AccountId: 011433970860
ContactId: 28ef6482-29a8-46e6-8edf-8e0ae8d2be94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 612099 ms
Total Talk Time (AGENT): 166923 ms
Total Talk Time (CUSTOMER): 354738 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/28ef6482-29a8-46e6-8edf-8e0ae8d2be94_20250501T13:33_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] Hi [PII], my name is [PII]
[AGENT][POSITIVE] Hi [PII], how are you doing today?
[CUSTOMER][NEUTRAL] And I am with.
[CUSTOMER][NEUTRAL] Oh, I'm doing OK as long as these storms don't connect me I'll be good.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's storming outside and it's like 01 of the girls on our team we're in [PII].
[AGENT][NEUTRAL] It is, where are you?
[AGENT][NEUTRAL] OK, some of our team members are in [PII] and they were talking about the storm too.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] Oh, you know, and one of the girls I work with, she lost connection because of the storm, so I'm hoping that that doesn't happen to me. Yeah, I have.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] Right, I'm in [PII] and it's like it's all around me.
[CUSTOMER][NEUTRAL] But it's going all around you, huh?
[CUSTOMER][NEUTRAL] Well, well, you're, you're lucky and I saw um on TV this morning this [PII], she's gone to the Kentucky Derby and she says she's got a big hat that she's gonna wear to keep the rain from coming on her. I know, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] I hope it don't fly away.
[CUSTOMER][NEUTRAL] Anyway, um, I have several claims for the same patient. I'm showing that you are secondary to AvMed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I don't know what you need so you can look these claims up to see if you have them.
[AGENT][NEUTRAL] OK, um, well, 1st may I have a good contact number in case we're disconnected and then the policy number.
[CUSTOMER][NEUTRAL] OK, [PII], that is a direct line.
[CUSTOMER][NEUTRAL] And what did you say the member ID?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Or OK.
[CUSTOMER][NEUTRAL] In one place I am showing it is 01802550.
[CUSTOMER][NEUTRAL] But then in another place it has that same number with an M as in Michael, L as in Lima 8 after that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII], it's [PII] or [PII]. I don't [PII]. 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 if you want, um, you can give me all the dates of service and the total bill, and I'll just search them all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I'll just go from the top. They're all for 50, no, no, they're not, no, they're not, never mind, um, the first one is 226-2024.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The total charge amount was $336.
[CUSTOMER][NEUTRAL] But we're billing you for the $50 co-pay.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 3:18, I just wanna make sure that it's just one day for these because sometimes they.
[CUSTOMER][NEUTRAL] Messed me up. OK, it's 318 2024, total charge is $1,108 even and again $50 co-pay.
[CUSTOMER][NEUTRAL] Um, September.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For total charge of $75.
[CUSTOMER][NEUTRAL] And on that one there's a $25 copay.
[CUSTOMER][NEUTRAL] Oh, and then we're going really far back.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that is $274.
[CUSTOMER][NEUTRAL] And we're billing you for 40.
[CUSTOMER][NEUTRAL] And then 71 2022.
[CUSTOMER][NEUTRAL] For $828.
[CUSTOMER][NEUTRAL] And we're billing you for $50.
[CUSTOMER][NEUTRAL] And last but not least.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, data service [PII]. OK, and that one is for.
[CUSTOMER][NEUTRAL] $277 and we're billing you for $50.
[AGENT][NEUTRAL] Alrighty, and is, is it alright if I place you on just a brief hold while I go through these dates and the bills?
[CUSTOMER][POSITIVE] Absolutely, thank you, [PII].
[AGENT][NEUTRAL] You're very welcome. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Alright, let's see how 226 04.
[AGENT][NEUTRAL] 00.
[AGENT][NEUTRAL] Oh, this is it.
[AGENT][NEUTRAL] Let's try that again. [PII] 2624.
[AGENT][NEUTRAL] Uh oh.
[AGENT][NEUTRAL] No claims.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] 00.
[AGENT][NEUTRAL] What? I mean, I've never seen it where it's a whole list. We can't get none.
[AGENT][NEUTRAL] No other policy. I just checked. [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] 223 [PII]. 0.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So we have not received any of these claims. Um, there's no claim on file for any of these dates of service, but there's also no timely filing, and this policy has been active since [PII]. So you still could file for each of these claims because the policy was active on the date of service.
[CUSTOMER][NEUTRAL] OK, can I fax them to you or do they need to be OK, what is your fax number?
[AGENT][NEUTRAL] So it's [PII].
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, now do you need the primary COB along with that, or do you just?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and then if I would mail.
[AGENT][NEUTRAL] The primary EOB and
[CUSTOMER][NEUTRAL] Go ahead, I'm go ahead.
[AGENT][NEUTRAL] It's OK, the primary EOB and then the itemized billing.
[CUSTOMER][NEUTRAL] OK, tell me what your mailing address is because I, I am showing that they were sent paper, but that doesn't mean, OK, I have [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, well, I'm wondering if it.
[AGENT][NEUTRAL] And you said 248,950, right?
[CUSTOMER][NEUTRAL] 248,950 yes mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, maybe instead of faxing them because it's gonna be, it would be like on in each individual one and I don't know if I can do the EOB at the same time that I do.
[CUSTOMER][NEUTRAL] So what I'll do is I'll I'll just send these hard copy, but what I'll do is I'll send them certified so then that way we have a tracking number on them since we do have the right address.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And we also have a payer ID if that will help. I don't know.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh, absolutely. What is a payer ID?
[AGENT][NEUTRAL] OK, it's 60801.
[CUSTOMER][NEUTRAL] OK, let me see once if they have that listed because I don't know.
[CUSTOMER][NEUTRAL] This is crazy.
[CUSTOMER][NEUTRAL] American
[CUSTOMER][NEUTRAL] Additional
[CUSTOMER][NEUTRAL] Nope, they don't have it listed.
[CUSTOMER][NEUTRAL] So what I will do since you don't have any timely filings since that one is a [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I'll just go ahead and send it to our registration department to add the electronic payer ID and then maybe that will.
[CUSTOMER][NEUTRAL] Um, speed, speed things up a little once. I mean if they come electronically, yes, yes, OK, [PII], do you have a call reference number for me?
[AGENT][NEUTRAL] Speed it up a little bit.
[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][POSITIVE] OK, I think you should say [PII] like lovely because you were a pleasure to talk to.
[AGENT][POSITIVE] Oh, that's cute.
[AGENT][POSITIVE] Oh, thank you.
[CUSTOMER][POSITIVE] OK. Oh, thank you so much and you have a blessed day. Oh, I mean, it's a, it's, it is a time to refresh and strengthen. That is what our church tells us, and I have a bracelet on my arm that says that, and I had to put it on today because it's a new month.
[AGENT][POSITIVE] Thank you, as you also.
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] And I'm going to refresh and strengthen so anyway it was like a, what does yours say?
[AGENT][NEUTRAL] And guess what my bracelet says.
[AGENT][POSITIVE] Enjoy the journey.
[CUSTOMER][POSITIVE] Oh I love that. I love that. And my, well my other bracelet that I that I that that is like a thick one like this, it's um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I can do all things.
[CUSTOMER][POSITIVE] You know, through [PII] who gives me strength and it's like amen to that. So, but yes, let's enjoy the journey.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's right.
[CUSTOMER][POSITIVE] Thank you, [PII]. It was, it was, it was certainly a pleasure and be lovely.
[AGENT][POSITIVE] Well, I'm glad I could assist you [PII]. Thank you and I will be lovely. And thank you so much for calling APL. I hope you have a great day and a good weekend.
[CUSTOMER][POSITIVE] Thank you, you as well. Bye-bye.
[AGENT][NEUTRAL] Bye bye.