AccountId: 011433970860
ContactId: 5346b64d-45f1-4e15-a288-f03390e08c4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553080 ms
Total Talk Time (AGENT): 194080 ms
Total Talk Time (CUSTOMER): 128732 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/5346b64d-45f1-4e15-a288-f03390e08c4e_20250225T18:21_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the product office to check on the claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you and your name is again? I'm sorry.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what is the policy number, please?
[CUSTOMER][NEUTRAL] The member ID is 02049395 M as in Mike, L as in Lima 7.
[AGENT][NEUTRAL] OK. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes. The callback number is [PII].
[AGENT][NEUTRAL] I'm sorry, you were like a little fast again.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] The patient name is [PII].
[CUSTOMER][NEUTRAL] [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] I'm sorry, what is that patient's name because I don't see it. That's not the date of birth I'm showing for her.
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] Mhm. And the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, ma'am. That's not the date of birth I'm showing for this insured. Uh, you may want to contact them to verify the date of birth.
[CUSTOMER][NEUTRAL] Uh let me check it. OK. All right. Could you please check with the date of birth of?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that's what I'm showing. What was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is
[CUSTOMER][NEUTRAL] 760, I'm sorry, $34 even.
[AGENT][NEUTRAL] OK, and what was the balance after primary?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You said the date of service was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The balance deductible amount was.
[CUSTOMER][NEUTRAL] Let me check it.
[CUSTOMER][NEUTRAL] It's $488.18.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the name of the provider's office?
[CUSTOMER][NEUTRAL] Pediatrics Medical Group.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Says, uh, it looks like the claim processes information received from provider and complete cannot process until additional slash corrected information has been received from the provider.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Additional information you want, you want the additional information from the provider?
[AGENT][NEUTRAL] It says information received from the provider incomplete cannot process until additional slash corrected information received from the provider. Um, moment, look at the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Well, it looks like on the claim you gave a date of birth for that patient like you gave me earlier, which is not the date of birth. So we need to correct the claim with the correct date of birth for this patient.
[CUSTOMER][NEUTRAL] You want the correct date of birth?
[AGENT][NEUTRAL] You need to submit a claim, a corrected claim with the correct date of birth for this patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] I have one more data service. Could you please check?
[AGENT][NEUTRAL] OK. What is the, for the same patient?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What was the date of service and amount of charge?
[CUSTOMER][NEUTRAL] So the data services.
[CUSTOMER][NEUTRAL] The date of this [PII] and the bill amount is $560 even.
[AGENT][NEUTRAL] You said data service [PII]?
[CUSTOMER][NEUTRAL] Yes. And the amount is $760 even.
[AGENT][NEUTRAL] You said the total charge amount was $560?
[CUSTOMER][NEUTRAL] No, it's $760 a.
[CUSTOMER][NEUTRAL] So whether it's also want the correct date of birth?
[CUSTOMER][NEUTRAL] Patient's date of birth?
[AGENT][NEUTRAL] Correct, because you have um a different date of birth for the patient than what we have, so you need to submit a correct claim with the correct date of birth for the patient.
[CUSTOMER][NEUTRAL] So the [PII] is not the correct date of birth?
[AGENT][NEUTRAL] Ma'am, what's the patient's name that you're inquiring about?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what are you showing as her date of birth? Remember when you initially asked and I tell you that we have a different date of birth in the system. What date of birth are you showing for this patient, [PII]?
[CUSTOMER][NEUTRAL] Yeah, initially, I said [PII], you said it was different than I have said the date of birth of the subscriber, which is [PII].
[AGENT][NEUTRAL] OK, so the claim is for Ms. [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you have a copy of the claims in front of you? If you show on the claim where you have her date of birth, it's different than what you just verified of [PII].
[CUSTOMER][NEUTRAL] What I'm asking is whether the 7.
[CUSTOMER][NEUTRAL] The date of birth of [PII] is correct or not.
[AGENT][NEUTRAL] And what I'm explaining to you, what is the patient you're inquiring about? It's for [PII], correct? And what date of birth are you showing in your system for her date of birth?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] In our client form, the date of birth is, it shows [PII].
[AGENT][NEUTRAL] OK, which is not the date of birth we have in our system. You need to contact the patient to verify their date of birth and verify the correct patient if it's supposed to be for Ms. [PII] and submit the correct claim with her correct date of birth.
[CUSTOMER][NEUTRAL] OK. May I have the contact claim mailing address?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you must uh submit a letter stating the reason for the correction.
[CUSTOMER][NEUTRAL] May I have the call reference number?
[AGENT][NEUTRAL] We don't give reference numbers, you may use my name in today's date.
[CUSTOMER][NEUTRAL] May I have your name?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a great day.