AccountId: 011433970860
ContactId: 180bba6f-fc0d-4d74-a4c7-fae5716373c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1132349 ms
Total Talk Time (AGENT): 367680 ms
Total Talk Time (CUSTOMER): 214893 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/180bba6f-fc0d-4d74-a4c7-fae5716373c3_20250424T14:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] I'm looking for the status of claims.
[AGENT][NEUTRAL] OK, 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] [PII] no extension.
[AGENT][NEUTRAL] OK. And then did you have that policy number?
[CUSTOMER][NEUTRAL] Yes, 024550367.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[AGENT][NEUTRAL] Oh, actually, I
[CUSTOMER][NEUTRAL] Nearest.
[AGENT][NEUTRAL] Oh, never mind, no, you're good sorry go ahead.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII] is their date of birth.
[AGENT][NEUTRAL] Got it, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and do you have that bill amount?
[CUSTOMER][NEUTRAL] Uh yes, one second.
[CUSTOMER][NEUTRAL] Uh, this is for 662.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, so I'm not showing that we have received the claim for that date of service, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I've got a uh mailing address, a fax number, and a payer ID I can give you.
[CUSTOMER][NEUTRAL] Uh, yes, I'll take all those.
[AGENT][NEUTRAL] OK, let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, so our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and that payer ID?
[AGENT][NEUTRAL] Pay ID is 60801.
[AGENT][NEUTRAL] And did you need that fax number as well?
[CUSTOMER][NEUTRAL] That fax.
[AGENT][NEUTRAL] Yes, OK, fax number is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Also have a reference number as well.
[AGENT][NEUTRAL] Yes, that would just be my first name, last initial and today's date and so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Uh, yes, I do have some other members I need to look at.
[AGENT][NEUTRAL] OK, uh, give me just a moment. I'll let you know when I'm ready for those, uh, next policy numbers.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I am ready for that next policy number when you are.
[CUSTOMER][NEUTRAL] Uh, this is, give me one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, I'm not sure if this is the right number. It seems a little small, but it's [PII].
[AGENT][NEUTRAL] Um, give me just a moment, let's see.
[AGENT][NEUTRAL] And what was the name and date of birth for the member?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yeah, that is a policy that's one of hers that's a bit older, um.
[AGENT][NEUTRAL] What was the date of service for this claim?
[CUSTOMER][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] [PII], sorry.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] That was 681?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, uh, so I will say that this policy terminated, uh, [PII]. Uh, did you want me to still check to see if we received it?
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] What was the name of this provider's office?
[CUSTOMER][NEUTRAL] Uh, this is Comprehensive breast Care Center.
[AGENT][NEUTRAL] OK, OK, so yes, we did receive this claim, um, of course it was denied as services are rendered after the coverage was terminated.
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that one more time?
[AGENT][NEUTRAL] I've got that claim number if you need that, yeah, um, so it denied as the services were rendered after coverage was terminated.
[CUSTOMER][POSITIVE] Yes please.
[CUSTOMER][NEUTRAL] What's that claim number?
[AGENT][NEUTRAL] That is 357.
[AGENT][NEUTRAL] 390.
[CUSTOMER][NEUTRAL] OK, and then you said they termed December 1 of 23?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what was the denial date on this claim?
[AGENT][NEUTRAL] Oh let me see when that was processed one moment.
[AGENT][NEUTRAL] Uh, so this claim was processed and denied [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, allow me a moment.
[AGENT][NEUTRAL] Sure
[CUSTOMER][POSITIVE] OK perfect and I do have some more members I need to look at as well.
[AGENT][NEUTRAL] OK, um, yeah, you can go ahead and give me that next policy number.
[CUSTOMER][NEUTRAL] This is 02265871.
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and then uh what was the date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] This is for 681.
[AGENT][NEUTRAL] 681 OK thank you one moment.
[AGENT][NEGATIVE] OK, so we received this one as well and for this one we were unable to pay a benefit as the policy provides no benefits for the treatment of conditions other than a sickness or an injury.
[CUSTOMER][NEGATIVE] Run nothing out by me one more time.
[AGENT][NEUTRAL] Sure, so the policy provides no benefits for the treatment of conditions other than a sickness or an injury under this policy.
[CUSTOMER][NEUTRAL] And what was that process on?
[AGENT][NEUTRAL] Oh let me get that one moment.
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] And how many claims do you like to do per call?
[AGENT][NEUTRAL] We don't necessarily have a limit. How many more do you have left?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have 3.
[AGENT][POSITIVE] OK yeah I can help you out with that.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Did you need this claim number before we proceed?
[CUSTOMER][NEUTRAL] The next ID number.
[CUSTOMER][NEUTRAL] Oh yes, yes, I do. I didn't realize I didn't grab that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're OK, um, OK, so that claim number is 35.
[AGENT][NEUTRAL] 64144.
[AGENT][POSITIVE] And and I'm ready for that next policy number when you are.
[CUSTOMER][NEUTRAL] OK, that is 021.
[CUSTOMER][NEUTRAL] 16622
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the uh name and date of birth for this number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then what was that date of service, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], uh, what was the, uh, tax ID, uh, for this provider please?
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so I do have a claim for that.
[AGENT][NEUTRAL] Date of service for this number, but it is for a different amount. Give me just a moment.
[AGENT][NEUTRAL] So this claim that we received um from this provider on that date uh was for $722.38.
[AGENT][NEUTRAL] Was that the amount left after uh primary paid?
[CUSTOMER][NEUTRAL] No, this is the full amount that I have.
[CUSTOMER][NEUTRAL] Uh, could it be under 662?
[AGENT][NEUTRAL] No, this is the only claim I have for this state of service. Um, it does have 4 procedure codes.
[CUSTOMER][NEUTRAL] Yeah, I have the same, but you have a different bill amount.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Give me 1 2nd, let's see if we change this.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so I did just look [PII], and this was, this is the claim this is the right one, so the total bill charge I had to look at what was submitted to us instead of what was actually in our system, um, so the total bill charges that we for this one was 1,262 so I don't know why it's showing me that in the system, um, but is it for these four procedure codes? Does that sound right to you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[AGENT][NEUTRAL] OK. OK, so for this claim, we did pay a benefit of $122.38 and we paid uh
[AGENT][NEUTRAL] Both procedures for 76641, uh, we did not pay a benefit for 77066 or G0279. Let me see.
[AGENT][NEUTRAL] Oh, that's OK. From what we have, uh, we were unable to pay those benefits as their major medical, um, provided full benefits, so there was nothing additional for us to pay.
[CUSTOMER][NEUTRAL] OK. When was this, uh,
[CUSTOMER][NEUTRAL] Process that.
[AGENT][NEUTRAL] Uh, give me just a moment. I'll get that for you.
[AGENT][NEUTRAL] This was processed [PII].
[CUSTOMER][NEUTRAL] I'm sorry for the 76641s, what what was the outcome of these calls again?
[AGENT][NEUTRAL] Um, yeah, I, we did pay both of those benefits, um, so that was a total benefit of, uh, $122.38 that we paid.
[CUSTOMER][POSITIVE] Oh perfect. Can I have the payment info for that?
[AGENT][NEUTRAL] Of course, um, so that check number that is 2017.
[AGENT][NEUTRAL] 827.
[AGENT][NEUTRAL] And let's see, so uh that was issued [PII].
[AGENT][NEUTRAL] And I am showing that they they did clear [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I have the claim number as well?
[AGENT][NEUTRAL] Yes, uh, that is 353-9934.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, we can move on to the next number.
[AGENT][POSITIVE] OK. I am ready when you are.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] OK, actually that was my last claim, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright well thanks for giving us a call [PII] yeah.
[CUSTOMER][POSITIVE] So thank you very much for helping me with these.
[AGENT][POSITIVE] Absolutely. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] No, ma'am, but you have a wonderful day.
[AGENT][POSITIVE] All right, yeah, thanks for giving us a call. You too. Alright, bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.