AccountId: 011433970860
ContactId: 3a835f9a-b0a9-4bd4-bfdb-09fbd641c588
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1336560 ms
Total Talk Time (AGENT): 245942 ms
Total Talk Time (CUSTOMER): 369872 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/3a835f9a-b0a9-4bd4-bfdb-09fbd641c588_20250429T13:55_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider office to check on the claim status.
[AGENT][NEUTRAL] And yes, Ms. [PII], can I assist you with claim status. How many claims do you have today?
[CUSTOMER][NEUTRAL] Uh, today, I have 5 claims.
[AGENT][NEUTRAL] OK. I'm gonna try my best to do all 5, but um we'll see, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, callback number is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] What's the first policy number?
[CUSTOMER][NEUTRAL] Policy number is, uh, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. The member ID is 148427 M as in Mike, L as in Lima, 7.
[AGENT][NEUTRAL] That's not enough number. Repeat the number one more time.
[CUSTOMER][NEUTRAL] 148427. M as in Mike, L as in Lima, 7.
[AGENT][NEGATIVE] Not even
[AGENT][NEUTRAL] Not enough numbers. Do you have the copy of the card?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, just a moment. I'll check for that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, I'm able, I have a card here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Member ID here is uh
[CUSTOMER][NEUTRAL] just
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, it's uh showing the same in hospital benefit uh number is 1484271 M as in Mike, L as in Lima 7. And uh for outpatient benefit, uh cert number is 1484271 M as in Mike, L as in Lima 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One.
[AGENT][NEUTRAL] Yes, I got it. It was, you were missing the one. Yeah, you were missing the one. OK, what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Only this do I have here.
[CUSTOMER][NEUTRAL] Uh, member
[CUSTOMER][NEUTRAL] Name is uh [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh date of service is [PII] and the bill amount is $807 even.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] That was [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] One moment and how much is the total charge?
[CUSTOMER][NEUTRAL] $807.
[AGENT][NEUTRAL] 807. What's the procedure called?
[CUSTOMER][NEUTRAL] Procedure code is 74177.
[AGENT][NEUTRAL] The claim is not on file.
[CUSTOMER][NEUTRAL] Claim note on. Here, I have a claim number. Shall I provide you with the claim number?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK. OK. No, no, that is not the claim number. Sorry.
[CUSTOMER][NEUTRAL] Uh, and the member is active for the date of service.
[AGENT][NEUTRAL] Not under the policy you was giving me. He has another policy, Miss [PII].
[CUSTOMER][NEUTRAL] So, as for you, member is uh not have this uh AmeriHealth, uh.
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] American Public Life Insurance.
[AGENT][NEGATIVE] We have not received the claim.
[CUSTOMER][NEUTRAL] But it is active for the date of service.
[AGENT][NEUTRAL] Again, under the new policy, he is.
[CUSTOMER][NEUTRAL] OK, on the new policy.
[CUSTOMER][NEUTRAL] Uh, can you provide me the policy ID number?
[AGENT][NEUTRAL] Mhm. One moment.
[AGENT][NEUTRAL] OK, the policy number is 0230.
[AGENT][NEUTRAL] 4093.
[CUSTOMER][NEUTRAL] 02304093. Correct?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Uh, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, as per your system, uh, for this member, uh, which is primary insurance?
[AGENT][NEUTRAL] No, we're secondary insurance.
[CUSTOMER][NEUTRAL] OK, uh, may I know which is primary?
[AGENT][NEUTRAL] Let me see if I have that information. One moment.
[AGENT][NEUTRAL] United Healthcare.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, as per checking here, uh, the United Healthcare has been, uh, allowed and, uh, it, uh, applied towards deductible.
[CUSTOMER][NEUTRAL] And it is crossover to the American Public license.
[AGENT][NEUTRAL] We have not received it, Ms. [PII]. We have not received the claim. You need to send us the claim, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm ready for the next policy.
[CUSTOMER][NEUTRAL] OK. I will move to the next patient and the member ID is uh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] to
[CUSTOMER][NEUTRAL] It is 1066574.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Member name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Date of service is uh [PII].
[AGENT][NEUTRAL] How much is the total charge of the claim?
[CUSTOMER][NEUTRAL] Uh, $807 even.
[AGENT][NEUTRAL] We have not received that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh may I know the patient policy effective date and the term date?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Effective date is [PII]. It is active at the moment.
[CUSTOMER][NEUTRAL] And uh this is also is uh as a pri a secondary claim.
[AGENT][POSITIVE] Secondary, mhm correct.
[CUSTOMER][NEUTRAL] OK. And uh may I know the primary?
[AGENT][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Florida Bloom.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, here I have a claim number. Shall I provide you the claim number?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It's 7, H as in Hotel, B as in Bravo, D as in doctor.
[AGENT][NEUTRAL] That's not our claim.
[AGENT][NEUTRAL] Miss Miss [PII], that's not our claim. We don't have letters in our claim numbers.
[CUSTOMER][NEUTRAL] OK. Uh it is 10242482849-10.
[AGENT][NEUTRAL] That's not.
[AGENT][NEUTRAL] Claim is not on file, you just need to submit the claim.
[CUSTOMER][NEUTRAL] This is not your claim.
[CUSTOMER][NEUTRAL] OK. Uh, ma[PII] I know the timely filing limit?
[AGENT][NEUTRAL] We don't have timely funding limits.
[CUSTOMER][NEUTRAL] And uh can you please provide me the claim mailing address?
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Can you spell that?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh may I know the payer ID?
[AGENT][NEUTRAL] And this one is a secondary, so we need to claim either fax or mail.
[CUSTOMER][NEUTRAL] OK. And also, can you please provide me the fax number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] Uh, shall I book the next patient?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, member ID is 1071078.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] M
[CUSTOMER][NEUTRAL] Member name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII], and the bill amount is $336 even.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] There's no claims on file for that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh is this uh as a secondary, right? This payer is actually as a secondary.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know the patient policy effective date?
[AGENT][NEUTRAL] OK, we have [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Shall we move to the next patient?
[AGENT][NEUTRAL] Yes, go ahead.
[CUSTOMER][NEUTRAL] Uh, member ID is 0188.
[CUSTOMER][NEUTRAL] 0925
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] And the name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII]. And the total bill amount is $3550 even.
[AGENT][NEUTRAL] That it's [PII], correct?
[CUSTOMER][NEUTRAL] Sorry, it's uh [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] One moment
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And how much was it for?
[CUSTOMER][NEUTRAL] $3550.
[AGENT][NEUTRAL] Do you know what's the procedure code on this one?
[CUSTOMER][NEUTRAL] It's 44,970.
[AGENT][NEUTRAL] One moment, let me see if this is.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, we have not received that claim.
[CUSTOMER][NEUTRAL] Just
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, may I know the patient policy effective date?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] and it is active.
[CUSTOMER][NEUTRAL] OK. And that these claims uh need to be submitted uh electronically, right?
[AGENT][NEUTRAL] No, by, by fax or mail.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, should I move to the last patient?
[AGENT][NEUTRAL] Was the policy number?
[CUSTOMER][NEUTRAL] Member ID is D as in Delta 43301781.
[AGENT][NEUTRAL] That's not our number.
[CUSTOMER][NEUTRAL] Uh, just a moment. I will check whether I have an insurance card.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] They may
[CUSTOMER][NEUTRAL] Uh, I don't have my insurance card.
[AGENT][NEUTRAL] Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] OK. Can you please uh verify with the member name?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] What's the spelling of the last name?
[CUSTOMER][NEUTRAL] Last name is [PII]. That is uh [PII].
[CUSTOMER][NEUTRAL] And the first name is [PII].
[AGENT][NEUTRAL] What's the spelling?
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] No, I don't have a [PII] with that date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and, uh, can you please spell your name?
[AGENT][NEUTRAL] Sure, that's all. That's [PII]. That's initial [PII].
[CUSTOMER][NEUTRAL] OK. Uh, and, uh, can you just provide me the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's name.
[CUSTOMER][POSITIVE] OK. Thank you, sir. Thank you for the information about the claims and have a wonderful day.
[AGENT][POSITIVE] You sir. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] No