, wait, wait, wait, let me have here let me check something here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] State number state state state.
[CUSTOMER][NEUTRAL] the claim form.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's in, yep, mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm just checking if I'll get any social or anything um I didn't fix it.
[AGENT][NEUTRAL] Yes, so you may have to because there is
[AGENT][NEUTRAL] There are a whole lot of [PII].
[CUSTOMER][NEGATIVE] And there is no uh clue or anything getting with that um.
[AGENT][NEUTRAL] No, sir, the policy number would be helpful.
[CUSTOMER][NEUTRAL] Last 3.
[CUSTOMER][NEUTRAL] Mhm I'm also trying to check if I have it.
[AGENT][NEGATIVE] I can't search, yes, I can't search by just the last four of the social.
[CUSTOMER][POSITIVE] Mm I can understand, yes, you're right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sorry for that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, is that OK if I place your call on hold for one minute?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Just one moment, OK?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, sir. Uh-huh. Indeed, I'm still here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, thank you, thank you very much for being on line. Um, actually I checked in my system. I didn't get any details regarding the patient's ID card, um, as well as with the social. I, I was still looking after what, but now I didn't get any details, so I'll do one thing. I'll check with my patient itself for the um correct ID number or the social.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK. Yes, sir, because I wasn't able to locate a [PII] in [PII] with that any, with the last four of that social that you provided for me.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][POSITIVE] Mhm I got it. No problem. I can keep, as I said, I, I'll get in touch with my patient itself, so thank you, thank you very much for, uh, for providing the details regarding the claim previous claim. Oh wait, wait, wait, wait, wait, wait, uh, I, I got it. I got it, I got it. Uh, I got the social for the member. um, it is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me see if I can locate.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, there is no one in our system as the primary subscriber with that social security number.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Let's try, let me refresh.
[CUSTOMER][NEUTRAL] That means you
[AGENT][NEUTRAL] Mhm. You said [PII], is that correct?
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, there's no one in our system with that social security number.
[CUSTOMER][POSITIVE] OK, no problem. I will, I, I'll, I can check with the patient itself now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, is there anything else?
[CUSTOMER][NEUTRAL] OK, so that's all for now. No, there is nothing now, there is nothing now. Thank you very much for providing the details here and.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you're very welcome.
[CUSTOMER][NEUTRAL] OK, uh, what was the status for the, uh, what was the status for the previous claim which we talked about?
[AGENT][NEUTRAL] We didn't, we talked about a claim that I said was not on file.
[CUSTOMER][NEUTRAL] Um, OK, but we did, we didn't receive your, uh,
[AGENT][NEUTRAL] Yes sir, you said that you had received a $50 payment on the another claim for a different billed amount, and I said yes, that was correct.
[CUSTOMER][NEUTRAL] Give me a second, OK for.
[CUSTOMER][POSITIVE] Uh-huh, yes, yes, yes, you're right. Mhm. OK, no problem.
[AGENT][NEUTRAL] But you said you had that information.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Yes, I, I do have that information. That's what I'll do. Thank you very much and have a nice day. Bye bye. Stay safe.
[AGENT][POSITIVE] Uh, you too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Bye-bye.