AccountId: 011433970860
ContactId: 424ab7f3-8ef2-419d-a27e-21f4d07c4abd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402609 ms
Total Talk Time (AGENT): 139929 ms
Total Talk Time (CUSTOMER): 114021 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/424ab7f3-8ef2-419d-a27e-21f4d07c4abd_20250115T22:05_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] calling for provider service to check on the claim status.
[AGENT][NEUTRAL] OK, I'll be more than happy to help you with the claim status. The phone was going in and out. Did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] OK, [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] And the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's 967-629.
[AGENT][POSITIVE] Thank you for that, Ms. [PII]. How many clients do you have in total today?
[CUSTOMER][NEUTRAL] 1
[AGENT][NEUTRAL] Alright, and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yeah, sure. It's uh [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] All right. So the bill amount is $4,978 even.
[AGENT][NEUTRAL] $4,978 even.
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, it's Memorial Home and Surgical Hospital.
[AGENT][NEUTRAL] I'm sorry, can you repeat that? You sounded far away at first.
[CUSTOMER][NEUTRAL] It's Memorial Home and Surgical Hospital.
[AGENT][NEUTRAL] OK, so we, we do not have a claim on file for your total bills or with that provider.
[CUSTOMER][NEUTRAL] Um, the total bill is $4,978 even and uh facility name, it's Memorial Home and Surgical Hospital first calling.
[CUSTOMER][NEUTRAL] Let me check.
[AGENT][NEUTRAL] Right, there is no claim on file?
[CUSTOMER][NEUTRAL] No claim on file.
[AGENT][NEUTRAL] But there's no timely filing limit. So if you'd like to file the claim, you still can.
[CUSTOMER][NEUTRAL] I wanna make sure uh if that member is active for the.
[CUSTOMER][NEUTRAL] Data service?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and this policy actually was not active. So the policy was effective from [PII], and there were no active policies after that with APL.
[CUSTOMER][NEUTRAL] Oh, hold on one second, effective.
[CUSTOMER][NEUTRAL] Remember it's effective on [PII].
[AGENT][NEUTRAL] Um, hold on one second. Let me go, hold on one moment.
[AGENT][NEUTRAL] The policy was active from [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] So [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Did you be able to provide me uh like uh is there any other active insurances available?
[AGENT][NEUTRAL] Um, there's no other active insurance with APL.
[CUSTOMER][NEUTRAL] All right. Do you have any uh proof for this one like.
[CUSTOMER][NEUTRAL] Eligibility proof or else did you able to send the copy of the UBR like that? Did you have the access?
[AGENT][NEUTRAL] Well, there's no explanation there's no explanation of benefits because the claim was never received, so nothing was processed and the only proof of eligibility that I can give you is the effective date and the termination date of the policy.
[CUSTOMER][NEUTRAL] I can provide you the fax number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so what is the call reference number.
[AGENT][NEUTRAL] OK, did you need the date again?
[AGENT][NEUTRAL] So there's no
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK, so there's no call reference number. Um you can use my name and today's date, and that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I mean just the name that's the call reference number, right?
[AGENT][NEUTRAL] Yes, my name and today's date.
[CUSTOMER][NEUTRAL] So I wanna make sure uh the claim is uh I mean the claim is got denied due to member is not an active for the data servers or else the claim is not on file.
[AGENT][NEUTRAL] There's no, the claim is not on file. There's no denial reason because we never received the claim.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] I will make sure the claim mailing address. Could you please provide me that?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] I find on please.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, what is the timely ailing limit?
[AGENT][NEUTRAL] Um, there's no timely filing limit as long as the policy was active on the data service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. And was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] That's my pleasure and thank you for your assistance. Have a great day. Bye bye. Thank you.
[AGENT][POSITIVE] You also, thanks for calling APO. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.