AccountId: 011433970860
ContactId: 1990c5b7-eb5a-4181-9f05-e7154ef86cae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 870760 ms
Total Talk Time (AGENT): 255402 ms
Total Talk Time (CUSTOMER): 350998 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/1990c5b7-eb5a-4181-9f05-e7154ef86cae_20250213T20:55_UTC.wav
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[CUSTOMER][NEUTRAL] Oh, I'm sorry you cut out.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Uh, yes, this is [PII]. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII], and I am calling to check, um, on eligibility for a patient.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with eligibility. Can you please give me your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Patient's name is [PII]
[AGENT][NEUTRAL] OK, and then what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] And the policy number please?
[CUSTOMER][NEUTRAL] 01792084
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy, and the effective date is [PII].
[CUSTOMER][NEUTRAL] [PII] active. OK.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] All right. Um,
[CUSTOMER][NEUTRAL] Can I just verify where payments are where the claims are supposed to be mailed to?
[AGENT][NEUTRAL] Yes, ma'am. You can send them to APL claims.
[AGENT][NEUTRAL] And that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, that was
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, that's correct. And I also have a payer ID number if that will help you.
[CUSTOMER][NEUTRAL] Oh, sure. What is that?
[AGENT][NEUTRAL] That is 60801.
[CUSTOMER][NEUTRAL] 60801. OK, um, yeah, well, for some reason we had the claims were going to a [PII].
[AGENT][NEUTRAL] Yes, that's our old claims address. We haven't had that one for about 2 years.
[CUSTOMER][NEUTRAL] Oh jeez, OK, they gave us a real old card. OK, so the chances of, of them, yeah, the chances of the cleaning getting forwarded on would not, that would not happen.
[AGENT][NEUTRAL] Yes ma'am
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Um, mhm.
[AGENT][NEUTRAL] And there's, and there's not um uh there's not a timely filing limit as long as the policy was active on the date of service, you can file a claim at any time.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Oh great.
[AGENT][POSITIVE] Yes, that's a blessing.
[CUSTOMER][POSITIVE] Yeah, yeah, I, I don't, I think you guys are the first. I, I haven't, haven't really uh ran across any that that had something like that, so that's great.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um, OK. I was, uh, so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Could you, could you, uh,
[CUSTOMER][NEUTRAL] Just can uh let me just check this person here.
[CUSTOMER][NEUTRAL] OK, they have the correct address this next person. Can you just verify um.
[CUSTOMER][NEUTRAL] Coverage for um another patient? OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, let me put my note in this one and then we'll move on to the next one.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] [PII], what facility are you calling from?
[CUSTOMER][NEUTRAL] SSM Health Medical Group.
[CUSTOMER][NEUTRAL] It could be under Shawnee Medical Center as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me look here.
[AGENT][NEUTRAL] OK. What's the next patient's name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK and then what's [PII]'s date?
[CUSTOMER][NEUTRAL] Her date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and her policy number?
[CUSTOMER][NEUTRAL] That is 01792085.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show that [PII] is not active on this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is uh let's see.
[AGENT][NEUTRAL] It's an individual coverage only so it's only coverage for.
[AGENT][NEUTRAL] Uh, account holder and the dependents.
[CUSTOMER][NEGATIVE] Uh, can, can you repeat that again? Your, your phone's cutting out terribly.
[AGENT][POSITIVE] I am so sorry about that. This um policy is an individual policy and it only covers the account holder and no dependents.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. Let me cover.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] because they have other people here.
[CUSTOMER][NEUTRAL] Um, so that's [PII].
[CUSTOMER][NEUTRAL] And I'm not sure this, this could be the, the policy holder, um.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Yeah, I'm gonna.
[CUSTOMER][NEUTRAL] chop up her name. I don't mean to. It's [PII].
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] So it's [PII] and then.
[CUSTOMER][NEUTRAL] Uh, [PII] then [PII]
[AGENT][NEUTRAL] Yes, that is the only person. Yes, that's the only person covered on this policy, and the effective date is [PII].
[CUSTOMER][NEUTRAL] Same last name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can, can we verify if you have any claims on file for her?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Those were mailed to the correct um address.
[AGENT][NEUTRAL] OK, what is the um data service?
[CUSTOMER][NEUTRAL] OK, first one I have is gonna be [PII].
[CUSTOMER][NEUTRAL] Total amount billed is 282.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary paid their part?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] They have
[CUSTOMER][NEUTRAL] They have you listed as primary and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the the blue cross is secondary.
[AGENT][NEUTRAL] Yeah, we're the secondary insurance. We're, um, we're a gap insurance that helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. So I'll just get, we won't even need uh to check these other ones. I'll go ahead and get all these flipped around and get them sent to the
[CUSTOMER][POSITIVE] Yeah correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, get it sent to Blue Cross first. Um, it's funny because the one that isn't.
[CUSTOMER][NEUTRAL] [PII], the, the one that the first, the daughter that we checked.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hers went to Blue Cross first, I see. And then they had her, her coverage set up well, not really, cause she didn't have coverage, but um at least it was secondary, but they didn't do that on the number here. So I'm just gonna quickly jot this down.
[CUSTOMER][NEUTRAL] OK and
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And then, um,
[CUSTOMER][NEUTRAL] Um, one more, there's, I have one other person I would like to check.
[AGENT][NEUTRAL] OK, what's the other person's name?
[CUSTOMER][NEUTRAL] That's gonna be [PII], so it's, it's a different um.
[CUSTOMER][NEUTRAL] Subscriber.
[AGENT][NEUTRAL] OK. And what's Ms [PII]'s date of birth?
[CUSTOMER][NEUTRAL] That is gonna be [PII].
[AGENT][NEUTRAL] OK, and then her policy number?
[CUSTOMER][NEUTRAL] 01954452
[AGENT][NEUTRAL] OK, let me look her up.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy and her effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can you check data service of [PII]?
[AGENT][NEUTRAL] OK, and what's the charge amount?
[CUSTOMER][NEUTRAL] 253.29.
[AGENT][NEUTRAL] OK, and then the charges after primary paid?
[CUSTOMER][NEUTRAL] Oh, I'm sorry. Um, yeah, that is.
[CUSTOMER][NEUTRAL] $30.
[AGENT][NEUTRAL] OK. All right, let me look.
[AGENT][NEUTRAL] Give me just a second so the computer can pull it in.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and what is the name of the facility for this one?
[CUSTOMER][NEUTRAL] Yeah, that is going to be um SSM Health Medical Group.
[AGENT][NEUTRAL] OK. Um, do you have the doctor? We have it, looks like it's by the doc.
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, thank you. I just needed to verify that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the claim number for this one is 3450601.
[AGENT][NEUTRAL] The claim was denied because office visits are not covered by the patient's policy.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And what was the date that that was denied?
[AGENT][NEUTRAL] Let me check that for you.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][POSITIVE] [PII]. OK, perfect.
[CUSTOMER][POSITIVE] Right, that's all I have. Thank you so much. I appreciate you giving me all that information.
[AGENT][POSITIVE] Oh, it's no problem at all, Ms. [PII]. I'm glad I was able to help you with them.
[CUSTOMER][NEUTRAL] OK. Awesome. Um, OK. So, and, and because we were having some phone issues hearing, um, can you tell me your name again?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII]
[CUSTOMER][NEUTRAL] OK. And do you have a reference number or do you use your first name?
[AGENT][NEUTRAL] Use you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] All right. Well, thank you so much, [PII]. You have a great rest of your day and um
[CUSTOMER][POSITIVE] Have a great weekend coming up.
[AGENT][POSITIVE] Thank you Ms. [PII] you too and I hope you have a great [PII] thanks for calling APL.
[CUSTOMER][POSITIVE] Oh thank you. All right. Thanks. Bye-bye.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][NEUTRAL] Mm bye bye.
[CUSTOMER][NEUTRAL] All right. Bye.