AccountId: 011433970860
ContactId: 11a3f979-5839-4bb8-a640-7389c9418e66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1178319 ms
Total Talk Time (AGENT): 269299 ms
Total Talk Time (CUSTOMER): 313643 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/11a3f979-5839-4bb8-a640-7389c9418e66_20250108T19:53_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check the claim status.
[AGENT][NEUTRAL] OK [PII], can I get a good call back number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, thank you [PII]. Can I get the policy number?
[CUSTOMER][NEUTRAL] Yeah, policy number is
[CUSTOMER][NEUTRAL] 015
[CUSTOMER][NEUTRAL] 75678 M as in Mike, L as in Lima, 7.
[AGENT][NEUTRAL] OK, thank you and [PII], can you confirm the insured's name and date of birth for me?
[CUSTOMER][NEUTRAL] Sorry, uh, yeah, so [PII] and the last name is [PII].
[AGENT][NEUTRAL] Can you
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you and you said you're calling to check claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can definitely take a look. What's that data service and build out?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Um, what's that data service and build amount?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII] and the bill amount is $79,855.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] You said it's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, give me just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna pull up a claim and see if this is the one on file.
[AGENT][NEUTRAL] Uh, bear with me for just a minute.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you spell out your name, please?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Um, so we have you received any correspondence on this claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it was stating required primary EOB and the claim number is 3471495.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 3471.
[AGENT][NEUTRAL] 495.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] So did y'all resubmit the claim with the primary EMB?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh sorry?
[AGENT][NEUTRAL] Did y'all resubmit the claim with the primary EMB?
[CUSTOMER][NEUTRAL] Yeah, we have already sent the primary EOP. Did you receive it?
[AGENT][NEUTRAL] I don't know yet. Give me just a second. OK, so the date range on this claim is from [PII]. That's why I couldn't find it.
[AGENT][NEUTRAL] OK, so we have not received the primary EOB yet. We've only received that first claim that was denied, so we haven't uh received the second claim that you guys submitted. When did y'all submit the claim?
[CUSTOMER][NEUTRAL] Yeah, what is the?
[AGENT][NEUTRAL] When did y'all resubmit that claim?
[CUSTOMER][NEUTRAL] Did you find the
[AGENT][NEUTRAL] With the primary EOB when was it resubmitted?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, we have resubmitted [PII].
[AGENT][NEUTRAL] OK, we have not we have not received it yet was.
[CUSTOMER][NEUTRAL] Can I get the, when it was received or when it?
[AGENT][NEGATIVE] We haven't received it yet.
[CUSTOMER][NEUTRAL] Uh, we're looking
[AGENT][NEUTRAL] Did y'all did y'all mail it in?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Was the claim in the EOB mailed in on [PII]?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, typically we say to allow at least 30 business days for documents to be received by mail.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] But since [PII] and [PII] were business days as well, I would say to allow just a little bit more time because we just haven't received that claim with the primary EB yet.
[CUSTOMER][NEUTRAL] Do you received it or not?
[AGENT][NEUTRAL] No, we have not.
[CUSTOMER][NEUTRAL] OK, what is the received date?
[AGENT][NEUTRAL] I can't give you a OK.
[CUSTOMER][NEUTRAL] Previous claim.
[CUSTOMER][NEUTRAL] I'm asking about the previous claim.
[AGENT][NEUTRAL] OK, so that claim was received on [PII] and denied [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII] is on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. What is the claim number?
[AGENT][NEUTRAL] The one that you gave me.
[CUSTOMER][NEUTRAL] Is the claim number is correct which I provided you.
[AGENT][NEUTRAL] Yes, that's the correct claim number for the original claim.
[CUSTOMER][NEUTRAL] OK, it was denied due to the
[AGENT][NEGATIVE] Missing primary EMB.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, that
[AGENT][NEUTRAL] Is there anything else I can take a look at for you?
[CUSTOMER][NEUTRAL] Yeah, what is the mailing address we need to send?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the
[CUSTOMER][NEUTRAL] Timely filing limit?
[AGENT][NEUTRAL] There's not one.
[CUSTOMER][NEUTRAL] Can I get the fax number, please?
[AGENT][NEUTRAL] 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] 877.
[CUSTOMER][POSITIVE] Excellent.
[AGENT][NEUTRAL] 365
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 94
[AGENT][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK. Can I get the claim number?
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][POSITIVE] I'm sorry for that.
[AGENT][NEUTRAL] OK, do you need the claim number again?
[CUSTOMER][NEUTRAL] No. Can I get the call reference number, please?
[AGENT][NEUTRAL] It's gonna be my name [PII] with the first initial to my last name [PII] and today's date.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEUTRAL] I do have one of the claims. Could you help me with that?
[AGENT][NEUTRAL] Is it for the same member?
[CUSTOMER][NEUTRAL] No, different number.
[AGENT][NEUTRAL] OK, what's the member ID?
[CUSTOMER][NEUTRAL] 844
[CUSTOMER][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] 844
[CUSTOMER][NEUTRAL] Play.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, member ID is 1,572,980.
[AGENT][NEUTRAL] Members's name and date of birth?
[CUSTOMER][NEUTRAL] Member's name is uh [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yes, date of birth is uh [PII].
[AGENT][NEUTRAL] The data service and build amount?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the build amount
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] The amount is $4000 490 dollars.
[CUSTOMER][NEGATIVE] Sorry, $4490 even.
[AGENT][NEUTRAL] OK, so the claim number is gonna be 348.
[AGENT][NEUTRAL] 2046.
[CUSTOMER][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] To find
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Thanks for your patience. One moment. Yes.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, are you ready for the claim number?
[AGENT][NEUTRAL] OK, so the claim number is 3482046.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] The claim was received [PII], processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it did, it did deny missing the primary insurance EOB.
[CUSTOMER][NEUTRAL] OK, missing the denied due to the missing the primary year, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Is the mailing address the same?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's [PII], right?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Is there anything else I can take a look at for you?
[CUSTOMER][NEUTRAL] Yeah, I do have another claims. Could you help me with that?
[AGENT][NEUTRAL] You have another claim for the same insured?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, you said it is.
[CUSTOMER][NEUTRAL] No, my different number.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Yeah, 11 moment. Let me look that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's the call reference name is your name and today's straight, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How will you
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I, I'm really.
[CUSTOMER][NEUTRAL] And you gotta go
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] And see what the product is
[CUSTOMER][NEUTRAL] Yeah, uh, member ID is 01887312.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 7.
[AGENT][NEUTRAL] Insured's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's a sole.
[CUSTOMER][NEUTRAL] Martinis.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Date of birth is uh [PII].
[CUSTOMER][NEUTRAL] I you
[AGENT][NEUTRAL] Data service and build them out.
[CUSTOMER][NEUTRAL] Yeah, date of services.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Build it, you said [PII], and what's that bill amount?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 4000
[CUSTOMER][NEUTRAL] $523.
[AGENT][NEUTRAL] OK, let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah, one moment, please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, what is the claim number, please?
[AGENT][NEUTRAL] 345-8870
[AGENT][NEUTRAL] It was received.
[CUSTOMER][NEUTRAL] When it was received?
[AGENT][NEUTRAL] [PII] process [PII] and it was denied missing the primary insurance EOB.
[CUSTOMER][NEUTRAL] Uh yeah, what is the process date? Could you repeat it again?
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] [PII] or [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, we have already sent the primary or did you receive it or not?
[AGENT][NEGATIVE] We have not received it. That's the only claim that we've received, and that's the one we denied missing the primary insurance EIB.
[CUSTOMER][NEUTRAL] OK, we need to send it again.
[AGENT][NEGATIVE] Yes, because we have not received it.
[CUSTOMER][NEUTRAL] Is the mailing address the same?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, it's the call uh name is also same, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I do have another claim. Could you help me with that?
[AGENT][NEUTRAL] Um, no, ma'am, unfortunately we have a limit of 3 per call.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you so much for providing the information. Thank you so much.
[AGENT][POSITIVE] You're welcome. You're welcome. Well thank you for calling APL and I hope you, you too. I hope you have a great day bye bye.
[CUSTOMER][POSITIVE] Have a nice day. Bye-bye.