AccountId: 011433970860
ContactId: 0a9b9329-dd4b-4c50-9675-95a40b9a71de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 787219 ms
Total Talk Time (AGENT): 348734 ms
Total Talk Time (CUSTOMER): 255105 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/0a9b9329-dd4b-4c50-9675-95a40b9a71de_20250117T17:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Uh, yes, I, my first name is [PII], my last name is [PII] calling you from the provider's office looking for a claim status.
[AGENT][NEUTRAL] All right, [PII], can I have the phone number?
[CUSTOMER][NEUTRAL] Uh, yes, the callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what's the name of the doctor you're calling from, please?
[CUSTOMER][NEUTRAL] Uh, this is calling from San Francis Hospital.
[AGENT][NEUTRAL] All right. May I have a policy number, [PII]?
[CUSTOMER][NEUTRAL] 2,331,800.
[AGENT][NEUTRAL] And that patient name and date of birth?
[CUSTOMER][NEUTRAL] Date of birth is uh [PII]. 1st name is [PII] and the last name is uh [PII].
[AGENT][POSITIVE] OK. Thank you for that information.
[AGENT][NEUTRAL] What is that uh data service you're looking for because you're calling for claim status, correct?
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] OK, what's the data service?
[CUSTOMER][NEUTRAL] [PII], total charge is $4,526 even.
[AGENT][NEUTRAL] OK, let me see. Do I have that?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And the total charge is how much?
[CUSTOMER][NEUTRAL] $4,526 even.
[AGENT][NEUTRAL] OK, let me see, do I see that? Hold on one moment.
[AGENT][NEUTRAL] Mhm mhm mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 88, OK.
[AGENT][NEUTRAL] Mm, so I'm looking for 56 and 7356.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And 73. OK, let's see this one is.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, that's not it. OK. 56.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK, let's see what this one says, am I.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And for data service 728, I don't see that amount for that particular uh hospital for that data service. I don't see that claim on file for 728.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I have the members effective date?
[AGENT][NEUTRAL] I.
[AGENT][NEUTRAL] OK, I can give you that. The number effective date is.
[AGENT][NEUTRAL] [PII] and the policy terminated for [PII], but if you have a claim within that time period, you can submit that claim and I can give you a fax number where you can submit that claim along with the explanation of benefit.
[CUSTOMER][NEUTRAL] OK, so, uh, what is the claim timely filing limit?
[AGENT][NEUTRAL] There's no time limit to filing a claim.
[CUSTOMER][NEUTRAL] OK. And uh just to verify the claim address that I have here is [PII].
[AGENT][POSITIVE] That's correct. That is the mailing address, yes.
[CUSTOMER][NEUTRAL] OK, uh, thank you. Let's move to the next patient under the same tax ID.
[AGENT][NEUTRAL] OK. OK, hold on. So it's a, it's a different person?
[AGENT][NEUTRAL] Is that correct? It's gonna be a different. OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All righty, I'm ready. What's the next policy number?
[CUSTOMER][NEUTRAL] Uh yes, the patient's ID is 2,489,250.
[AGENT][NEUTRAL] Patient name and date of birth.
[CUSTOMER][NEUTRAL] Uh, the patient's date of birth is [PII] and the first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] Alright, and what's that date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the dollar charge is $2,162 even.
[AGENT][NEUTRAL] OK, I do see that. Let me bring it up.
[AGENT][NEUTRAL] Uh, this is number 943.
[AGENT][NEUTRAL] We received that claim on [PII]. It was processed on [PII]. The claim number is 352.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3943 and an explanation of benefit went out, but that data service, the maximum amount that can be paid for that particular uh data service has been met.
[AGENT][NEUTRAL] Any, any, any balance would be the patient responsibility.
[CUSTOMER][NEUTRAL] So you know this maximum benefit.
[CUSTOMER][NEUTRAL] So you're saying that uh the claim is denied as benefit max, right?
[AGENT][NEUTRAL] For that date of service, yes.
[CUSTOMER][NEUTRAL] Uh, what is the IPU time family limit?
[AGENT][NEUTRAL] What is the what now?
[CUSTOMER][NEUTRAL] Uh, a timely filing limit.
[AGENT][NEUTRAL] 180 days from the date that the claim was processed and the claim processed was [PII], so you have 180 days to do an appeal.
[CUSTOMER][NEUTRAL] And how about the billing address?
[AGENT][NEUTRAL] How about what?
[CUSTOMER][NEUTRAL] Uh, a billing address.
[AGENT][NEUTRAL] The address. The address would be the same address that you gave me previously. If you need me to give it to you again, I can give it to you. It's [PII] and you're gonna put attention appeal department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you. Let's move to the next patient.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] Uh, this is gonna be.
[CUSTOMER][NEUTRAL] Under the different providers and the patient's ID is [PII], I'm sorry.
[CUSTOMER][NEUTRAL] The patient ID is 233.
[CUSTOMER][NEUTRAL] 1800.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] OK, just.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Uh, I think that's the wrong ID. Uh, let me give you another ID. The ID is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII] and the first name is [PII], last name is [PII].
[AGENT][NEUTRAL] All right, and what is the date of service?
[CUSTOMER][NEUTRAL] [PII], total charge is $3,938.75.
[AGENT][NEUTRAL] OK, for data service [PII], we do not have a claim on file.
[CUSTOMER][NEUTRAL] OK, can I have the member's effective date?
[AGENT][NEUTRAL] OK, give me one second, [PII], and I'll give you that memo effect today.
[AGENT][NEUTRAL] All [PII]. Her affected date was
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII] and the policy terminated [PII].
[CUSTOMER][POSITIVE] Thank you. Let's move to the next item. I have just, uh, 2 more members.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. What's the next one?
[CUSTOMER][NEUTRAL] Uh, next ID 021-73249.
[AGENT][NEUTRAL] And that patient name and date of birth, please?
[CUSTOMER][NEUTRAL] And the patient's uh date of birth is [PII] and the first name is [PII] Last name is [PII].
[AGENT][NEUTRAL] All right, and the date of service?
[CUSTOMER][NEUTRAL] [PII] total charge is $7,386 even.
[AGENT][NEUTRAL] Did you say [PII]?
[CUSTOMER][NEUTRAL] Uh, no, [PII].
[AGENT][NEUTRAL] OK. I, I'm not say it in normal for me cause I can't understand what you're saying.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes, the data service is [PII].
[AGENT][NEUTRAL] OK, thank you. You were saying April. OK.
[AGENT][NEUTRAL] All right. And how much is the total amount of the bill is $7000 you said?
[CUSTOMER][NEUTRAL] Uh, $7,386 even.
[AGENT][NEUTRAL] OK, let me see, do I see that?
[AGENT][NEUTRAL] 7:13.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, April, April.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if this we only have one bill that came in for that data service.
[AGENT][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] OK. We do not have a bill on file for that amount, for that date of service for this patient.
[CUSTOMER][NEUTRAL] OK, can I have the member's effective date?
[AGENT][NEUTRAL] that the date was [PII] and it's still an active policy as of today.
[CUSTOMER][POSITIVE] OK, thank you, let's move to the last patient.
[AGENT][NEUTRAL] OK. Give me 1 2nd, [PII].
[AGENT][POSITIVE] All righty. I'm ready for the next patient.
[CUSTOMER][NEUTRAL] 02399312.
[AGENT][NEUTRAL] And the name of the patient?
[CUSTOMER][NEUTRAL] And the patient's first name is.
[CUSTOMER][NEUTRAL] Uh [PII] Last name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the data service you're looking for on this page?
[CUSTOMER][NEUTRAL] Uh, data services, uh, [PII] total charges.
[CUSTOMER][NEUTRAL] Uh, $3,702 even.
[AGENT][NEUTRAL] OK. Let me see. Do I see anything for that data service for that patient. Give me one second to pull it up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So this is [PII] and 75.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let's see the first one that I'm gonna look at. We had 2 clients came in.
[AGENT][NEUTRAL] OK, that was not it. So let's look at the next one.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] 775.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, let's get this one.
[AGENT][NEUTRAL] And that's not it. No, we don't have that on file.
[CUSTOMER][NEUTRAL] OK, can I have the uh members effective date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much and do you have any call reference number?
[AGENT][NEUTRAL] You'll use my name, [PII] and today's dates reference. Anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, that's all I need. really appreciate. That's all I need very good.
[AGENT][POSITIVE] All right. Well, thank you for calling American For Life, and you have a great day, [PII]. Bye-bye.
[CUSTOMER][POSITIVE] Thank you, thank you