AccountId: 011433970860
ContactId: 56120cf2-bece-43d7-841e-31969f3f6ae4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 407010 ms
Total Talk Time (AGENT): 153269 ms
Total Talk Time (CUSTOMER): 146213 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/56120cf2-bece-43d7-841e-31969f3f6ae4_20250227T19:36_UTC.wav
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[AGENT][NEUTRAL] Good afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. My last name is um for my calling on behalf of provider's office to check the claim status.
[AGENT][NEUTRAL] OK, my, I'm sorry, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, your voice cut out. What, repeat the phone number, [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yes, OK. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] One dressing.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] 02473
[CUSTOMER][NEUTRAL] 403
[CUSTOMER][NEUTRAL] M for Mary, L for Leo.
[CUSTOMER][NEUTRAL] Number 8.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And in the information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient first name spells like uh [PII] and the last name spells like [PII] And the date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for her place.
[CUSTOMER][NEUTRAL] [PII] with the charge amount of $2,444 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do not have a claim on file for her at this time.
[AGENT][NEUTRAL] For that data service and that bill amount.
[AGENT][NEUTRAL] You did say it was [PII] for $2,444 is that correct? Yes sir, no claim on file.
[CUSTOMER][NEUTRAL] Uh, well
[CUSTOMER][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] We are submitted on [PII] on through paper.
[CUSTOMER][NEUTRAL] Uh, to the [PII] address.
[AGENT][NEUTRAL] What [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that is a very old.
[AGENT][NEUTRAL] Yes, sir, that is a very old address.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Our correct mailing address for claims is now [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what is the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes sir, and I don't know if you all submitted it before, but you will also need to include the primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] Oh no, we are, actually, we, no, we can't submit the both at the time.
[AGENT][NEUTRAL] OK, we have to have.
[CUSTOMER][NEUTRAL] After getting the denial only, we will submit that.
[AGENT][NEUTRAL] Yes sir, because we cannot review a claim, yes sir, we.
[CUSTOMER][NEUTRAL] Along with the claim, we can't send that.
[AGENT][NEUTRAL] We can't review a claim on this type of policy without the primary insurance company's explanation of benefits also it's required.
[CUSTOMER][NEUTRAL] Yeah, but we are, uh, you know, in my software, software, we can't send the boo at that time. We can send the through only through uh the like uh only the claim we can send that later uh after some time, we will follow up to the your insurance, then it will be denied or something, it will be there that. After that, we will send the uh your primary UV after getting denial only. Along with the claim, we can't uh provide the EOB.
[CUSTOMER][NEUTRAL] Of our software is designed as like that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What is the TFL for that time?
[AGENT][NEUTRAL] No timely filing limits?
[CUSTOMER][NEUTRAL] The terminal filing limit, OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] My name in today's state and then once we have received the claim and it's been processed by APL you we do have a portal that you can check claim status and also print the explanation of benefits for us by going to [PII].
[CUSTOMER][NEUTRAL] Yeah, got it, [PII].
[CUSTOMER][POSITIVE] OK, yeah, I think that's it from my end and thank you for assisting me.
[AGENT][POSITIVE] OK, well, you're very welcome [PII]. So again, thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And I have another question. is the member effective from?
[AGENT][NEUTRAL] For [PII] and the policy is currently active.
[AGENT][NEUTRAL] No term date.
[CUSTOMER][NEUTRAL] Is it uh [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Still active. I got it.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, [PII], I think that's it from mine. Thank you. Bye-bye.
[AGENT][POSITIVE] OK, well, you're very welcome and thank you again for calling APL. I hope you have a nice day.
[CUSTOMER][NEUTRAL] Yeah