AccountId: 011433970860
ContactId: fd4ab376-698f-42c5-b519-51003f449452
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 628369 ms
Total Talk Time (AGENT): 180687 ms
Total Talk Time (CUSTOMER): 247958 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/fd4ab376-698f-42c5-b519-51003f449452_20250227T16:03_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh hello ma'am. My name is [PII] calling from the office.
[AGENT][POSITIVE] Thank you, [PII]. And what is a good callback number, please?
[CUSTOMER][NEUTRAL] Uh, ma'am, callback number is [PII]. Extension is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Um, member ID is D as in dog 45302593.
[AGENT][NEUTRAL] Thank you, [PII], and that that is not the APL policy number. Our policy numbers are all numerical. Start with a 0. Do you happen to have another policy number for the patient?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, ma'am, I have first and last name.
[AGENT][NEUTRAL] OK. What is the patient's last name?
[CUSTOMER][NEUTRAL] My last name is [PII]. First name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And I'm sorry, last name is [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the date of birth, please?
[CUSTOMER][NEUTRAL] Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And Roger, I do have the policy pulled up. Let me give you the policy number for APL.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Ma'am, I have the patient number ID card.
[AGENT][NEUTRAL] And do you have the, do you have the
[CUSTOMER][NEUTRAL] Insurance card, insurance card.
[AGENT][NEUTRAL] Do you have that APL ID card or does it say IMA?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh, just a moment, please. Uh, I need to confirm.
[CUSTOMER][NEUTRAL] It's an APL insurance card, American Public Life Insurance.
[AGENT][NEUTRAL] Then you should see the policy certificate number 2514682.
[CUSTOMER][POSITIVE] Uh, sorry, I, I apologize, ma'am. I apologize.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so the policy number is 202514682.
[AGENT][NEUTRAL] Yes, that is the correct policy number for APL. You're welcome. And how can I assist you with this policy today?
[CUSTOMER][POSITIVE] Yeah, sure, thank you so much, yeah.
[CUSTOMER][NEUTRAL] Actually, ma'am, I am.
[CUSTOMER][NEUTRAL] I need to see regarding claim status.
[AGENT][POSITIVE] It would be my pleasure to help you with that claim status. What is the date of service?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] The service is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is the bill amount, please?
[CUSTOMER][NEUTRAL] Bill amount is $342.09.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And Roger, what is the facility name?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The facility is primary care.
[CUSTOMER][NEUTRAL] PLLC primary care port.
[AGENT][NEUTRAL] Is that clearly
[CUSTOMER][NEUTRAL] primary care.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do see that we received that claim on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] The claim was denied because this policy does not provide a wellness expense benefit.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Uh, just a moment, ma'am. You said, uh, the date is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And then and the date is [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And the claim is due to the reason of uh this insurance does not pay annual balance CPT.
[AGENT][NEUTRAL] That's correct. It does not provide a wellness expense benefit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, so we should, uh, uh, the CBT and find the claim.
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, ma'am, uh, I said we should remove the CPT and then find the collective claim for the insurance.
[AGENT][NEUTRAL] Oh, I can't, um.
[CUSTOMER][NEUTRAL] Maybe
[AGENT][NEUTRAL] Tell you what to do for the claim, but the wellness expense is not covered.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Did
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Could you please provide me the filing for collective claim?
[AGENT][NEGATIVE] No timely filing for corrected claim.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Could you please provide me the claim number?
[AGENT][NEUTRAL] The cream
[AGENT][NEUTRAL] Excuse me. Claim number is 355.
[AGENT][NEUTRAL] 676 8.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And so the claim number is 3556768.
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] Just
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Can you repeat that?
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] [PII], are you there?
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, ma'am, could you please provide me the claim mailing address?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII], that's [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] You know, much attention.
[AGENT][NEUTRAL] Claims.
[CUSTOMER][NEUTRAL] was a fax number.
[AGENT][NEUTRAL] There's no fax number.
[CUSTOMER][NEUTRAL] Our provider in network or out of network?
[AGENT][NEUTRAL] Um, APL has no contractual involvement in the processing of the claim. The claim does participate in the multi-plan network, but that is strictly through multiplan.
[AGENT][NEUTRAL] You would need to check with them.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Can you get me?
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] First initial of my last name is [PII].
[AGENT][POSITIVE] And it was a pleasure to assist you with that claim status. Is there anything else I can help you with today, Roger?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Could you please provide me that before.
[AGENT][NEUTRAL] Reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, ma'am. Thank you so much for providing the information. Have a great day.
[AGENT][POSITIVE] And thank you for calling APL Roger. I hope you have a wonderful day as well. Take care.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.