AccountId: 011433970860
ContactId: 40142564-18da-4453-8e7b-a0f9729c71a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368730 ms
Total Talk Time (AGENT): 137191 ms
Total Talk Time (CUSTOMER): 163068 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/40142564-18da-4453-8e7b-a0f9729c71a9_20250501T14:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling to verify eligibility and policy number for a patient.
[AGENT][NEUTRAL] OK, I can help you with both the eligibility and give you the policy number. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Sure, it is [PII]
[CUSTOMER][NEUTRAL] And call back is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] 180 Medical.
[AGENT][NEUTRAL] OK. And may I please get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh-huh. It's um [PII]. It's [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] I have a policy number. I have a policy number, but we received a letter stating you couldn't find this person is insurable.
[AGENT][NEUTRAL] OK. All right. What is the policy number that you have?
[CUSTOMER][NEUTRAL] I have 02392646.
[AGENT][NEUTRAL] OK, let me see, that sounds like a good policy number let me look and see.
[AGENT][NEUTRAL] Yeah, I'm pulling her up right now.
[AGENT][POSITIVE] And that is a good policy number. Uh, she does have an effective date of [PII] and her policy is active and current.
[CUSTOMER][NEUTRAL] OK then um is there any way you could tell me why we received this letter? It just says um.
[CUSTOMER][NEUTRAL] Oh well, it says [PII] [PII], her husband. Is he the policy holder?
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] That could be the issue.
[AGENT][NEUTRAL] That is the issue. He's not on the policy.
[CUSTOMER][NEUTRAL] Hm, I wonder why it's.
[CUSTOMER][NEUTRAL] OK, because the claim we sent says [PII], he's not listed as a policyholder in any way, shape, or form.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But then this letter comes back to us RE [PII], dear business partner, the enclosed information was submitted to APL. However, we're unable to locate the correct policy with the information provided.
[CUSTOMER][NEUTRAL] Which we provided the policy number and her name and date of birth.
[AGENT][NEUTRAL] Oh, OK. When did you get that letter?
[CUSTOMER][NEUTRAL] Because we, we sent over a claim.
[AGENT][NEUTRAL] When did you get that letter?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's dated [PII].
[CUSTOMER][NEUTRAL] It's we were sending a claim for a January data service.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] For [PII], is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, let me look and see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What what is the facility name that the claim would be under?
[CUSTOMER][NEUTRAL] 180 Medical.
[AGENT][NEUTRAL] 180 medical. OK. What was the date of service?
[CUSTOMER][NEUTRAL] Um, January, [PII].
[AGENT][NEUTRAL] For her.
[AGENT][NEUTRAL] OK, and what was the charge amount?
[CUSTOMER][NEUTRAL] $719.22.
[AGENT][NEUTRAL] Let me see if I can find the claim on my end over here.
[CUSTOMER][NEGATIVE] I'm not sure it was even processed based on the this letter. It seems like they didn't process it.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Yeah, I do not see that it has been processed.
[AGENT][NEUTRAL] Let me see if she had a previous policy that.
[CUSTOMER][NEUTRAL] You know what?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] This says interesting. OK, so there's a 2nd page that has kind of like a super blurry.
[CUSTOMER][NEUTRAL] Version
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Of the claim?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it says the insured name and patient's name is [PII], which is incorrect.
[AGENT][NEUTRAL] OK. That's why.
[CUSTOMER][NEUTRAL] But then it has
[CUSTOMER][NEUTRAL] It has our provider information from 180 Medical, but he is not our patient and this is not the CMS form we sent.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] How did his name get on this?
[AGENT][NEUTRAL] I am unsure about that but I can if you need to speak with the claims specialist.
[AGENT][NEUTRAL] They can talk to you and see what information they received, but I'm looking at it right now and I do not see the claim for Ms. [PII] has been sent in yet, which you can resubmit that we don't have a timely filing limit for claims, but if you would like to um see about the information that you have received, we can I can transfer you to a claims specialist and you could talk to somebody there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm trying to look at the claim here we send it electronically.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So somewhere there had to be a change in information.
[CUSTOMER][NEGATIVE] That doesn't make sense.
[CUSTOMER][NEUTRAL] OK, let me, let me work on it on my end and then if I need to I'll call back and speak with somebody but let me see if I can track down what's going on here.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, yes ma'am, yes ma'am, and always feel free to call back if you need to. You're very welcome. Is there anything else I can help with before we go?
[CUSTOMER][POSITIVE] Well, I appreciate you verifying that.
[CUSTOMER][POSITIVE] OK, that sounds great.
[CUSTOMER][POSITIVE] No, that's it. Thank you so much.
[AGENT][POSITIVE] All right. You're welcome, Ms. [PII]. You have a wonderful rest of your day and thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.