AccountId: 011433970860
ContactId: 34f44815-1b7f-4391-9471-469260ce0bae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1065810 ms
Total Talk Time (AGENT): 286608 ms
Total Talk Time (CUSTOMER): 332384 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/34f44815-1b7f-4391-9471-469260ce0bae_20250224T21:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling for Resociation Alabama to check on our client status and please inform me that this call is being recorded and monitored for the quality and training purpose.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Uh yeah, sure. The member ID number is?
[CUSTOMER][NEUTRAL] 795153
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure, the call back number is [PII] and it's a direct line.
[AGENT][NEUTRAL] I'm sorry, could you repeat the callback number?
[CUSTOMER][NEUTRAL] Uh yeah, sure. The callback number is [PII].
[AGENT][POSITIVE] OK. Thank you. Thank you.
[CUSTOMER][NEUTRAL] And it's a line.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the member name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information and you said you're checking a claim status, uh, [PII]?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] For for what date of service?
[CUSTOMER][NEUTRAL] Uh, sure. The rate of service is [PII]. And this is for the total charge amount of
[CUSTOMER][NEUTRAL] Just a minute, it's still loading.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. The charge amount is $242.17.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just for an office visit charge?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the provider's name?
[AGENT][NEUTRAL] Or the practice name?
[CUSTOMER][NEUTRAL] The name is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Just [PII]
[CUSTOMER][POSITIVE] Uh, the facility is, yes, you're right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so I showed that the claim was not payable, um, the date of service is after the policy, uh, is no longer active. Uh, the policy lapsed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I show the effective date was [PII].
[AGENT][NEUTRAL] [PII] and the claim number is 354.
[AGENT][NEUTRAL] 1775.
[AGENT][NEUTRAL] Claim was processed on [PII].
[AGENT][NEUTRAL] You can also check your status online at [PII], [PII].
[AGENT][NEUTRAL] And did you have any further questions?
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Uh, yes. May I know the claim received it?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The client received it?
[AGENT][NEGATIVE] I didn't understand the question.
[CUSTOMER][NEUTRAL] Received it. I received date of the claim.
[AGENT][NEUTRAL] Oh, the received date, [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And you said the policy is effective from [PII] to this I'm sorry, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And there is no active plan for this number, am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, may I know the call reference number?
[AGENT][NEUTRAL] My name and today's date, [PII].
[AGENT][NEUTRAL] [PII] first initial and last name is [PII]. Anything else, [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, yes. May I know how many claims can you assist me?
[AGENT][NEUTRAL] How many do you have?
[CUSTOMER][NEUTRAL] Actually I have 5 more.
[AGENT][NEUTRAL] OK, I can um assist you with creating the online account and walk you through that process to check status if you would like.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm, can you please provide me your status?
[AGENT][NEUTRAL] I can, but I was just offering to help you to create the account. Is that a yes or no?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh no, that's OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I can do 3 more claims for you. What's the next policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. It's going to be 024.
[CUSTOMER][NEUTRAL] 193.
[CUSTOMER][NEUTRAL] 86
[AGENT][NEUTRAL] What's the date of service in charge?
[CUSTOMER][NEUTRAL] M as in Mike,
[CUSTOMER][NEUTRAL] OK, date of service is [PII]. And the total charge amount is
[CUSTOMER][NEUTRAL] Uh, it's still loading.
[CUSTOMER][NEUTRAL] OK, the bill amount is $59.04.
[AGENT][NEUTRAL] OK, what's the next date of service?
[CUSTOMER][NEUTRAL] OK, next, next week of service is [PII].
[AGENT][NEUTRAL] The next policy number.
[AGENT][NEUTRAL] The Next policy number and date of service.
[CUSTOMER][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] It's still loading. Give me a minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the policy number is?
[CUSTOMER][NEUTRAL] something
[CUSTOMER][NEUTRAL] It's 669-448-50.
[AGENT][NEUTRAL] Yeah, that's not one of our policy numbers.
[CUSTOMER][NEUTRAL] Or can you for this number using name and date of birth?
[AGENT][NEUTRAL] Go ahead and give me the ones that you have with the policy numbers.
[CUSTOMER][NEUTRAL] OK. The next member's ID policy number is.
[CUSTOMER][NEUTRAL] 01660278 my Clarie 7.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] It's to the member ID number is. So this is not your policy number, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I, I, I'm trying to verify, can you repeat it?
[CUSTOMER][NEUTRAL] OK. It's going to be 01660278 M as in Mike, L as in Larry, [PII].
[AGENT][NEUTRAL] OK, what's the data service?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh this is for the charge amount of?
[CUSTOMER][NEUTRAL] $58 even.
[AGENT][NEUTRAL] OK, and the next one?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] So the policy number you gave me 241-9386, what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. OK. And my name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Still looking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the procedure code on the claim?
[CUSTOMER][NEUTRAL] 97,110.
[AGENT][NEUTRAL] OK, I have it here, one moment.
[AGENT][NEUTRAL] Looks like a benefit of $40.16.
[AGENT][NEUTRAL] Was processed on [PII], showing a received date of [PII] as well.
[AGENT][NEUTRAL] The claim number?
[AGENT][NEUTRAL] Is 354.
[AGENT][NEUTRAL] 1741.
[CUSTOMER][NEUTRAL] OK. The paid amount is $40.60.
[AGENT][NEUTRAL] 1616 cent.
[CUSTOMER][NEUTRAL] OK. May I know the uh
[CUSTOMER][NEUTRAL] Payment information is just paid through check or EFT?
[AGENT][NEUTRAL] Of our checks are individual checks.
[CUSTOMER][NEUTRAL] OK. and the check number?
[AGENT][NEUTRAL] 201844884.
[CUSTOMER][NEUTRAL] May I know the payment issued and clear date?
[AGENT][POSITIVE] Was issued on the day that it was processed [PII] I show it outstanding.
[CUSTOMER][NEUTRAL] Still outstanding. Do you have a patient account number?
[AGENT][NEUTRAL] So patient account number that's on your claim.
[CUSTOMER][NEUTRAL] I have a patient account number here which is [PII].
[AGENT][NEUTRAL] Mhm, that's what's on your claim, that's what we have.
[CUSTOMER][NEUTRAL] OK. And the initial you'll be sent to address or the pay to address is
[AGENT][NEUTRAL] It was sent to your billing address or to the billing address.
[CUSTOMER][NEUTRAL] Yeah, I have your
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's, I'm showing a different billing address.
[CUSTOMER][NEUTRAL] It's just [PII].
[AGENT][NEUTRAL] Give me the first one again.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] That is the one it was mailed to.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh-huh, let me document this call.
[CUSTOMER][NEUTRAL] And is it possible to fax the copy of your?
[AGENT][NEUTRAL] You can download the ELB from our website. It was already mailed along with the check, and so you can download the ELB from [PII]. Let me document this call and then we can move to the last policy number.
[CUSTOMER][POSITIVE] Secured.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Can you please repeat the website name again?
[AGENT][POSITIVE] I'm sorry. It's [PII]
[CUSTOMER][NEUTRAL] The web
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so you can't fax or mail, we have to get it from the website, am I right?
[AGENT][NEUTRAL] I didn't understand what you said.
[CUSTOMER][NEUTRAL] You can fax or mail, I have to get it from the website.
[AGENT][NEUTRAL] Yeah, you can download it from the from our website. It's already been, it's already been mailed to the that PO box number that you verified.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I'm pulling up claim number 1660278. What is the patient's name and date of birth for this one?
[CUSTOMER][NEUTRAL] Uh, OK. The member name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service is [PII] for $58.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, let me check. It's still loading.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's for [PII]. And the charge amount.
[CUSTOMER][NEUTRAL] $58 even.
[AGENT][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] OK, now I do not show this claim on file for for [PII].
[CUSTOMER][NEUTRAL] OK, so no claim on file, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, may I know the mailing address for submitting a claim?
[AGENT][NEUTRAL] Um, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] 8950.
[CUSTOMER][NEUTRAL] Attention to clients.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And the time the filing limit?
[AGENT][NEGATIVE] To submit a claim, there's no timely.
[CUSTOMER][NEUTRAL] Uh, there's no timely filing limit. May I know the member's policy that to date?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] The policy effective date is [PII]. The policy is active.
[CUSTOMER][NEUTRAL] [PII] to still active and you are the second insurance for this number, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the mode of submission you prefer to submit a claim?
[AGENT][NEUTRAL] OK, so we've provided the mailing address. There's a fax number as well, your choice.
[CUSTOMER][NEUTRAL] Yes, OK. May I have the fax number?
[AGENT][NEUTRAL] Or send it via pay ID I mean electronically via pay ID number.
[CUSTOMER][NEUTRAL] OK, may I need to be ready?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] And the fax number?
[AGENT][NEUTRAL] It's the same one that I gave you earlier [PII].
[CUSTOMER][NEUTRAL] OK. And the mode of submission you prefer is to fax and mail, am I right?
[AGENT][NEUTRAL] And then I gave you the payer ID number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Shall you move to the next number?
[AGENT][NEUTRAL] OK, and this is the last one. What is that policy number?
[CUSTOMER][NEUTRAL] OK. It's going to be 02538451 M as in Mike, L as in Larry, 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] My name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you, date of service to charge.
[CUSTOMER][NEUTRAL] Uh yeah, sure. The date of service is going to be [PII]. And this is for the bill amount of $1,362.50.
[AGENT][NEUTRAL] 15 or 50 cents?
[CUSTOMER][NEUTRAL] 1362.50.
[AGENT][NEUTRAL] 50, OK.
[AGENT][NEUTRAL] And is this a professional charge or facility?
[CUSTOMER][NEUTRAL] Facility?
[AGENT][NEUTRAL] And I do not see that claim on file for the facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you have any plan for professional?
[AGENT][NEUTRAL] OK, are you calling on the professional or the or the facility?
[CUSTOMER][NEUTRAL] Under the state of service and bill amount?
[CUSTOMER][NEUTRAL] Facility.
[AGENT][NEUTRAL] OK, I do not show that claim on file, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the member's policy effective date?
[AGENT][NEUTRAL] Policy effective date is [PII] currently active.
[CUSTOMER][NEUTRAL] And you are the 2nd insurance for this member, am I right?
[AGENT][POSITIVE] Correct. Correct.
[CUSTOMER][NEUTRAL] And the address, everything will be the same.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and I'm ready for the call reference number.
[AGENT][NEUTRAL] It's my name in today's date.
[CUSTOMER][POSITIVE] Oh, OK. And thank you so much for your Taia. Have a wonderful day.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day, [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too bye bye.