AccountId: 011433970860
ContactId: 27971e57-104c-49ad-98ce-f2745808d4c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 682190 ms
Total Talk Time (AGENT): 189000 ms
Total Talk Time (CUSTOMER): 342928 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/27971e57-104c-49ad-98ce-f2745808d4c2_20250225T17:52_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. It is spelled like that. [PII], and I'm calling from
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][POSITIVE] Yes, I'm [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Well, I want to know about your claim status today.
[AGENT][NEUTRAL] OK, are the two claims that you're needing status on for the same member or different patients?
[CUSTOMER][NEUTRAL] Uh, well, I believe it is a different patients.
[AGENT][NEUTRAL] So it's 2 different policy numbers?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Sure, it is [PII].
[AGENT][NEUTRAL] Thank you. So, um, [PII], you will use my name along with today's date as each of your call reference numbers. Again, my name is [PII] and the first initials of my last name is [PII]
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Also, any information that I provide for you today will be a verification of benefits and not a guarantee of payment. And lastly receive, should we have the claims on file and you need a copy of the explanation of benefits, you may print that by going to our portal.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Which is located at [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Am public.
[AGENT][NEUTRAL] And what is your first patient's policy number? Yes, they secured. [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, well, it is APL American. OK, no worries. I will.
[CUSTOMER][NEUTRAL] I will go ahead with after the call with this portal. Uh, the first ID number is, it is 98, uh, just one moment please, just uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so that's not gonna, mhm.
[CUSTOMER][NEUTRAL] OK, OK. Well, just one moment, please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, OK. Yes, it is 022.
[CUSTOMER][NEUTRAL] 92711.
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Like that.
[AGENT][NEUTRAL] And your patient's name, please, and date of birth?
[CUSTOMER][NEUTRAL] Sure, the patient's name is?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] This for uh Sep sorry, [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Sure, the date of service is for.
[CUSTOMER][NEUTRAL] OK, just for.
[CUSTOMER][NEUTRAL] [PII] and the total bill amount is for $19,866.39.
[AGENT][NEUTRAL] And you said data services [PII], is that correct? OK, so give me just a couple of moments.
[CUSTOMER][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] Mhm. Sure. Take your time. And I have a specific question for this. Uh, once you
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] And do you have the claim number you said you had a specific question regarding this data service?
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Mhm. Uh, well, the claim was, uh, not, not on the file and verify the mailing address, it is [PII] [PII], [PII]. And the uh ZIP code is [PII]. So we send the primary EOB for, with the claim status, sorry, with the claim.
[CUSTOMER][NEUTRAL] Uh, and the claim form and primary EOB was delivered.
[CUSTOMER][NEUTRAL] To leave it on, uh, [PII]. Could you please check if you received any.
[CUSTOMER][NEUTRAL] You'll be from you'll be in the claim form, please.
[AGENT][NEUTRAL] No, so there is no claim on file for this data service and total bill amount that you provided for me.
[CUSTOMER][NEUTRAL] Mhm. Well, I, I show that uh there is a Cigna Primary Insurance.
[CUSTOMER][NEUTRAL] And so, uh, so could you, could you please help me what is the
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, like correct
[CUSTOMER][NEUTRAL] Uh, correct, uh, mailing address and, uh, PS ID please.
[AGENT][NEUTRAL] OK, you gave me the correct mailing address.
[CUSTOMER][NEUTRAL] Mhm, however.
[AGENT][NEUTRAL] The payer ID is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, well, could you please help me with the timing for limit for submitting the primary UOB?
[AGENT][NEUTRAL] We will need the claim and the primary insurance company's explanation of benefits, and there is no timely filing limit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, no worries, and well.
[CUSTOMER][NEUTRAL] And could, could you please uh help me like the mailing address is, it is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII] thank you.
[AGENT][POSITIVE] Uh-huh, you're welcome.
[CUSTOMER][NEUTRAL] Well, I, I would just want, just want to confirm the mailing address. I'm sorry about that because it is a [PII] that.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] So, well, could you please, uh, can we go ahead with another.
[CUSTOMER][NEUTRAL] Member then.
[AGENT][NEUTRAL] OK, just one moment. So that's all the information that you need for this number on this policy?
[CUSTOMER][NEUTRAL] Yes, I want to know about.
[AGENT][NEUTRAL] OK, in just a moment I'll let you know when we can move on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Hope he doesn't want to.
[AGENT][NEUTRAL] OK, and the next number's policy number?
[CUSTOMER][NEUTRAL] Sure, the next policy number is, uh, just one moment please.
[CUSTOMER][NEUTRAL] Well, it is 02450109.
[AGENT][POSITIVE] Thank, thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm. The patient's name is [PII] and the date of birth is for.
[CUSTOMER][NEUTRAL] Just one moment please. OK, it is for [PII].
[AGENT][NEUTRAL] And what is the data service and total bill amount please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure. It is for November 15, 2024 and the total bill amount is for some $1,787 even.
[AGENT][NEUTRAL] OK, so give me again one more time to make sure I heard all of those ones right. November, give me the date again.
[CUSTOMER][NEUTRAL] Mhm. Number 15, 2024.
[AGENT][NEUTRAL] Uh-huh, and build the meal was.
[CUSTOMER][NEUTRAL] And the total, sure it is 1787 1787 mhm.
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] Mhm. Even.
[CUSTOMER][NEUTRAL] Mhm. $1,787.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so we also do not have a claim on file for her for this data service and total bill amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just, just one moment. Let me check the clearing house if we got any rejection.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] And we billed the claim to [PII]. And the and the
[CUSTOMER][NEUTRAL] Uh, well, the PS ID is 64556.
[AGENT][NEGATIVE] No sir, that is an incorrect payer ID.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The payer ID for this member's policy is 60801.
[CUSTOMER][POSITIVE] OK, thank you. And
[CUSTOMER][NEUTRAL] OK, thank you. Well, we, we have to, mhm, we have to send the uh primary EOB for this member ID which.
[AGENT][POSITIVE] Yes, sir, you're welcome.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes sir, the claim, yes sir, we will need to claim and the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so can, can we like send the.
[CUSTOMER][NEUTRAL] Uh, you'll be to the mailing address directly.
[AGENT][NEUTRAL] Yes, she would send the claim and the and yes the claim in the EOB may go to the mailing PO box.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thank you for the information.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] You're welcome. And is there anything else that I can help you with today, [PII]?
[CUSTOMER][POSITIVE] Mm, yeah, have a great day. Thank you.
[AGENT][POSITIVE] Well, you're certainly welcome and thank you again for calling APL and I hope you have a great afternoon as well.
[CUSTOMER][NEUTRAL] You too. Bye for now.
[AGENT][POSITIVE] Thank you. Uh-huh. Bye-bye.