AccountId: 011433970860
ContactId: 0938de3f-8357-4898-8265-0465de1ca7c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 374730 ms
Total Talk Time (AGENT): 166840 ms
Total Talk Time (CUSTOMER): 91181 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/0938de3f-8357-4898-8265-0465de1ca7c4_20250203T13:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office to check on our claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, callback number [PII].
[CUSTOMER][NEUTRAL] [PII] line.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Policy number 1514651.
[AGENT][NEUTRAL] OK, thank you. Give me a moment to get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information else that I provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] And what is the first name?
[CUSTOMER][NEUTRAL] Uh, one moment, let me double check on that.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Actually, first name is [PII]
[AGENT][NEUTRAL] OK, thank you. And again, any information that I provide for you would be a verification of benefits and not a guarantee of payment. What is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Date of service is [PII]. But the amount is
[CUSTOMER][NEUTRAL] $30,627.37.
[AGENT][NEUTRAL] OK, so listen, I mean, I'm sorry, [PII], the policy number you gave me is an old policy number that termed in 2020.
[AGENT][NEUTRAL] Her current active policy that would be active for your data service is a different number. I need to give you that number, and then I'll have to check that policy to see if we received it on the on there, but the correct policy number for her active policy is 0186.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] 8789.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And it has an effective date of [PII].
[AGENT][NEUTRAL] So give me a moment to get that information to pull up, pulled up to see if we received and process the claim under that correct policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Uh, so just one moment, please.
[CUSTOMER][NEUTRAL] Actually, this claim denied for primary EUP and uh
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] We already sent the EUP.
[AGENT][NEGATIVE] OK, we never received that. We've received the claim, the claim itself, two additional times, but no primary EOB included.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] We only need
[CUSTOMER][NEUTRAL] OK, shall we submit uh correct?
[AGENT][NEGATIVE] We did not receive that.
[CUSTOMER][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][NEUTRAL] Actually, uh, shall we submit the credit claim along with the primary EOB so you can get the EOB with the claim.
[AGENT][NEUTRAL] We only need primary insurance EOB sent to us.
[AGENT][NEUTRAL] We already have the claim.
[CUSTOMER][NEUTRAL] OK, ma'am. What is the mailing address?
[AGENT][NEUTRAL] OK, what address do you have for claims?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. No, ma'am, that is not correct. That's a very old address. So it does need to be updated, which may be why we never received that.
[CUSTOMER][NEUTRAL] M M
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If that, if you mailed it, it should go to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you, ma'am. What is the timely filing?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Family failing to submit EOP.
[AGENT][NEGATIVE] Yes ma'am, I said there is no timely filing.
[CUSTOMER][POSITIVE] Thank you, ma'am. Could you please spell your name?
[AGENT][NEUTRAL] Just one additional thing. I'm also going to give you our website for our portal Alice where you can also check claim status, and that portal website is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And did you say that you need for me to give you my name again?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And my name and today's date will be your call reference number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for your assistance, [PII]. Have a wonderful day.
[AGENT][POSITIVE] You're very, yes ma'am, you too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.