AccountId: 011433970860
ContactId: 0e3d3b59-39c6-4315-918c-c32fae8bdc86
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 700270 ms
Total Talk Time (AGENT): 188145 ms
Total Talk Time (CUSTOMER): 170407 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/0e3d3b59-39c6-4315-918c-c32fae8bdc86_20250306T17:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hello, [PII]. This is [PII] calling from the Louisiana Healthcare Associate to verify the claim status.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] That would be [PII] is a direct line.
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number?
[CUSTOMER][NEUTRAL] Member's ID would be 01739515.
[AGENT][NEUTRAL] OK. And then, uh, what was the name and date of birth for the insured, please?
[CUSTOMER][NEUTRAL] Uh, member's name would be [PII], and date of birth is uh [PII].
[AGENT][NEUTRAL] OK, I apologize, [PII]. I think I might have misheard that policy number. Could you repeat that for me?
[CUSTOMER][NEUTRAL] member's ID would be 017.
[CUSTOMER][NEUTRAL] 39515
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that right, um, that was 01789515.
[CUSTOMER][NEUTRAL] Uh, no, 39515.
[AGENT][NEUTRAL] 39515. OK, I apologize, thank you one moment.
[AGENT][NEUTRAL] OK, and this was for [PII], um, if you wouldn't mind [PII], I'm sorry, could you repeat his date of birth?
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying that information, [PII]. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] The date of service would be [PII] for the total charge amount of $155.
[AGENT][NEUTRAL] 155 even OK thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and you did say that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'd say Louisiana Healthcare Associates?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I did find one claim for that date of service from this provider. It was for $141.88.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 5 times.
[AGENT][NEUTRAL] Was it for procedure code 99214?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so then I do believe that was this claim um we were unable to pay that benefit, um.
[AGENT][NEUTRAL] Uh, office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] Yes, that is 3556518.
[AGENT][NEUTRAL] Uh, there was a procedure code, um, the 81003, um, and we paid that benefit it was $1.88 just so that you are aware.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Now, what will be the next step for this claim?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, what will be the next step for this claim?
[AGENT][NEUTRAL] Um, I could send you a copy of the EOB if you'd like.
[CUSTOMER][NEUTRAL] Mm, sure.
[AGENT][NEUTRAL] OK, do you have a fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you hear me, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Did you have a fax number I could send this EOB to?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh yes. That would be [PII].
[CUSTOMER][NEUTRAL] Hello? Am I audible?
[AGENT][NEUTRAL] Yes, yes, 877.
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] OK, I'm going to read that back to make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, I will go ahead and get that sent to you. You should get it here within 10-15 minutes. Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh yes, uh, I have 2 more claims.
[AGENT][NEUTRAL] Were this for the same patient or was it for a different member?
[CUSTOMER][NEUTRAL] uh for the different patients.
[AGENT][NEUTRAL] Different patient. OK, give me just a moment. I'm gonna send this EOB and I'll let you know when I'm ready for that, uh, next policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][POSITIVE] OK, [PII], thank you for your patience. Um, I'm ready for that next policy number when you are.
[CUSTOMER][NEUTRAL] And the member's ID would be 017.
[CUSTOMER][NEUTRAL] 39515.
[AGENT][NEUTRAL] OK, so was this still for [PII]?
[CUSTOMER][NEUTRAL] Mm, no.
[CUSTOMER][NEUTRAL] Uh, patient was uh different.
[AGENT][NEUTRAL] OK, what was the name for the patient and the date of birth?
[CUSTOMER][NEUTRAL] Uh, member's name spelled as in [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the date of service for that claim?
[CUSTOMER][NEUTRAL] Uh, [PII], uh, for the total charge amount, $390.09.
[AGENT][NEUTRAL] And 90. OK, thank you one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm sorry, you did say that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm not showing that we received a claim for that date of service for this number.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] And uh may I know the payer ID number?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] 601. OK.
[CUSTOMER][NEUTRAL] And uh may I know the timely filing limit?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I have the same, I will do another claim for the same member.
[AGENT][NEUTRAL] This is still for uh [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what was that date of service?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] And date of service would be [PII] for the total charge amount $200.09.
[AGENT][NEUTRAL] I'm sorry [PII], that was uh [PII]. Could you repeat that bill amount please?
[CUSTOMER][NEUTRAL] Uh, $200.09 for the code 99214.
[AGENT][NEUTRAL] 200.
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] I'm not showing we received that uh claim for that date of service either.
[CUSTOMER][NEUTRAL] Uh, for the CPT code 99214.
[AGENT][NEUTRAL] We've not received any claims for this member for that date of service.
[CUSTOMER][NEUTRAL] Anytime.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][NEUTRAL] Mm, OK, got it. And uh may I know the card reference number?
[AGENT][NEUTRAL] A reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Last [PII] Was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] Uh, no, thank you for asking, [PII]. Thanks so much for providing the assistance. Have a great day.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye.