AccountId: 011433970860
ContactId: 3cd04e65-03c4-4dc5-adac-0febb135aef8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395220 ms
Total Talk Time (AGENT): 94250 ms
Total Talk Time (CUSTOMER): 116639 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/3cd04e65-03c4-4dc5-adac-0febb135aef8_20250411T17:14_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. That's [PII] calling from provider office for the claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And patient, uh, policy number?
[CUSTOMER][NEUTRAL] OK. Policy number I have is
[CUSTOMER][NEUTRAL] 1420528 M as Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII]. Date of birth will be [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] of services [PII].
[CUSTOMER][NEUTRAL] Total bill amount $501.
[CUSTOMER][NEUTRAL] one
[AGENT][NEUTRAL] OK, it looks like um we received it 3 times. Let me see which, which one is right.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 5
[AGENT][NEUTRAL] OK, looks like we needed an explanation of benefits. Let me see if we got that.
[CUSTOMER][NEUTRAL] We have already mailed you through.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, it looks like we're still requesting the explanation of benefits. Do you know when that was sent?
[CUSTOMER][NEUTRAL] Uh, let me, I, I'll be seeing like one specific date. Can you just check for any document you have received on that particular date?
[AGENT][NEGATIVE] Yeah, we have the claim on file, but it's denied for we don't have the explanation of benefits.
[CUSTOMER][NEUTRAL] OK, they did.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, you need the explanation of benefits and uh we have already submitted you on 27227 27 actually. There is like no any primary will be information listed over there.
[AGENT][NEUTRAL] Um, let me pull up what we received.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, no, it does not look like there's an explanation of benefits attached. There's a remittance, but that's not the EOB.
[AGENT][NEUTRAL] We're looking for the explanation of benefits from the primary insurance carrier, so we have not received that.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] And uh when was the claim received to you, like final claim?
[AGENT][NEUTRAL] [PII] and denied on [PII].
[CUSTOMER][NEUTRAL] And then airport I may like uh primary will be requested.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And uh according to who's the primary insurance?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Uh, looks like we have Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] OK. Do you have any other information like uh member ID eligibility for this member for the BCBS?
[AGENT][NEUTRAL] I don't.
[AGENT][NEUTRAL] No, I don't.
[CUSTOMER][NEUTRAL] OK, I got it. And uh I need your name.
[AGENT][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh can I have the mailing address to do the appeals information?
[AGENT][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, thanks for the correction and uh do you have fax number?
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] And what is the timely filing limit to submit this information like uh for any appeals?
[AGENT][NEUTRAL] For appeals, it's 180 days from the process date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Got it. And uh for this primary, it will be, can we send the information through this inform uh through this mailing address that you provided me?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And then that's it. Thank you so much. I need the call reference number to end the call.
[AGENT][NEUTRAL] Uh, it's just my name and today's date.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] OK. That's it. Thank you so much for this all the information. Bye-bye. Have a great day.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a great day.