AccountId: 011433970860
ContactId: 4c184819-8f6f-45b4-b2bd-d8d209a06a3b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331100 ms
Total Talk Time (AGENT): 133143 ms
Total Talk Time (CUSTOMER): 80199 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/4c184819-8f6f-45b4-b2bd-d8d209a06a3b_20250219T15:49_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from private office and I'm looking for.
[AGENT][NEUTRAL] Sure, may I have a callback number just in case we get disconnected, Mr. [PII]?
[CUSTOMER][NEUTRAL] And callback number is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's SSM Health Endoscopy Center.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number for claim status, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, policy number is 02006183.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, patient name is [PII]. No name and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charge amount is $6200 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let me see if I can find this claim for you and that was for [PII], correct?
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] There's no claims on file for [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And member was activated service.
[AGENT][NEUTRAL] Mhm, let me check one more place, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I did find something. Let me see this 11 moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] What is the procedure code?
[CUSTOMER][NEUTRAL] Yeah, it is 453-85 and 43239.
[AGENT][NEUTRAL] OK, so yeah, this 11 moment, let me try to pull this EB one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so it looks like we only received um
[AGENT][NEUTRAL] A claim for the procedure called 45385. I don't see the other one listed.
[CUSTOMER][NEUTRAL] And how much is the bill amount?
[AGENT][NEUTRAL] Total bill $1,318.
[CUSTOMER][NEGATIVE] Oh, no, this is for the wrong facility.
[AGENT][NEUTRAL] Where is he?
[CUSTOMER][NEUTRAL] SSM Health endoscopy centers so.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, this then no, I don't have that one on file.
[CUSTOMER][NEUTRAL] OK. And the service is correct, it's 827 of 2024.
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK. So could you please verify the mailing address?
[AGENT][POSITIVE] Yes, the the effective date.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] And the policy effective date was [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] Oh, OK. And do you guys accept paper claims?
[AGENT][NEUTRAL] Yes, you can either fax it or mail it. Uh, do you need the fax number?
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] That number is [PII].
[CUSTOMER][NEUTRAL] It's [PII], correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And pay ID is 60801. Is it correct?
[AGENT][NEUTRAL] That is correct. Now, this is a secondary policy, so it needs to be the fax or mail, OK? We need the EOB attached to it, the primary EOB.
[CUSTOMER][NEUTRAL] OK, thank you. So could you please provide me your reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You need the spelling of my name?
[CUSTOMER][NEUTRAL] And is there any time you're planning to submit claim?
[AGENT][NEGATIVE] No timely filing limits.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] No, I'm done. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you