AccountId: 011433970860
ContactId: 1a7189a5-3e93-4fa1-8375-4e39f6965c0b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 795049 ms
Total Talk Time (AGENT): 166455 ms
Total Talk Time (CUSTOMER): 416273 ms
Interruptions: 3
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/1a7189a5-3e93-4fa1-8375-4e39f6965c0b_20250605T17:00_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi. Uh, this is [PII] and I'm calling from Emeri Clinic. Uh, in total, I have 4 plans to check.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII]. And what is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah. Uh, for the first claim, uh, that is going to be 02488097.
[CUSTOMER][NEUTRAL] Uh, it's M as in Mike, L as in Lima, 7.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Uh yeah, sure. That is going to be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and patient's name, date of birth?
[CUSTOMER][NEUTRAL] Uh, the member's name is uh [PII] and the date of birth is [PII]. And if you want, I can spell it out the first name.
[AGENT][NEUTRAL] No, you don't have to. Um, what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Yeah. Uh, it's on [PII]. And the total bill amount is uh $428.24.
[AGENT][NEUTRAL] OK, and what was the balance after primary process the claim?
[CUSTOMER][NEUTRAL] That is going to be actually they have allowed $269.20. So did that allowed the amount, uh, you bring it towards members uh deductible.
[AGENT][NEUTRAL] Oh, don't show we received that claim. Can you verify the address it was submitted to?
[CUSTOMER][NEUTRAL] So the, you guys, yeah.
[CUSTOMER][NEUTRAL] Mm, let me check.
[CUSTOMER][NEUTRAL] So, actually, it was uh, oh.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It was sent via mail and the
[CUSTOMER][NEUTRAL] Yeah. It says uh [PII].
[AGENT][NEUTRAL] Uh, that is the incorrect address. When you're ready, I can give you the correct address and or a fax number.
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, I'm ready for the address.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. So, [PII]. Then uh can I have the ZIP code again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] O.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, just give me a second. Uh, I just found the member's uh, ID card here.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Oh, it says the same thing. I think we have submitted to that. Yeah. Uh, by the way, uh, may I know the time limit test, sir?
[AGENT][NEUTRAL] Uh, there's no time limit to submit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK. And uh let me check. Yeah, uh, I'm ready with the 2nd claim with the 2nd member.
[AGENT][NEUTRAL] 01 moment.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and what is next policy number?
[CUSTOMER][NEUTRAL] Yeah. Uh, the next policy number will be
[CUSTOMER][NEUTRAL] That is 02485251.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Wait a second.
[AGENT][NEUTRAL] Patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah. Uh, the member's name is, uh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that is um
[CUSTOMER][NEUTRAL] Ms. [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Yeah. Uh, it's on [PII], and the total bill amount is uh $478.74.
[AGENT][NEUTRAL] Uh, we have not received that claim. Can you verify the address that claim was submitted to?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh yeah, that one also.
[CUSTOMER][NEGATIVE] Yeah, we will send it to the address which I gave you previously. That, that is incorrect.
[CUSTOMER][NEUTRAL] OK. And also we have to correct the address. Uh, by the way, so, uh,
[CUSTOMER][NEUTRAL] So you guys don't process a claim for the members as primary, right? For this member also should have a primary payer, right?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Are you asking if they should have a primary insurance? Yes, this is a secondary policy owner.
[CUSTOMER][NEUTRAL] Uh, so, uh.
[CUSTOMER][NEUTRAL] Yeah, yes, yes.
[CUSTOMER][NEUTRAL] OK. OK. OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, I'm on file.
[AGENT][POSITIVE] OK. I'm ready when you are for the next one.
[CUSTOMER][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] Yes, I'm ready. So, the next member ID, uh, that is going to be 01.
[CUSTOMER][NEUTRAL] 858-300 M as in Mike, uh L as in Lima, 8.
[AGENT][NEUTRAL] OK. Patient's name, date of birth?
[CUSTOMER][NEUTRAL] Uh, the member's name is, uh,
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK. And date of service, amount of the charge?
[CUSTOMER][NEUTRAL] Yeah. The service, uh, that is on [PII], and the total bill amount is $362 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEGATIVE] And I don't show we received a claim for that date of service, as also the patient was not active at the time of service. Policy terminated on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And they don't have any other coverage with us.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So, can I get the effect due date as well?
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. Uh, so you have to contact the member.
[CUSTOMER][NEUTRAL] Check
[CUSTOMER][NEUTRAL] OK. Um, I'm ready with the last number.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK. And what is that last policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, that is going to be, yeah.
[CUSTOMER][NEUTRAL] That is D as in Delta 45401602.
[AGENT][NEUTRAL] It's not one of our policy numbers. What is the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, I'm sorry. Uh, can you check this one? Uh, that, uh that is uh 02587959.
[AGENT][NEUTRAL] Uh, get that one more time. [PII].
[CUSTOMER][NEUTRAL] Yes. Uh, that is uh 02587959.
[AGENT][NEUTRAL] Oh, I
[AGENT][NEUTRAL] Patient's name, date of birth?
[CUSTOMER][NEUTRAL] Uh, the member's name is uh [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, data service amount on the charge.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] The bill amount is uh
[CUSTOMER][NEUTRAL] Uh, is $1,277.44.
[CUSTOMER][NEUTRAL] And the date of service will be [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And we have not received that claim. Can you verify the address that claim was submitted to?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. This one, we have submitted.
[CUSTOMER][NEUTRAL] Electronically, and I have the pay ID which is 42011.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Uh yeah. Uh, this one, we have submitted, uh, the claim via electronically and I have the pay ID. So the pay ID is 42011.
[AGENT][NEUTRAL] No, that is incorrect. Payer ID number is 64556.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah. Uh, that is 64, hold on. Uh.
[CUSTOMER][NEUTRAL] I don't, uh, actually, I have called you guys yesterday I said, so I got a different, uh, pay ID number which is uh
[CUSTOMER][NEUTRAL] Uh, yeah, that is 60801. Uh, that also, is that also correct?
[AGENT][NEUTRAL] Uh, that's to a different address, but no, the payer ID is 64556.
[CUSTOMER][NEUTRAL] Got you. And the, can I get the claim mailing address, sir, is it the same as previous one or it's different?
[AGENT][NEUTRAL] Uh, I don't know what you have, but if it's the [PII], that is the correct address.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the address is, by the way, uh, it's depending on the plan, right? Because the previous one, we had a different, uh, mailing address now, yeah, OK. For this one also, we don't have a time we find a limit and uh this one has a primary insurance?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, do you guys have that coordination of me?
[AGENT][NEUTRAL] Well, I don't know if they have any other insurance. This one is a hospital indemnity policy, so necessarily have the pri the primary.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah. So that is all and uh
[CUSTOMER][NEUTRAL] Yeah. Uh, may I know your name again with the last name initial and the call reference number?
[AGENT][NEUTRAL] Uh, my name is [PII]
[CUSTOMER][NEUTRAL] Uh, that is uh [PII], right?
[AGENT][NEUTRAL] [PII] last initial [PII]
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, OK. Uh, can I get some?
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date.
[CUSTOMER][POSITIVE] Sure. Uh, that is all and uh thank you very much. Uh, take care, bye for now.
[AGENT][POSITIVE] Mhm you're welcome thank you for calling APL bye.