AccountId: 011433970860
ContactId: 1cd5fb72-7aa5-484a-be11-8be36115ba7c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 649000 ms
Total Talk Time (AGENT): 214569 ms
Total Talk Time (CUSTOMER): 441864 ms
Interruptions: 24
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/1cd5fb72-7aa5-484a-be11-8be36115ba7c_20250326T14:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from the provider's office checking on claims.
[AGENT][NEUTRAL] OK, I missed your, your, your first name. You were, I couldn't hear you.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Your name is
[AGENT][NEUTRAL] [PII], OK, and you said you're checking claim status?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the policy number and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] The callback number [PII].
[CUSTOMER][NEUTRAL] And the policy number is 016.
[CUSTOMER][NEUTRAL] 6028.
[CUSTOMER][NEUTRAL] 1 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you. Can I repeat your phone number back to you? What I've written down is [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK got it.
[CUSTOMER][POSITIVE] You got it.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] Date of birth, [PII].
[AGENT][NEUTRAL] Thank you and you said you're checking claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, if I can get the date of service and the total bills.
[CUSTOMER][NEUTRAL] Of course, [PII] $418.47.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What um what's the procedure code or codes on the claim?
[CUSTOMER][NEUTRAL] Just give me a moment, please. I'm checking.
[AGENT][NEUTRAL] Uh-huh. OK.
[CUSTOMER][NEUTRAL] Uh, not for the $418.47. Can you please check for the $315.66?
[AGENT][NEUTRAL] 31566. What's the procedure code on that one?
[CUSTOMER][NEUTRAL] I, mhm.
[CUSTOMER][NEUTRAL] It is PA code 88305 with modifier 26.
[AGENT][NEUTRAL] 883-05 modifier 26. OK, hold on a second.
[CUSTOMER][NEUTRAL] Actually, I have the claim status with me. Uh-huh.
[AGENT][NEUTRAL] What's the name of the doctors?
[AGENT][NEUTRAL] You have a claim number?
[CUSTOMER][NEUTRAL] Um, I'm checking. Give me a moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm checking. Please wait.
[AGENT][POSITIVE] Mhm. No problems.
[CUSTOMER][NEUTRAL] maybe
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Who?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually, for this member, there are two claims, one for the amount which I told you earlier. I have a claim number for that amount, not for the one which I'm looking for. OK, it's 3559177.
[AGENT][NEUTRAL] Mhm. What's, what's that number?
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you've already received the status for that one, so you're looking for the other code?
[CUSTOMER][NEUTRAL] Yes, uh, for the dollar amount of 31566.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 88305. Yes, 88305.
[AGENT][NEUTRAL] And what was the procedure code on that one?
[AGENT][NEUTRAL] The 3 15 6.
[AGENT][NEUTRAL] OK, I do not show that one. I show the one for, I show the one for 4 1847, but not.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Modifyer 26.
[CUSTOMER][NEUTRAL] modify 26 and PC? OK. Yeah, you said you don't have claim for that amount, 31566, right?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Correct, and you said it was procedure 88305 modify your 26.
[CUSTOMER][NEUTRAL] Yeah, 26 or it might be PC, but you don't have the claim for that amount, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] T as in Tom, C as in Charlie.
[AGENT][NEUTRAL] I'm just trying to verify. So did you say the modifier, is it T as in Tom, C as in Charlie?
[CUSTOMER][NEUTRAL] They do.
[CUSTOMER][NEUTRAL] No. P as in Paul, C as in Charlie. OK, OK.
[AGENT][NEUTRAL] OK, I do not show the charge for 3:15.66 on file for for [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it. Uh, what is the timely selling limit?
[AGENT][NEGATIVE] To submit a claim, there is no timely.
[CUSTOMER][NEUTRAL] OK. Can you please verify the address?
[AGENT][NEUTRAL] The claims mailing address? what do you have on file for our mailing address and I can confirm.
[CUSTOMER][NEUTRAL] Um, mhm.
[CUSTOMER][NEUTRAL] Uh-huh. [PII].
[AGENT][NEUTRAL] Just submit a claim it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 73.
[CUSTOMER][NEUTRAL] Uh, the one which you have with you for.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Yeah, uh, [PII], right?
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm. One moment, please.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But you said you have the claim for 41847 that we sent on the address which I um that was sent on the address which I just said, uh [PII].
[AGENT][NEUTRAL] We do.
[AGENT][NEUTRAL] That's not our address for claims.
[CUSTOMER][NEUTRAL] S
[AGENT][NEUTRAL] So are you sure it was sent to that PO box? That's our claims mailing address.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] But we processed it, so that's that's a mute point so this claim that we have not received sent it to the PO box provided.
[CUSTOMER][NEUTRAL] 00.
[CUSTOMER][NEUTRAL] OK, so this one should go on the correct address. That's what you mean, right?
[AGENT][NEUTRAL] Yeah, so the, the, the, the address that you gave me before is not for claims. The one that I just gave you is for claims. If you could update your records, please.
[CUSTOMER][NEUTRAL] for all.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, OK. The one, which I said, it's not the claims address, but it is for your department, right?
[AGENT][NEUTRAL] The one that I just gave you is for the for to submit a claim.
[CUSTOMER][NEUTRAL] OK, but my question is, the address which I told you, we have submitted the claim on that address. You guys have received it, the one for $418.47.
[AGENT][NEUTRAL] I can't confirm where it came from or what address you mailed it to. I can tell you that it's here and then I provided you with the correct PO box number.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm not gonna go back and forth, just use the correct number that I provided please.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Can you help me with the timely fiing limit?
[AGENT][NEUTRAL] To submit a claim, there's no timely filing limit.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Is there any fax number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] we
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Is there uh any payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][NEUTRAL] Is the policy active?
[AGENT][NEUTRAL] It is currently active at this time.
[CUSTOMER][NEUTRAL] Can you help me with the effective date, please? Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The policy effective date is [PII].
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] Can I have the call reference number?
[AGENT][NEUTRAL] My name in today's date. [PII], and any other questions, [PII]?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I have one more claim to check on. Can you assist me with that?
[AGENT][NEUTRAL] I can, and you can also check your status online at [PII], and would you like for me to help you set up an account?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Uh, not right now. I'll check it afterwards. Uh-huh.
[AGENT][NEUTRAL] OK, what is the policy number?
[CUSTOMER][NEUTRAL] A as in Alfa. F as in Frank. 00. S as in Sam 3584201.
[AGENT][NEUTRAL] OK, that's not our policy number.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, can you please check once with the name and date of birth?
[AGENT][NEUTRAL] OK. Do, do you have the ID card for the patient?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, this is the member ID on the ID card listed.
[AGENT][NEUTRAL] And what's the insurance, what's the insurance name on the card?
[CUSTOMER][NEUTRAL] American family.
[AGENT][NEUTRAL] OK, so that would be the name of the insurance company, which is different than American Public Life. Is there a phone number on the card?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Unknown
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, so this doesn't belong to your department, right?
[AGENT][NEUTRAL] OK. So you may have a contact.
[AGENT][NEUTRAL] Yeah, the name that you provided that's on the card is not American Public Life and the policy number is not American Public Life.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much for your assistance. Have a great day ahead. Bye-bye.
[AGENT][POSITIVE] Alright, you're, you're welcome, [PII]. Thanks for calling APL have a good day.