AccountId: 011433970860
ContactId: f9cc8bb6-4a48-4abe-be59-ba3f73d47ffb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 859900 ms
Total Talk Time (AGENT): 206674 ms
Total Talk Time (CUSTOMER): 250073 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/f9cc8bb6-4a48-4abe-be59-ba3f73d47ffb_20250403T14:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Medlife Healthcare LLC to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know if I can help with the patient's information or provider's information?
[AGENT][NEUTRAL] May I have a callback number please?
[CUSTOMER][NEUTRAL] It's [PII]. It's a direct line without extension.
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 302-203-464.
[AGENT][NEUTRAL] That's not one of our numbers.
[CUSTOMER][NEUTRAL] I have one more with me just a moment.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] D as in Delta 434103777.
[AGENT][NEUTRAL] May I have the member's first and last name please? because that's not one of our policy numbers either.
[AGENT][NEUTRAL] I start with the 01 or 02?
[CUSTOMER][NEUTRAL] OK, it's a [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you spell that for me, please?
[CUSTOMER][POSITIVE] Great for us.
[CUSTOMER][NEUTRAL] He first last name and first name?
[AGENT][NEUTRAL] Last name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And you're calling in for status of claim for this member?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] May I please have the date of service and total bill?
[CUSTOMER][NEUTRAL] Data service is [PII] and the total charge is $150 each.
[AGENT][NEUTRAL] And I'm putting that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it does look like we have received this claim in 4 times, so for the first receipt of this claim, it shows that we did receive it on.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That claim number is 3497837. The claim processed and denied that the maximum benefit had been met.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Just a moment you received this um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So we
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK, so we resubmit this claim on [PII].
[CUSTOMER][NEUTRAL] We you submitted with the medical records.
[AGENT][NEUTRAL] OK, so as I was stating we did receive it in 4 times. The main claim denied, which was received on [PII]. The other claims that did come in, they denied as a duplicate of the previous submitted claim. Would you like the rest of those claim numbers and receipt dates as well?
[CUSTOMER][NEUTRAL] Yeah, I have some specific questions for you. Just give me a moment.
[CUSTOMER][NEUTRAL] OK, so we need the original claim status only because you said the.
[CUSTOMER][NEUTRAL] All the recent claim you received that was denied as duplicate. So give me the OK, you give me the received date. Can you give me re denied date?
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] On the other 3?
[CUSTOMER][NEUTRAL] Is the process date is it denied date?
[AGENT][NEUTRAL] What, what information are you needing? Because I gave you the reason of the denial of the main claim.
[CUSTOMER][NEUTRAL] Yes, so the main.
[AGENT][NEUTRAL] And then the other claims that came in as a duplicate, so are you needing all the status of each claim number?
[CUSTOMER][NEUTRAL] No, actually I just uh want, uh, the original claim denied details which is the, the original claim receipt on [PII] and the processed on [PII]. Is the denied date is same as processed date?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, what are the allowed service amount per time frame?
[AGENT][NEUTRAL] Let me pull that information up for you.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And for this member, verification of coverage does not guarantee the payment of the claim. At the time of this policy, it is showing that the member has up to $75 with the maximum of 5 visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When was the last service built?
[AGENT][NEUTRAL] I can't advise you of any other claim. I can just advise you of the claims that was submitted in by the provider.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, what is the time period to build the service?
[AGENT][NEGATIVE] There's no timely filing for this policy. It does look like you all submitted it in 3 times after the first denial, and those claims were reviewed and they denied as a duplicate.
[AGENT][NEUTRAL] That the denial was correct on the previous claim.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] My mailing address to submit correctly. It's just for my documentation.
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, just let me reconfirm. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And I'm filing for appeal.
[AGENT][NEGATIVE] We have no timely filing, but we do see that you, as I stated, it was submitted in 3 times after, so that appeal had been reviewed and it denied as a duplicate.
[CUSTOMER][NEUTRAL] just for documentation for the normal timely filing for a bill.
[AGENT][NEGATIVE] We have no timely filing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The mailing address for the same?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. And is there any specific form for appeal?
[AGENT][NEUTRAL] No specific form.
[CUSTOMER][NEUTRAL] I'll take
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Is there any attention for a bill?
[AGENT][NEUTRAL] You can just put attention and just put appeals.
[CUSTOMER][NEUTRAL] You do me back after it's not.
[CUSTOMER][NEUTRAL] OK, there is a tension with appeals.
[AGENT][NEUTRAL] You would just put attention appeals.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and uh
[CUSTOMER][NEUTRAL] Denied you'll be required for free submission.
[AGENT][NEUTRAL] No, we don't need to the EOB.
[CUSTOMER][NEUTRAL] And you can give me your claim number?
[AGENT][NEUTRAL] You're needing the claim number again?
[CUSTOMER][NEUTRAL] I'm sorry, I got it. I just forget.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] OK, there we go. I have just heard a little bit confusion over it, so the CPD code on CPT code, where is it?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Can you give me a call reference number?
[AGENT][NEUTRAL] The call reference would be my first name [PII], last initial of [PII] in today's date.
[CUSTOMER][NEUTRAL] All right. And uh
[CUSTOMER][NEUTRAL] Just for my confirmation the.
[CUSTOMER][NEUTRAL] Actually we submitted appeal, so that appeal was denied as duplicate, correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] A resend the bill also denied. All right, got it. All right, [PII], thank you for your assistance. Have a
[AGENT][NEUTRAL] Would you like for me to give you that, that number and the receipt time of that?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] For a few
[AGENT][NEUTRAL] The information that we received in, it was just recently received [PII]. We processed that claim on [PII].
[AGENT][NEUTRAL] That claim number is 3550093. It denied as a duplicate of the previous submitted claim.
[CUSTOMER][NEUTRAL] OK, so the appeal you received on [PII] and processed on [PII] and the denied on same date [PII] and it's denied as duplicate, correct?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Alright, [PII]. Thank you for your assistance. Have a great day ahead.
[AGENT][POSITIVE] You're welcome, thank you so much for calling American Public Life, [PII] have a great day as well.
[CUSTOMER][NEUTRAL] Bye.