AccountId: 011433970860
ContactId: 466070b6-66cd-4e2f-8a54-e514afb95f37
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 628500 ms
Total Talk Time (AGENT): 154286 ms
Total Talk Time (CUSTOMER): 247352 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/466070b6-66cd-4e2f-8a54-e514afb95f37_20250424T19:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] A is.
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from provider's office to look up on the claim status.
[CUSTOMER][NEUTRAL] And this call will be recorded for quality and training purposes.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, sure. That's going to be [PII]. And it's a direct line. And uh your name, please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII]. Hi [PII].
[AGENT][NEUTRAL] And what's the policy number of the patient?
[CUSTOMER][NEUTRAL] It's uh 02295896 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII] I uh it's IQ Edo.
[CUSTOMER][NEUTRAL] It's like [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] And the date of birth is, it's [PII].
[AGENT][NEUTRAL] OK, and do you have the date of service and bill charges?
[CUSTOMER][NEUTRAL] Yeah. That's going to be [PII].
[CUSTOMER][NEUTRAL] It's 2023 claim. And the bill amount is $2,461 even.
[AGENT][NEUTRAL] Um, it looks like we received that claim on 12-16-2024.
[AGENT][NEUTRAL] That was processed 12-18-2024.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, it looks like we're needing a primary explanation of benefits.
[CUSTOMER][NEUTRAL] OK. How to send that, uh, do we need to send it to mailing address or through fax?
[AGENT][NEUTRAL] Uh, fax would be fine.
[CUSTOMER][NEUTRAL] Oh, can I get the fax number, please?
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And uh do we need to send the primary UBI claim form, both?
[AGENT][NEUTRAL] No, you can just send the primary explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Thank you so much. And is there any attention for this uh facts?
[AGENT][NEUTRAL] No, it'll go straight to our claims department.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][NEUTRAL] And just one moment, what is the claim number?
[AGENT][NEUTRAL] Claim number is 3,542,300.
[CUSTOMER][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] OK, and uh, uh, what is the TSL to submit this primary EOB?
[AGENT][NEUTRAL] Um, there's no time limit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, no time limit. OK.
[CUSTOMER][NEUTRAL] And [PII], what is the call reference number?
[AGENT][NEUTRAL] Uh, call reference number will be my name, [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK. And uh how many claims will you assist in this call?
[AGENT][NEUTRAL] Um, how many do you have?
[CUSTOMER][NEUTRAL] I have a mode 2.
[AGENT][NEUTRAL] OK. 2 more.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yeah, that's fine. Hold on one minute.
[CUSTOMER][NEUTRAL] For different patients.
[AGENT][NEUTRAL] OK, hold on just a second.
[CUSTOMER][NEUTRAL] Fine.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well I didn't.
[AGENT][NEUTRAL] OK, and I'm ready for the next uh policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's going to be 01678152 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK date of service and build them out.
[CUSTOMER][NEUTRAL] It's for [PII] with the bill amount of
[CUSTOMER][NEUTRAL] It's $1,752 even.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, looks like we received that on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, receive 4 29 24 process 51 2024 and look.
[AGENT][NEUTRAL] Like we requested the explanation of benefits, but I have another claim. Let me check it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, received another claim 619-2024, process 6/21.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Duplicate.
[AGENT][NEUTRAL] Let me pull up the claim because it says it was a duplicate but.
[CUSTOMER][NEUTRAL] It was a duplicate.
[AGENT][NEUTRAL] Let me see if the EOB is attached.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it doesn't look like we received the EOB. Do you have any date of when you sent it?
[CUSTOMER][NEGATIVE] Uh, actually, we have not sent it, uh, by mistakenly, it was submitted twice.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do we need to send the EOB first to process the claim?
[AGENT][POSITIVE] Yes, we do need the EOB, yes.
[CUSTOMER][NEUTRAL] Sure, to the same fax number?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And uh can I get the original uh claim number?
[CUSTOMER][NEUTRAL] For the first one,
[AGENT][NEUTRAL] Yes, that claim number is 3472185.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you so much for that. And uh just one moment, we'll move to the next one.
[CUSTOMER][POSITIVE] I'm ready with the next member ID.
[AGENT][POSITIVE] OK, I will. I'm ready too.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] It's 182-583-7.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII]. The first name is like [PII]
[CUSTOMER][NEUTRAL] And the middle initial is [PII] and the last name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] OK, and the date of service and build them out?
[CUSTOMER][NEUTRAL] Yeah, it's for [PII] with the bill amount of $2,583 even.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It looks like that was received on [PII].
[AGENT][NEUTRAL] Uh, process 35 [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] I mean
[AGENT][POSITIVE] Maximum payable for the occurrence was met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So this has a per occurrence dollar benefit and then and per occurrence is in a 90 day period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So the the dollar amount was met for this occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, it's then it's not, I mean, the max benefits exhausted for the member.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. Um.
[CUSTOMER][NEUTRAL] Is there any providers discount on this?
[AGENT][NEUTRAL] Um, no, this is a secondary policy, so.
[AGENT][NEUTRAL] We don't have networks or anything.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Fine.
[CUSTOMER][POSITIVE] Thank you so much for the information now.
[CUSTOMER][POSITIVE] Have a good day.
[AGENT][POSITIVE] OK, thanks for calling APLU as well.
[CUSTOMER][POSITIVE] Yeah, thank you, [PII].
[AGENT][POSITIVE] Thank you. Bye.
[CUSTOMER][NEUTRAL] 237.