AccountId: 011433970860
ContactId: 2e96b810-fe08-45a6-9460-47a32a380623
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 415369 ms
Total Talk Time (AGENT): 165179 ms
Total Talk Time (CUSTOMER): 136842 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/2e96b810-fe08-45a6-9460-47a32a380623_20250527T17:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ADL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'd like to confirm that, uh, claims are on file for a member, uh, just before I refund them because I'm having some of the claims being returned via mail, so I just want to confirm which date of service you guys have on file.
[AGENT][NEUTRAL] Yes, I can help you with claims. um, can I please get your name and your call back number?
[CUSTOMER][NEUTRAL] Um, yes, [PII] and my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, Miss [PII], and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Um, South Florida physical therapy and sports rehab.
[AGENT][NEUTRAL] OK, and what is the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] It is, patient's name is [PII] and you need the ID number, correct?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK, you're cutting off a little bit. It's 01887.
[CUSTOMER][NEUTRAL] 294 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] OK thank you let me look up this policy real quick.
[AGENT][NEUTRAL] And what's [PII]'s date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I show several claims were submitted on [PII].
[AGENT][NEUTRAL] There's 123456789, 1011, 1213 in total.
[CUSTOMER][NEUTRAL] OK, so that's weird because I got an error message back from my clearing house saying that the payer ID was incorrect. So these were sent electronically. Do you see that it was received electronically as well?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, that's really good, so you guys.
[AGENT][NEUTRAL] And the payer ID number is 6.
[AGENT][NEUTRAL] 60801 is that the payer ID number that you use because that's what I mean I'm showing confirmation number that we received it.
[AGENT][NEUTRAL] On [PII] and they're in progress.
[CUSTOMER][NEUTRAL] OK, that's really good. Yes, that is the number. Oh, I'm sorry, you know what, it could have been I had a different payer ID number, so I think when it was updated it was corrected.
[AGENT][POSITIVE] OK. OK. Good deal.
[CUSTOMER][NEUTRAL] What is your name again?
[AGENT][NEUTRAL] My name is [PII]. It's [PII]
[CUSTOMER][NEUTRAL] So you can confirm, confirm all date for it.
[CUSTOMER][NEUTRAL] For the EIT and
[CUSTOMER][NEUTRAL] That are all currently lash I. OK, awesome. That is great. um, sorry, can you confirm that payer ID number again?
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][POSITIVE] Awesome, uh, [PII], is there a reference number for our call today?
[AGENT][NEUTRAL] Yes ma'am, you can use my name and today's date.
[CUSTOMER][POSITIVE] Yes ma'am, you can
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And just to confirm, I have um data service ranging from [PII] all the [PII]. Do you have those on file?
[AGENT][NEUTRAL] I can't see the dates on them because they're in progress. The information is not available to me to look up the data service, but I do show that on [PII], 13 claims were sent electronically and all have confirmation numbers.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And does this number have benefits for these claims to be paid out?
[AGENT][NEUTRAL] Uh, it depends on what you sent in on your statement as far as your diagnosis and procedure codes, and this is just to verify benefits. It's not a guarantee of payment. This policy is a supplemental policy that's built secondary to the primary, and it helps with deductible copay and co-insurance only.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][POSITIVE] Perfect. OK, yes, that's this they have all processed towards patient deductible.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show that the policy did lapse on [PII], so it would have to be data service before [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, I'm sorry, the policy did, well, I'm, I'm, I'm sorry, I lost you there.
[AGENT][NEUTRAL] The policy did terminate on [PII].
[CUSTOMER][NEUTRAL] So any date of service after [PII] would not be covered?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if he's got another policy though let me look and see if they, if they issued a new one. Let me check that real quick.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] No, ma'am, it, it did end on [PII]. I don't see any other active policies at this time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] All right. I will call the patient. Thank you.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful day is that everything I can help you with Ms. [PII] before we go?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's all. Have a great one.
[AGENT][POSITIVE] You too and thank you for calling APL bye bye now.
[CUSTOMER][POSITIVE] You too thank you for
[CUSTOMER][POSITIVE] Have a good one bye.