AccountId: 011433970860
ContactId: 0cce192a-969b-4d6d-b8ab-f0c9cef08b36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 443179 ms
Total Talk Time (AGENT): 217144 ms
Total Talk Time (CUSTOMER): 140380 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/0cce192a-969b-4d6d-b8ab-f0c9cef08b36_20250409T15:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I'm calling to check on a couple of claims for a patient.
[AGENT][NEUTRAL] Sure, I can check the clients for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] [PII] and what was your, sorry, I did not catch it.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah it's 006-04575.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that um I know you said there were a couple of claims are they both for this member?
[CUSTOMER][NEUTRAL] Yeah, there's uh there's 3 days of service um all from last year on her. It looks like on [PII] we resubmitted it and we mailed it in so we're just trying to see if y'all received them and.
[AGENT][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Like if y'all are in the process of processing them or what's going on?
[AGENT][NEUTRAL] Sure, OK, um, what was that first date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for [PII] and I don't have any claims for that date of service for [PII].
[CUSTOMER][NEUTRAL] Um, do you have a [PII]?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I do not.
[CUSTOMER][NEUTRAL] Or a [PII].
[AGENT][POSITIVE] What was that date? I'm so sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, one moment.
[AGENT][NEUTRAL] OK. I do have some for that day. Um, give me just a moment.
[AGENT][NEUTRAL] I have a fee for that one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] That's weird though because we sent them all together.
[AGENT][NEUTRAL] What was the
[AGENT][NEUTRAL] What was the bill amount uh for this claim for the [PII]?
[CUSTOMER][NEUTRAL] Um, $11,678.
[AGENT][NEUTRAL] OK, all right, one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm sorry, what was the name of the provider this was with [PII]?
[CUSTOMER][NEUTRAL] They don't have
[CUSTOMER][NEUTRAL] Um, for the [PII] it is Doctor [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it does look like we received this one.
[AGENT][NEUTRAL] Give me just a moment, let me verify.
[AGENT][NEUTRAL] Because again there were a couple for this data service.
[CUSTOMER][NEUTRAL] They're saying they don't have the August or September date, but they got the December date.
[AGENT][NEUTRAL] OK, I have, so one claim, uh, it shows the total bill charged, um, that's it was $1600 even, but it was for the same date of service and it was pulling, um, and for this claim we paid a benefit of $539 even.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Check
[AGENT][NEUTRAL] So I'm going to check this other date of service.
[AGENT][NEUTRAL] Uh, or, oh excuse me, yes, there's another claim for the same date of service. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, because they were
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, just to verify that. OK, give me just a moment.
[CUSTOMER][NEUTRAL] No, go ahead.
[AGENT][NEUTRAL] OK and then for this one we paid a benefit of and it was the same provider.
[AGENT][NEUTRAL] Uh, we had a benefit of $350 and it does look like we received these two, and again, both of these were for the [PII], and we received both of them, it looks like around the same time.
[AGENT][NEUTRAL] So this one I'm showing the total bill charges.
[CUSTOMER][NEUTRAL] Yeah, which the August sends it.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] No, they were all three sent together, which is kind of strange like y'all don't have the first two, but y'all got that one.
[AGENT][NEUTRAL] That is well.
[AGENT][NEUTRAL] And so this one, the total bill charges were $775 and we paid $350.
[AGENT][NEUTRAL] So give me just a moment. I'm getting this check, um, information and then the uh claim information as well, the claim numbers um and then we can go and look at those receipt dates.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, so for both of those for [PII] we received those claims [PII] of this year. Prior to that we haven't received any claims for this member um since September of last year.
[CUSTOMER][NEUTRAL] OK, yeah, because it looks like we mailed them out on [PII].
[CUSTOMER][NEGATIVE] Which I don't understand why y'all didn't have the other two. The other two are like a one's a denture.
[AGENT][NEUTRAL] Yeah, especially as long ago as that was, um, you know, it wasn't that long ago, but it was.
[AGENT][NEUTRAL] Enough that it should have been, you know, if it was we had received it now I will say I mean of course you can mail them again if you if you like, but I do have a fax number or a payer ID if that's easier.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, what's the, let's see, payer ID I have is 60801.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] But I think y'all don't, but do y'all do electronic claims because it looks like maybe.
[AGENT][NEUTRAL] Yeah, yes.
[CUSTOMER][NEUTRAL] OK, let me see electronic and then what's the fax number?
[AGENT][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then for the 12 6 data service that check's been processed and like out in the mail?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, so there are two checks. It was two different claims, um, and I can give you those claim numbers if you need those EOBs. I can send those to you as well, um, but they are 2 checks and yes they were issued, um, [PII], so just a couple of days ago.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so I'll go ahead and get those other two sent back out and then I'll just notate.
[CUSTOMER][NEUTRAL] The [PII] ones are in the process of being like sent to us.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Did you need the claim numbers or anything?
[CUSTOMER][NEUTRAL] OK, is there
[CUSTOMER][NEUTRAL] No, um, I just need a call reference number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Um, so my last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] No ma'am, that was all I was checking on.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too thanks.
[AGENT][POSITIVE] Thank you. Bye-bye.