AccountId: 011433970860
ContactId: 536936ad-6083-469d-bb3d-b7662798ec7c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 421750 ms
Total Talk Time (AGENT): 159231 ms
Total Talk Time (CUSTOMER): 97986 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/536936ad-6083-469d-bb3d-b7662798ec7c_20250116T22:22_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from the provider's office to check on the claim status.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with claim status today, Ms. [PII], and may I have a good callback number for you please?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Alright, and then the policy number?
[CUSTOMER][NEUTRAL] Yes policy number will be 01847993 M as in Mary L as in Lima 7.
[AGENT][POSITIVE] Perfect and you said.
[CUSTOMER][POSITIVE] Perfect
[AGENT][NEUTRAL] 7993 at the end, is that correct?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] 7993 S.
[AGENT][POSITIVE] OK, perfect, thank you.
[AGENT][NEUTRAL] Just one moment while I pull up that.
[AGENT][NEUTRAL] Insured for you.
[CUSTOMER][NEUTRAL] She
[AGENT][NEUTRAL] And that's the member's policy number?
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] She.
[AGENT][NEUTRAL] Um, what is your insured's name, my friend?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEGATIVE] Yeah. Unfortunately, I'm not having.
[AGENT][NEUTRAL] Anyone come up under that, but I can try searching for her by her first and last name if you'd like.
[CUSTOMER][NEUTRAL] Yeah, so, uh, I do have the claim number. Uh, if it's required, I can give you that.
[AGENT][POSITIVE] Yeah, can you give me that claim number? That'd be great.
[CUSTOMER][NEUTRAL] Yeah, it's 3441658.
[AGENT][NEUTRAL] OK, sorry. 3441658.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. um.
[AGENT][POSITIVE] Perfect. And can you verify [PII]'s date of birth for me?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][POSITIVE] Thank you. I really appreciate that. I do see her here. I think maybe I took the number down wrong cause I started it with 35 on the policy number and it just started with 18, so I'm sorry about that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But I do see that policy here for you. It looks like that claim was just denied because it was pending um an explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK. So, when did you receive this client?
[AGENT][NEUTRAL] Yeah, it looks like let me go back um.
[AGENT][POSITIVE] I'm so sorry. I'm just all thumbs today.
[AGENT][NEUTRAL] It looks like we received the claim [PII]. Um, we processed it on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, upon checking, we have already sent the primary AUB to you. So can you please check either you do have received it or not?
[AGENT][POSITIVE] Yeah, absolutely.
[AGENT][NEUTRAL] Alright, it looks like the only claim I have on file was that original one, so it does not look like we received the primary EOB.
[CUSTOMER][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] Uh, yeah, we have sent it through fax, and so you haven't received it?
[AGENT][NEUTRAL] No, I'm sorry.
[CUSTOMER][NEUTRAL] OK. Uh, so, also, may I know through which, uh, what is the preferable mode to send the primary EOP?
[AGENT][NEUTRAL] Yeah, absolutely, um, I don't know if you can send it through the electronic payer ID, um, but we have that it might be quick, um, our number there is 60801 and then typically the next best method would be that fax [PII].
[AGENT][NEUTRAL] Um, we also accept it via mail. It does take a little bit longer, but I can give you our mailing address if you need it.
[CUSTOMER][NEUTRAL] Yes, so before that, just give me a minute and uh
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] So, the, oh, just give me a minute. If you don't mind, could you repeat me one more time the fax number?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Got it. And what's the mailing address?
[AGENT][NEUTRAL] Mailing address here is going to be [PII], um, and that's going to be in [PII].
[AGENT][NEUTRAL] Our zip code here is [PII].
[CUSTOMER][NEUTRAL] OK. And what's the time depending limit?
[AGENT][NEUTRAL] Oh yeah, um, we don't have a timely filing limit. You're welcome to submit that at any time.
[CUSTOMER][NEUTRAL] OK. And may I get the claim number, please?
[AGENT][NEUTRAL] Oh yeah, uh, it's the same one you gave me, the 344-1658.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. And what's your call reference number?
[AGENT][NEUTRAL] Call reference number is gonna be my name, [PII] last name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for that information. Have a great day. Take care. Bye bye.
[AGENT][POSITIVE] My pleasure thank you bye bye.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Mhm.