AccountId: 011433970860
ContactId: 3370c798-e77d-470a-9aa7-6f4ecd383fe9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1018260 ms
Total Talk Time (AGENT): 234991 ms
Total Talk Time (CUSTOMER): 297798 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/3370c798-e77d-470a-9aa7-6f4ecd383fe9_20250314T17:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is.
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII] calling from doctor's office to check on a client status.
[AGENT][NEUTRAL] OK, I can help you with claim status [PII]. What is your callback number, sir? Just in case our call is disconnected.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you, sir. And then can you please give me the name, date of birth, and policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Member ID is 024377875 M as in Mary, L as in Lima 8.
[CUSTOMER][NEUTRAL] And the member's name is?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Gances and the date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $521 even.
[AGENT][NEUTRAL] OK, and then what is the charge after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, after the primary pay, the balance amount is $60 even.
[AGENT][NEUTRAL] Thank you. And then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Plastic surgery specialist of South Florida.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold [PII] while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh, come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me [PII]. I have the claim for you.
[AGENT][NEUTRAL] The claim number is 3569464.
[CUSTOMER][NEUTRAL] OK, your first.
[AGENT][NEUTRAL] The claim was denied because office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I know the patient's plan name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Can you please spell that?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please spell your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, can I get the call reference number for this one, Tory, and I have a few more clients.
[AGENT][NEUTRAL] Yes, you can use my name and today's date.
[CUSTOMER][NEUTRAL] Um, may I know your last name, sir?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Yeah, I got it. Just give me a second. I'll go with the next mobile ID.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, I got it. Shall I go ahead?
[AGENT][NEUTRAL] Yes. What's the next patient's name, date of birth, and policy number?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] It's 020.
[CUSTOMER][NEUTRAL] 44996 M as in Mary, L as [PII] Lima, 8. And the member's name is
[CUSTOMER][NEUTRAL] Member's name is uh [PII] and the date of birth is [PII]. And the date of service is [PII]. And the bill amount is $338 and the balance amount for secondary is $35 even.
[AGENT][NEUTRAL] Thank you and then is it for the same facility?
[CUSTOMER][NEUTRAL] Yeah, all the clients for the same facility.
[AGENT][NEUTRAL] OK and just so you know that the reference number for all of these will also be my name in today's date.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][POSITIVE] Yeah, I got it.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on a quick hold while I look up this one for you and I'll be right back.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] You.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Oh
[AGENT][NEGATIVE] Crap.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me [PII]. I've got this claim ready for you.
[CUSTOMER][POSITIVE] Oh yeah, thank you.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The claim number is 356.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 9618.
[AGENT][NEUTRAL] The claim was processed on policy number 247.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3219.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] That's the active policy the other policy number you gave me is no longer active and the claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For this one also, the offices would not cover, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, it's the same plan or a different plan?
[AGENT][NEUTRAL] Same plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] Shall I go ahead with the next member ID?
[AGENT][NEUTRAL] Yes, yes, sir.
[CUSTOMER][NEUTRAL] Yeah, it's 022.
[CUSTOMER][NEUTRAL] 70255 M as in Mary, L as in Lima, 8. And the member's name is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] And for this patient, I have two date of services. One is [PII] and the amount is $521 even and the balance amount for second is $60.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And shall I go ahead with the data service also?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Yes, it's [PII] and the bill amount is $338 even and the balance for secondary is $60.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold. I'm gonna look this up for you and I'll be right back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you very much, [PII], for holding for me. So on this one, the policy number you gave me, the 227-025-5 ML 8 is a lapsed policy is no longer active. So I looked on the active policy, which is 256-452-4.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You gave me the 22702.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And there is not a claim on file for either date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I get the claim number, uh sorry, new member ID?
[AGENT][NEUTRAL] Yes, it's 256-452-4.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, that's it. Uh, there is no ML.
[CUSTOMER][NEUTRAL] Uh, the first number is 0, is there any?
[AGENT][NEUTRAL] No, you can just use 256-452-4.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the effective date for this member ID?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And the policy is still active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Um, may I know the effective date for the previous one?
[AGENT][NEUTRAL] Yes, let me look at that.
[AGENT][NEUTRAL] The effective date of that one was [PII] and the policy lapsed on [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there wasn't a claim on file on that one either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the fax number or mailing address?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] I can give you both. The fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm. Yeah, go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The mailing address is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's in [PII], [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, I got it.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK, just give me a second.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] I'll go with the last number ID.
[AGENT][NEUTRAL] OK, what is the members?
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] Mhm. Yeah. It's 01606500.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the member's name is [PII] [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $3,036.48.
[CUSTOMER][NEUTRAL] The balance for secondary is $943.90.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again. I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Thank you for holding for me. Looking on data service of [PII], I do not find a claim on file for the amount you have given.
[CUSTOMER][NEUTRAL] All day service of [PII]. OK.
[CUSTOMER][NEUTRAL] OK. May I know the timely filing limit?
[AGENT][NEUTRAL] We don't have one.
[CUSTOMER][NEUTRAL] OK, and is the same, uh same fax number, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][POSITIVE] Uh, then, OK. Thank you so much, sir, for your assistance and uh have a great day. Stay safe.
[CUSTOMER][NEUTRAL] But I know
[AGENT][POSITIVE] You too, [PII] thank you bye bye. There's nothing else I can help you with before we go.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I can help you with before.
[CUSTOMER][POSITIVE] Um, no, thank you so much for asking.
[AGENT][POSITIVE] OK, well you have a wonderful weekend and thanks for calling APL.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Bye bye