AccountId: 011433970860
ContactId: 23231efb-7509-4077-a585-c26432ddc47f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292119 ms
Total Talk Time (AGENT): 113679 ms
Total Talk Time (CUSTOMER): 92047 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/23231efb-7509-4077-a585-c26432ddc47f_20250430T15:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII]. Last is [PII], and today I'm here to check the claim status. I'm calling from provider's office.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. And [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have only one claim with me.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Member's policy number is
[CUSTOMER][NEUTRAL] OK, that would be 019.
[CUSTOMER][NEUTRAL] 509
[CUSTOMER][NEUTRAL] 36
[CUSTOMER][NEUTRAL] M Mary, L Lima 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, that would be [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Date of service is [PII]. It's uh it's [PII] and the total bill amount is $115 even.
[AGENT][NEUTRAL] Thank you, and that was [PII]?
[CUSTOMER][NEUTRAL] My 3 your parents right. Yes. Mhm.
[AGENT][NEUTRAL] Alright, so the active policy at that time um was 243-6105. The policy number that you gave terminated on [PII]. So let me look on the active policy and see if there's a claim there. Hold on one moment.
[CUSTOMER][NEUTRAL] Uh, sorry, sorry. Can you provide me the act policy again one more time if you don't mind.
[AGENT][NEUTRAL] Sure, 243.
[AGENT][NEUTRAL] 6105.
[CUSTOMER][NEUTRAL] And this policy is active now?
[AGENT][NEUTRAL] Um, [PII] and it's still active.
[CUSTOMER][NEUTRAL] As a scan repair, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, as a scan repair, right? The patient policy is active as a scan repair.
[AGENT][NEUTRAL] I don't understand. Can you say that one more time slowly?
[CUSTOMER][POSITIVE] Uh, not a problem, not a problem. You can check the claim. That's OK.
[AGENT][NEUTRAL] Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, it's a Jupiter Hospitalist INC.
[AGENT][NEUTRAL] Alright, so I'm showing that we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3526535.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] You will be required from retirement insurance, OK. And
[CUSTOMER][NEUTRAL] Can you provide me
[CUSTOMER][NEUTRAL] Can you provide me the
[CUSTOMER][NEUTRAL] Do you have the fax number to submit a claim?
[AGENT][NEUTRAL] Yes, our fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And [PII], what is the timely filing to submit the claim?
[AGENT][NEUTRAL] There's no timely filing as long as the policy was active on the day of service, you can file at any time, um, but this is additional information, so as soon as we receive it, we'll go ahead and continue processing.
[CUSTOMER][NEUTRAL] And can you provide me the reference number for today's call right now?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, reference number for today's call.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] And it's [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you, thank you. Thank you, [PII]. Have a nice time.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can help with?
[CUSTOMER][POSITIVE] No, no, that's OK. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye-bye.