AccountId: 011433970860
ContactId: 535a847a-d3c0-4c5b-8bad-ee5ad5f47b7e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321980 ms
Total Talk Time (AGENT): 127680 ms
Total Talk Time (CUSTOMER): 169263 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/535a847a-d3c0-4c5b-8bad-ee5ad5f47b7e_20250319T20:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes [PII], I was calling to check the status of a claim.
[AGENT][NEUTRAL] All right, I can help you. Um, what's your name?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] That is 01823419.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] I'm sorry [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Like I I was like.
[CUSTOMER][NEUTRAL] Yeah, you say it so often and all of a sudden you're like uh.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Totally understand.
[AGENT][NEUTRAL] Um, [PII], what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] Thank you and you said we're checking claim status for you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the date of service and the charge?
[CUSTOMER][NEUTRAL] It is uh [PII]. The charge is 20185.
[AGENT][NEUTRAL] What type of service was this for?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] I know it, but
[CUSTOMER][NEUTRAL] It was for um physical therapy.
[AGENT][NEUTRAL] OK, because it sounds a little low for an inpatient claim, so PT OK.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Because
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And we've not heard anything back so it's possible that maybe a claim wasn't received.
[AGENT][NEUTRAL] I show one that is pending, but I will tell you that the policy.
[CUSTOMER][NEUTRAL] Third party
[CUSTOMER][NEUTRAL] Like a workers' comp.
[AGENT][NEUTRAL] Is no longer active as of [PII], but I do show a claim that's pending. Let me take a look and see if this is.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, from your, um, office.
[CUSTOMER][NEUTRAL] OK, so she, she, um she wasn't effective in December, is that what you're saying?
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Her policy lapsed [PII]. That's before your effective date of this uh claim. Just one moment.
[CUSTOMER][NEUTRAL] Is that correct? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did she pick it back up or is it just termed?
[AGENT][NEUTRAL] No active coverage with us at this time?
[CUSTOMER][NEUTRAL] They're looking to see OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] Yeah, so see she fell in the restroom at the door.
[AGENT][NEUTRAL] I'm not showing the data service this is for for from someone else, so I don't show your claim on file.
[CUSTOMER][NEUTRAL] OK, OK, um, well that helped anyway that she doesn't have, she's not active anyway, so right, so there's no reason to, to, to bill it really, you know, I was trying to get log into your system and it it I guess because she didn't, I didn't have the account number that's why I probably didn't give me a new user.
[AGENT][NEUTRAL] At least you know, right?
[AGENT][NEUTRAL] Right, and the fact that her policy is not active, but yes, you do, you would need to have her policy I mean not necessarily her policy number, um, when you tried to log in, what happened?
[CUSTOMER][NEUTRAL] You know you have to, yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It just says that the the no user found by that name and I guess probably because the um it says no user was found with the information that was entered so I'm assuming it's because the claim it says patient account number which would be the claim number since claim I mean since the claim number claim wasn't received and there wouldn't be a number on file.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Uh, incorrect. The patient account number is gonna be the number was it a a UBL4 form or a CMS 15004?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] UBO4.
[AGENT][NEUTRAL] So it's the patient account number on that claim in box I think 3A.
[CUSTOMER][NEUTRAL] Yeah, because that's
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 3 A.
[AGENT][NEUTRAL] So not the policy number, the patient account number is the number that's assigned by the hospital.
[CUSTOMER][NEUTRAL] Huh
[CUSTOMER][NEGATIVE] Well that's what I was putting in like the the the number that we were billing with her account number that's what I was putting in, but it didn't work anyway, so.
[AGENT][NEUTRAL] What were you entering? What number?
[CUSTOMER][NEUTRAL] Um, I entered in 461-859-501.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and it and it's not on file so that's probably why you got the message because we've not received it yet.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, OK, but I mean there's no reason for me to send it really since she doesn't have it, um.
[AGENT][NEUTRAL] Unless, unless you want an EOB of denial.
[CUSTOMER][NEUTRAL] Right, um, yeah I could probably do that too. uh, where would I send it to? Well, I think I have it on her card. I can just mail it out. Can I fax it?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You can fax it. I'll give you that number. Let me know when you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] It's 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942-3 attention claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then a call reference number please.
[AGENT][NEUTRAL] It's gonna be my name in today's date, [PII], and then first [PII] of my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and today's date?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you very much. I appreciate your time and you have a great rest of your day.
[AGENT][NEUTRAL] Oh, you're
[AGENT][POSITIVE] You too and thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] Mhm you too bye.