AccountId: 011433970860
ContactId: 0b98cfd5-edb9-44f2-8494-866f09f22d7c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 857109 ms
Total Talk Time (AGENT): 214727 ms
Total Talk Time (CUSTOMER): 251988 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/0b98cfd5-edb9-44f2-8494-866f09f22d7c_20250612T18:09_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, [PII], and I'm calling from provider office. Uh, I need claim information.
[AGENT][NEUTRAL] OK, it's very hard to hear you. All I heard was provider's office and claim information. Can you repeat your name for me, please?
[CUSTOMER][NEUTRAL] My name is [PII]. It's [PII]
[CUSTOMER][NEUTRAL] Last name is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 4542
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] May I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh, my policy number is 0312736.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and total bills?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[CUSTOMER][NEUTRAL] And the bill amount is 80 seconds.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The amount is $200 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim for you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] Retrofis is Becon Respiratory Services of Georgia.
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 336.
[AGENT][NEUTRAL] 4187.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Denied for expla when, so you need primary UV.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] So can we send the primary over the fax?
[AGENT][NEUTRAL] Yes, our fax number is 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] OK. 877.
[CUSTOMER][NEUTRAL] 3659423.
[AGENT][POSITIVE] Yes, that's correct. Mhm.
[CUSTOMER][NEUTRAL] That there is any timely filing for this or?
[AGENT][NEUTRAL] No, this is additional information. So once we receive the explanation of benefits, we'll go ahead and continue processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, we will send you over the fax.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, we will send you
[CUSTOMER][NEUTRAL] Now, I have another member ID.
[AGENT][NEUTRAL] OK, let me note this policy and how many claims do you have in total?
[CUSTOMER][NEUTRAL] Uh, I have 2 more claims for the same member.
[AGENT][NEUTRAL] OK, so 3 claims in total and it's for the same member, so I don't have to note this right now. OK, what are the other 2 dates of service and total bills?
[CUSTOMER][NEUTRAL] Wait a second, let me check.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So this is for another member.
[CUSTOMER][NEGATIVE] I have 2 claims for different member.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on. So the two claims that you have there is another member, but they have 2 claims?
[CUSTOMER][NEUTRAL] Yes, for another member there, there are 2 claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm just asking so I know how to note this policy. OK, so hold on, let me note this policy and then we can move on to the next one.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] Uh, can I give?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, member ID is 02386326.
[AGENT][NEUTRAL] Hold on, hold on, hold on, hold on, hold on. I'll let you know when I'm ready. Let me note this one and then we can move on to the next.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK. Take your time.
[CUSTOMER][POSITIVE] No issue.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Alright, and the next member's policy number?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 863-26.
[AGENT][NEUTRAL] Can you repeat that, please? The phone's going in and out. I heard 863.
[CUSTOMER][NEUTRAL] 863-26.
[AGENT][NEUTRAL] OK, [PII], your phone is breaking up. I heard 863-26.
[CUSTOMER][NEUTRAL] Oh my [PII].
[CUSTOMER][NEUTRAL] Yeah, can you hear me now properly?
[AGENT][NEUTRAL] For now, yes. Can you repeat it, please?
[CUSTOMER][NEUTRAL] Yes, I will repeat it again. Policy number is 0.
[CUSTOMER][NEUTRAL] 23863
[CUSTOMER][NEUTRAL] 26.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ma'am my name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Data service is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount is, let me check.
[CUSTOMER][NEUTRAL] Yeah, bill amount is $98.06.
[AGENT][NEUTRAL] And this member has 2 claims?
[CUSTOMER][NEUTRAL] Yes, 2 claims.
[AGENT][NEUTRAL] OK, and what's the next claim um I'm sorry, what's the next date of service and total bills?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Next date of service is [PII], sorry, sorry.
[CUSTOMER][NEUTRAL] Next date of service is [PII].
[CUSTOMER][NEUTRAL] Bill amount is $40 for that.
[AGENT][NEUTRAL] OK, hold on one moment. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You can check
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Alright, so I'm not showing a claim on file for [PII] or [PII] for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No claim on file?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Member was eligible on that data service?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um let me see. Yes, the policy was active from [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And still member is active?
[AGENT][NEUTRAL] No, it turned on [PII]. There is an active policy. It's a different policy number and it
[CUSTOMER][NEUTRAL] Everything is all
[AGENT][NEUTRAL] Wasn't active on your data service. I can give it to you if you need it though.
[CUSTOMER][NEUTRAL] OK, and what is the timely filing?
[AGENT][NEUTRAL] There's no timely filing as long as the policy is active on the data service, you can file the claim at any time.
[CUSTOMER][NEUTRAL] OK. Please wait a second, OK? Please stay on the call.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh hello, [PII]. Uh, can you confirm the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] but
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Wait a 2nd. 60801. Let me check.
[CUSTOMER][NEUTRAL] You can do it.
[CUSTOMER][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEUTRAL] OK. And can you please verify the mailing address also?
[AGENT][NEUTRAL] Our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], and the zip code is [PII].
[CUSTOMER][NEGATIVE] Not much.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Wait a second.
[CUSTOMER][NEUTRAL] And did you accept the claim, uh, or electronic and mail?
[AGENT][NEUTRAL] I'm sorry, can you repeat that, please?
[CUSTOMER][NEUTRAL] You accept the claims through electronic and mail both, am I right?
[AGENT][NEUTRAL] You can mail the claim, you can fax the claim, or you can send it electronically. Did you need our fax number also?
[CUSTOMER][NEUTRAL] Uh, no, no, wait a second.
[CUSTOMER][POSITIVE] OK. OK, thank you.
[CUSTOMER][NEUTRAL] Uh, we have another
[CUSTOMER][NEUTRAL] Uh, data service.
[CUSTOMER][NEUTRAL] Sorry, I already uh give you.
[AGENT][NEUTRAL] Is it the
[AGENT][NEUTRAL] OK, was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, I have, uh, I given you the another one data service. What about the status of this?
[AGENT][NEUTRAL] As I advise for both dates of service, there is no claim on file.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] I'm sorry, can you repeat that, please? Your phone's going in and out.
[CUSTOMER][NEUTRAL] I need call reference number only.
[AGENT][NEUTRAL] OK, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, no, bye bye.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye-bye.