AccountId: 011433970860
ContactId: 15d31255-2d90-4e6f-abe8-16338b3f1b2e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 998530 ms
Total Talk Time (AGENT): 270853 ms
Total Talk Time (CUSTOMER): 258581 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/15d31255-2d90-4e6f-abe8-16338b3f1b2e_20250324T20:53_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] Hi, [PII]. My name is [PII]. I'm calling from provider's office and I'm looking for the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] My callback number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah. It's 60801.
[AGENT][NEUTRAL] So that's our payer ID. Do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh just give me one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I don't have the ID card number. Can you please verify the name and date of birth?
[AGENT][NEUTRAL] Um, yes, what's the member's first and last name?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The patient's first name is [PII], last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, can you spell the first and last name for me, please?
[CUSTOMER][NEUTRAL] Yeah like
[CUSTOMER][NEUTRAL] Yeah. The first name spelled as [PII]. The last name will be spelled as [PII].
[AGENT][NEUTRAL] OK, hold on one moment. And then I was typing on the first name, but it wasn't typing in my notes. Can you repeat the spelling of the first name for me, please?
[CUSTOMER][NEUTRAL] Yeah. [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah that's.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII]. OK, hold on one moment.
[CUSTOMER][NEUTRAL] lot of
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hi, you there?
[AGENT][NEUTRAL] Yes, I'm here. I'm waiting for the policy to populate. It just popped up. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify the members, uh oh, you said it was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, and thank you so much for verifying his information. So the correct policy number is 241.
[AGENT][NEUTRAL] 685 6.
[AGENT][NEUTRAL] And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] With the bill amount of $1050 even.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I'm not showing a claim on file for [PII] for this.
[CUSTOMER][NEUTRAL] OK. Can you please provide me the policy on that?
[AGENT][NEUTRAL] The policy is still active and it's been effective since [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Can you please provide me the policy ID? I'm so, I'm so sorry.
[CUSTOMER][NEUTRAL] The ID.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can you please provide me the payer ID?
[AGENT][NEUTRAL] Yes, 60801.
[CUSTOMER][NEUTRAL] OK. What will be the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK. What will be the timely filing limit?
[AGENT][NEUTRAL] There's no timely filing as long as the policy is active on the date of service, you can file at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please provide me the call reference number for this number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date, which is [PII], first initial and my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can we please move to the next claim?
[AGENT][NEUTRAL] OK, and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] 3 claims.
[AGENT][NEUTRAL] And the next member's policy number?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It is for the different tax ID?
[AGENT][NEUTRAL] Is it the same member?
[CUSTOMER][NEUTRAL] No, it is for the different member, different tax ID.
[AGENT][NEUTRAL] OK, what's the member's policy number?
[CUSTOMER][NEUTRAL] Just give me one moment. My system is loading.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next member ID is [PII].
[AGENT][NEUTRAL] Is that the member's social?
[CUSTOMER][POSITIVE] I'm so sorry, what?
[AGENT][NEUTRAL] The number that you just provided, is that the member's social security number. It's not an APL policy number, so I'm trying to see what type of number it is.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, yeah, tell me.
[AGENT][NEUTRAL] I'm asking you a question. The number that the [PII] is not an APL policy number. So I'm asking is this the social, I can try it as the social security number.
[CUSTOMER][NEUTRAL] Uh, no. In my system, it is showing that this is the policy number. Can you please check with the name and date of birth?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Who
[CUSTOMER][NEUTRAL] The first name is [PII].
[CUSTOMER][NEUTRAL] And the last name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] No, [PII]
[AGENT][NEUTRAL] [PII], OK, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policies. Hold on one moment.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Does the member have a um middle initial?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] so
[AGENT][NEUTRAL] And can, um, can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so this member has a different date of birth. Um, let me try the next one. Hold on one moment.
[AGENT][NEUTRAL] OK, that's a different date of birth. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, so with the number that you provided and the member's first and last name, there's no, there's no policy on file. Uh, we have to get some more information. I went through all of the [PII]'s on file. There was a total of 4. They all had a different date of birth than your member.
[CUSTOMER][NEUTRAL] Um, it is [PII].
[AGENT][NEUTRAL] I understand of the four that we have on file, they have a different date of birth than your member. So we don't have their policy. Also that 681-314-284 is not an APL policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me one moment. Let me see if I can have the member ID card or not.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me another minute, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You mean to say that um the policy number I provided is not belongs to you, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Can you please tell me who is the insurance?
[AGENT][NEUTRAL] We don't have the member on file, so I, I don't know what type of insurance they have. You'll have to reach out to the insured and ask them what type of insurance they have.
[CUSTOMER][NEUTRAL] That will provide me the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If the call reference number is the same, right?
[AGENT][NEUTRAL] Yes, it will be my name and today's date, and the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK. Can we move to the next claim, please?
[CUSTOMER][NEUTRAL] It's the last one.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the member's policy number?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] The policy number is starting with the letters.
[CUSTOMER][NEUTRAL] E.
[AGENT][NEUTRAL] OK, so it's not an APO policy number. What's the member's first and last name?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And can you spell the last name for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. OK, thank you. I I didn't understand. Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Have you played basket.
[AGENT][NEUTRAL] And you said the first name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's very
[AGENT][NEUTRAL] So I'm just waiting for the um policies to populate here.
[AGENT][NEUTRAL] And does she have a middle initial or can you verify the last four of her social because there's quite a few [PII].
[CUSTOMER][NEUTRAL] Yeah, it's [PII] [PII].
[AGENT][NEUTRAL] Actually,
[AGENT][NEUTRAL] And you know what, now that I'm looking at them, they, they have a diff, they're spelled [PII], so we don't.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have her social?
[CUSTOMER][NEUTRAL] Mm let me see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I think that.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Alright, and nothing's coming up with that social that was provided. So I will check back with that member too to see who their insurance is through.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right. And was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.