AccountId: 011433970860
ContactId: 43af5641-e3b4-4511-92d7-7239857a1fc8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 581919 ms
Total Talk Time (AGENT): 143059 ms
Total Talk Time (CUSTOMER): 316961 ms
Interruptions: 10
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/43af5641-e3b4-4511-92d7-7239857a1fc8_20250320T20:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for the provider to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know if I can help you with the patient information and the provider information?
[AGENT][NEUTRAL] OK, thank you um [PII], can I please get your callback number?
[CUSTOMER][NEUTRAL] Sure. My callback number is [PII] and there is a direct line or extension.
[CUSTOMER][NEUTRAL] I'm.
[AGENT][NEUTRAL] Thank you and you're looking for claim status, is that correct?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK what is the patient's name, date of birth and policy number?
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Patient's member ID is 02100475.
[AGENT][NEUTRAL] OK, and um what is their name and date of birth?
[CUSTOMER][NEUTRAL] My, my name is [PII] and last name is [PII]. It's [PII]
[AGENT][NEUTRAL] And the date of birth, please?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Let me pull up this policy real quick.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And what's the date of service for [PII]?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] And the charge amount please?
[CUSTOMER][NEUTRAL] Um, just a moment.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It's $1300 even.
[AGENT][NEUTRAL] OK and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Mm, I don't have one.
[CUSTOMER][NEUTRAL] Charge amount only.
[AGENT][NEUTRAL] OK, and then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The facility name is Chatham Orthopedic Associates, PA.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look this claim up [PII] and I'll be right back.
[CUSTOMER][NEUTRAL] Yes, sure. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So looking on data service of [PII] for [PII] Living good, I do not find a claim on file for that date of service.
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] OK, so there is no claim on date of service.
[CUSTOMER][NEUTRAL] OK, so there is no claim on file for the date of service which I gave you, uh.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yes, which is [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And because of the bill amount is $1300 and that is the deductible to secondary $369.42. Can you find with the bill amount?
[AGENT][NEUTRAL] No ma'am, I don't have a claim on file for that date of service.
[CUSTOMER][POSITIVE] OK, thank you so much. And could you please give me the information about if the patient data of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can I give you what, ma'am?
[CUSTOMER][NEUTRAL] Is the patient active on date of service?
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the effective date of the policy is [PII] and the policy is active.
[CUSTOMER][POSITIVE] I'm so sorry. Ah, I'm so sorry. I couldn't hear you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm so sorry, but I couldn't hear you.
[AGENT][NEUTRAL] The effective date of the policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The effective date of the policy is [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just thought I.
[CUSTOMER][NEUTRAL] OK, are you primary or secondary?
[CUSTOMER][NEUTRAL] OK. When was the last coordination of benefits updated?
[AGENT][NEUTRAL] We are secondary.
[CUSTOMER][NEUTRAL] 9.
[AGENT][NEUTRAL] We don't do coordination of benefits.
[CUSTOMER][NEUTRAL] OK, what is the preferred mode of submission?
[AGENT][NEUTRAL] I'm sorry, what did you just ask me? Can you repeat that?
[CUSTOMER][NEUTRAL] OK, what is the preferred mode of submission?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, you can submit it electronically by fax or by mail, whatever is easiest for you.
[CUSTOMER][NEUTRAL] What is it if
[CUSTOMER][NEUTRAL] OK. Um, OK. Electronically fax uh mail. What is the fax number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And um OK, what is the claim submission timely filing limit?
[AGENT][NEUTRAL] We don't have one.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, and what is the claim submission mailing address?
[AGENT][NEUTRAL] It is PO [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, it's [PII], right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] Thank you so much and um.
[CUSTOMER][NEUTRAL] And what is the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much for the information and could you please give me the call reference number?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] OK. The call reference number will be [PII] and today's date is [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Thank you so much, [PII], and thank you so much for the information. I really appreciate your patience and have a good day. Bye-bye. Take care.
[AGENT][POSITIVE] Bye bye, [PII]. You take care too, and thank you for calling APL.