AccountId: 011433970860
ContactId: 34b79102-5fd1-4a0e-a6b2-1ecfd6885d17
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 416799 ms
Total Talk Time (AGENT): 162002 ms
Total Talk Time (CUSTOMER): 90827 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/34b79102-5fd1-4a0e-a6b2-1ecfd6885d17_20250522T19:16_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII] calling from office. I can claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Is a direct line?
[AGENT][NEUTRAL] Thank you. And what is the member's policy number?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] And this uh member ID is uh hello? Can you hear me?
[AGENT][NEUTRAL] I can now.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, sure, I can
[CUSTOMER][NEUTRAL] Yeah, member ID is 025816.
[CUSTOMER][NEUTRAL] I'll read it again. 02581601.
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And any information that I do provide for you today [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] yeah, how about [PII].
[AGENT][NEUTRAL] And what is the patient's name?
[CUSTOMER][NEUTRAL] The first name is [PII], the last name is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] [PII], total charge on $361 even.
[AGENT][NEUTRAL] I'm sorry, 361 or 351?
[CUSTOMER][NEUTRAL] And how can
[CUSTOMER][NEUTRAL] 361. And how can I spell your name?
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Again, it is spelled [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And you did say data services 48 of 2025 for 361, is that correct?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received. The received date on this claim was [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3,589,340.
[AGENT][NEUTRAL] And the reason for the denial is that we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And if you need a copy of that explanation of.
[CUSTOMER][NEUTRAL] I don't denied as a primary.
[AGENT][NEGATIVE] It is denied because we need the primary insurance company's explanation of benefits submitted.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] This is a supplemental policy. Yes sir.
[CUSTOMER][POSITIVE] Thank you so much. And uh how to submit this one?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It may be mailed or faxed.
[CUSTOMER][NEUTRAL] And may I know the family friendly limits for this?
[AGENT][NEUTRAL] There's no timely filing to submit the EOB, the primary?
[CUSTOMER][NEUTRAL] May I know the time limit?
[AGENT][NEUTRAL] Yes, I just said there was no timely filing limit to submit the ERP.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it may be faxed or mailed and if you need a copy of our explanation of benefits you can print that from our portal, [PII], by going to [PII].
[AGENT][NEUTRAL] The remark on our claim states.
[CUSTOMER][NEUTRAL] May I know the mailing address and the fax number?
[AGENT][NEUTRAL] Mm. The mailing address is the same as claims. What do you have for your claims mailing?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I have that one is [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the claims fax number?
[CUSTOMER][NEUTRAL] But the cat means the time limit is uh how many days?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] [PII], I explained there was no timely filing limit.
[AGENT][NEUTRAL] To submit the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK. May I have the fax number?
[AGENT][NEUTRAL] [PII] attention claims department.
[CUSTOMER][POSITIVE] Thanks so much. And can I have a call reference number?
[AGENT][NEUTRAL] My name along with today's date.
[CUSTOMER][NEUTRAL] And it is possible to send the copy of EOP fax.
[AGENT][NEUTRAL] You can actually print it by going to that website that I gave you. Did you take down the website when I gave it to you?
[CUSTOMER][POSITIVE] Yeah, I got it. Thank you.
[AGENT][NEUTRAL] Mhm. So you can actually print it from our portal?
[CUSTOMER][POSITIVE] And thank you, Ty. Thank you so much. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You're welcome, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's not interested. Thank you so much. Have a nice day.
[AGENT][POSITIVE] Well, you're very welcome and thank you for calling APL. I hope you have a nice day also.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye now.
[AGENT][NEUTRAL] Mhm. Bye-bye.