AccountId: 011433970860
ContactId: 5658f6f0-2155-44ae-87f7-ffce1b603653
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 647960 ms
Total Talk Time (AGENT): 187119 ms
Total Talk Time (CUSTOMER): 232931 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/5658f6f0-2155-44ae-87f7-ffce1b603653_20250313T14:21_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, uh, my name is [PII]. I'm calling on behalf of North Shore Medical Center. I just wanna check, uh, 11 claim for one of our patients.
[AGENT][POSITIVE] Sure, I can check the time for you. Uh, [PII], can I get a good call back number from you first?
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, yeah, give me a second.
[CUSTOMER][NEUTRAL] Yeah, a call back number would be [PII]. No extension, no email.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Got it, thank you. And then did you have that policy number?
[CUSTOMER][NEUTRAL] Yes, I have 021-99664.
[AGENT][NEUTRAL] I'm sorry, that was uh 9961 664?
[CUSTOMER][NEUTRAL] Yes, 664.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Uh, what was the name and date of birth for the the insured?
[CUSTOMER][NEUTRAL] Yeah, um, the name will be [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK and then did you have that bill amount?
[CUSTOMER][NEUTRAL] Yes, uh, $24,557 with 16 cents.
[AGENT][POSITIVE] Got it thank you one moment please.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um I'm sorry, [PII], what did you say the name of the provider's office was?
[CUSTOMER][NEUTRAL] Yes, uh, North Shore Medical Center.
[AGENT][NEUTRAL] OK, um, do you have that tax ID by chance?
[CUSTOMER][NEUTRAL] Yes, uh, tax ID is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you so it does not look like we've received this claim [PII] I have one for that.
[AGENT][NEUTRAL] But it's um for a different provider.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me check something here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, well, um, because I have, um, a claim that is with Aetna, but the, uh, the patient have you as the second insurance, so I just wanna check for that if you have the coverage for that date of service.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, so this is, yes, and so this is a secondary medical policy, so we would need that primary EOB, um, and this is designed to help with co-pay, deductible and co-insurance after major medical pays. Um, it was effective during that date of service, uh, the effective date was [PII], and it is currently active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, let me check. OK, let me put that here. Just give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I got I I have a mailing address, fax number and a payer ID I can give you if you need any of those.
[CUSTOMER][NEUTRAL] Um, yes, uh, also,
[CUSTOMER][NEUTRAL] Give me a second. OK, uh, the claim that you have is with the same date of service and build amount that I give you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, no, different build amount.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, OK. OK.
[CUSTOMER][NEUTRAL] Mm, OK, give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, can you give me that claim number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, I didn't, we didn't receive this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the other claim do you have for the same uh date of service?
[AGENT][NEUTRAL] Yes, I'm unable to disclose any of that information as it's through a different provider.
[CUSTOMER][NEUTRAL] Mhm. OK. OK. Yeah, I understand. OK.
[CUSTOMER][NEUTRAL] OK, you told me that the policy was effective on [PII].
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][POSITIVE] Uh, [PII]. OK, perfect.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it's active correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, you have the group name and group number?
[AGENT][NEUTRAL] Uh yes, let me get that for you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that group number is.
[AGENT][NEUTRAL] 490.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the group name istro Ford.
[CUSTOMER][NEUTRAL] OK. Did your number tell me only 490, correct?
[AGENT][NEUTRAL] 25,490, yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] 25,490. OK. You know if it's a large group healthspan?
[AGENT][NEUTRAL] Um, for the this group I'm not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's self-funded or fully funded?
[AGENT][NEUTRAL] This through the year.
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that?
[AGENT][NEUTRAL] It's funded through the employer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm employing.
[CUSTOMER][NEUTRAL] OK, um, the patient is a policy holder or a dependent?
[AGENT][NEUTRAL] Yes, the policy holder.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy holder
[CUSTOMER][NEUTRAL] Um, also, can you tell me what type of policy?
[AGENT][NEUTRAL] A secondary medical policy.
[CUSTOMER][NEUTRAL] Sorry, can you repeat it?
[AGENT][NEUTRAL] Secondary medical policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] OK. Also can I have your member services phone number?
[AGENT][NEUTRAL] Um, for our phone number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, that's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, perfect. Also, can you check if there's any COP update?
[AGENT][NEUTRAL] If there was what kind of update? I'm sorry.
[CUSTOMER][NEUTRAL] Um, for the coordination of benefits.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Most recent I have is of January of this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Oh, OK. You have a claim mailing, uh, address?
[AGENT][NEUTRAL] Yes, I have a mailing address, fax number and a payer ID.
[CUSTOMER][NEUTRAL] OK. Can I have it, please?
[AGENT][NEUTRAL] Yes, uh, mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then did you need the fax number as well?
[CUSTOMER][NEUTRAL] Um, sorry?
[AGENT][NEUTRAL] Did you want the fax number and the payer ID?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and the pay ID?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][POSITIVE] OK, perfect. OK, well, can I have your name again, please?
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][POSITIVE] OK, perfect. Also, can I have a call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date, uh, so my last initial is [PII] Was there anything else I could help you with [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, that will be it.
[AGENT][POSITIVE] OK, well thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sorry, I don't know if you're still there. Uh, um, sorry, I just have one more question, sorry, um, so, um.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] We can submit the claim, correct?
[AGENT][NEGATIVE] Yeah, there's no timely filing limit.
[CUSTOMER][POSITIVE] OK, perfect. Thank you.
[AGENT][POSITIVE] Of course, yeah, definitely have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too bye bye bye