AccountId: 011433970860
ContactId: f9aae7c9-461a-4318-ba65-627ccd8e23f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 799840 ms
Total Talk Time (AGENT): 252268 ms
Total Talk Time (CUSTOMER): 391146 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/f9aae7c9-461a-4318-ba65-627ccd8e23f0_20250306T13:17_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII] here. So I called you to check the claim status.
[AGENT][NEUTRAL] Policy number, [PII]?
[CUSTOMER][NEUTRAL] Uh, we have built a claim but we did not receive the.
[CUSTOMER][NEUTRAL] UB you mean member ID?
[AGENT][NEUTRAL] What is the
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] All right. It's 0202.
[CUSTOMER][NEUTRAL] 177.
[CUSTOMER][NEUTRAL] 8 M as in Mike L Lima, number 8.
[AGENT][NEUTRAL] I don't get OK and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] All right. It's [PII]. Date of birth is [PII]. May I know your name?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And I'm gonna give you the website to download the claim.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What is the date of service? What is the date of service of the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And the amount?
[CUSTOMER][NEUTRAL] The total bill amount is.
[CUSTOMER][NEUTRAL] $678.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you'll have to go online to download a copy of the explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said the date of service is [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Uh yes, you're right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII],
[AGENT][NEUTRAL] Uh huh I'm searching.
[CUSTOMER][NEUTRAL] Yes, even I'm in the um website, but we did not have the claim number, so how can I check?
[AGENT][NEUTRAL] I don't show that we've received that date of service for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] I don't show a claim received for that data service.
[CUSTOMER][NEUTRAL] All right, one moment. Um, can I verify the
[CUSTOMER][NEUTRAL] Payer ID is 6080.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Mhm, go ahead.
[CUSTOMER][NEUTRAL] It's 6080, payer ID.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, one moment, let me update that so that we can build it properly.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. It's 60801, correct? Can you check in the rejection file because I can see here the payer ID is 60801. It's already updated here.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yeah, I don't show that we've received the claim, ma'am. It'll have to be resubmitted.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right, no problem. Uh, and I want to tell you that the claim is submitted to paper. It's a paper submission.
[AGENT][NEUTRAL] To what what address?
[CUSTOMER][NEUTRAL] Uh, let me provide you that.
[AGENT][NEUTRAL] So you submitted it via payer ID and then you submitted it via paper?
[CUSTOMER][NEUTRAL] No, payer ID, it's not submitted electronically, it is submitted by paper and um mailing address is 24,890.
[CUSTOMER][NEUTRAL] I'm sorry, I'll start from the beginning. It's [PII], OK, [PII].
[AGENT][NEUTRAL] The last four is [PII].
[CUSTOMER][NEUTRAL] 01 moment. Uh oh.
[CUSTOMER][NEUTRAL] That means 73124. Can you just repeat that?
[AGENT][NEUTRAL] 8950.
[CUSTOMER][NEUTRAL] 8950.
[CUSTOMER][NEUTRAL] All right, so that the claim is not received yet, I guess. So we will send the claim through electronically. Is that OK?
[AGENT][NEUTRAL] However you choose to submit it electronically or by paper it's your choice and did you have any other questions, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, I do have two claims.
[AGENT][NEUTRAL] For the same person?
[CUSTOMER][NEUTRAL] No, for the different member ID.
[AGENT][POSITIVE] Thank you, give me one second, let me document this call and we can proceed.
[CUSTOMER][NEUTRAL] Sure, [PII], can you provide me the caller for?
[AGENT][NEUTRAL] Give me one moment please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let me go ahead and get the other claims and then we'll give you the call reference number at the end of the call. What's the next policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me provide you just a minute. It's loading.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] All right, the policy number is 0230.
[CUSTOMER][NEUTRAL] 296.
[CUSTOMER][NEUTRAL] 6 M. Mike L. Lima 8.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK, just a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII], sorry, [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] I'm showing a different first name.
[CUSTOMER][NEUTRAL] OK. One minute.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, it's [PII].
[AGENT][NEUTRAL] Spell the first name for me?
[CUSTOMER][NEUTRAL] Or B.
[CUSTOMER][POSITIVE] [PII], and the last name is [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you and you're checking claim status for what day?
[CUSTOMER][NEUTRAL] It's all
[CUSTOMER][NEUTRAL] It's on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me give you the policy number that's associated with that date of service. Let me know when you're ready.
[CUSTOMER][NEUTRAL] No, we have received the UBN and it says that medical records is necessary. So can you just uh provide me the information?
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] All right. It's 34.
[CUSTOMER][NEUTRAL] 354-835-1
[AGENT][NEUTRAL] Give me that one more time.
[CUSTOMER][NEUTRAL] 354-835-1
[AGENT][NEUTRAL] Let me give you the policy number that's the the correct policy number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] right
[AGENT][NEUTRAL] It's 249.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 84
[AGENT][NEUTRAL] 90.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. What is the denial? Can you, yeah.
[AGENT][NEUTRAL] And I'm
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it shows that the major medical denied the charges. And so when it's denied by the major medical, this policy does not cover it. Um, if it's reprocessed and paid, that corrected ELB can be submitted to American Public Life.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right. That is the primary UB is requested, right?
[AGENT][NEUTRAL] We're not requesting it. Oh well, did the primary pay anything on that charge or did they deny it?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Let me check. Yes, they have not paid primary is not paid.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so they denied it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So therefore this policy will not cover it either if they later go back and reprocess the claim and pay at that at that moment you can submit a corrected EOB.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] That means we have uh mhm.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] Yes, that means we have to connect with the primary insurance regarding that why the claim is not paid, right? After that we have to send the.
[CUSTOMER][NEUTRAL] Corrected claim to you.
[AGENT][NEUTRAL] I mean we can't advise. I'm just giving you the status of our claim and why it denied um how you proceed to be up to the provider's office.
[CUSTOMER][NEUTRAL] I mean we can't advise.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So what we have to do, just tell me simply I'll do that.
[AGENT][NEUTRAL] Yeah, we can't advise ma'am. I'm just giving you the status of the APL claim we denied this claim because the primary denied the claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what can be done further?
[AGENT][NEUTRAL] We cannot advise.
[CUSTOMER][NEUTRAL] not
[CUSTOMER][NEUTRAL] As per member policy or else it's uh come under provider's plan.
[AGENT][NEUTRAL] It's for the patient's policy that the charge was not covered.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And what is the next policy number?
[CUSTOMER][NEUTRAL] One minute, I'll give you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I think that we need to build patient right? for the remaining amount.
[AGENT][NEUTRAL] We cannot advise, ma'am.
[CUSTOMER][NEUTRAL] You got it. All right, no problem. Let me provide you the third member ID. It's yeah, it's 02480526.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Thank you. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and what's the data service in charge?
[CUSTOMER][NEUTRAL] It's November [PII]. Total charge amount is
[CUSTOMER][NEUTRAL] Let me go again one minute. It's $1,404 even.
[CUSTOMER][NEGATIVE] And we yet not received the EOB.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said November [PII], 24?
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] Uh, what are the procedure codes on that claim?
[CUSTOMER][NEUTRAL] Procedure code is 99203.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 95911
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 958-886
[AGENT][NEUTRAL] OK, thank you. So I do show that the claim was processed on [PII].
[CUSTOMER][NEUTRAL] So would you say that.
[AGENT][NEUTRAL] Uh, issuing a payment, uh, first of all, what's the name of the practice?
[CUSTOMER][POSITIVE] Oh, sure, I'll provide you that one minute.
[CUSTOMER][NEUTRAL] It's Johnson County Neurology LLC.
[AGENT][NEUTRAL] OK. So a payment of $766.66.
[AGENT][NEUTRAL] Was issued um can you verify the billing address?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] It's Johnson County Neurology LLC and the PO box is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] There a suit.
[CUSTOMER][NEUTRAL] Is it correct?
[AGENT][NEUTRAL] Is there a suite to that address?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, that is the correct PO box that we have on file and that's where the check was mailed um now the claim number associated with this data service is.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 354.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 8983.
[AGENT][NEUTRAL] And you could verify, uh, you could download the ELB from the website because it has been mailed.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And um check is um mailed to this PO box, right? [PII] right.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Hello? Oh, OK.
[CUSTOMER][NEUTRAL] Yes, yeah, so I'm sorry, can you provide me the call reference number?
[AGENT][NEUTRAL] You're gonna use my name and today's date as reference for today's call, [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, I can.
[AGENT][NEUTRAL] First initial last name is [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] It's 20250303 0 sorry 06 or else I use 0306 from the beginning.
[AGENT][NEUTRAL] Yeah, [PII], however you wanna write that out, it's up to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, no problem
[AGENT][NEUTRAL] Anything else? All right, [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. No, that's, thank you so much for your help. Have a great day to you. Bye-bye.
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too.