AccountId: 011433970860
ContactId: 57323dbc-e9e1-42b8-939b-2a08af36b208
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 595359 ms
Total Talk Time (AGENT): 124249 ms
Total Talk Time (CUSTOMER): 264864 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/57323dbc-e9e1-42b8-939b-2a08af36b208_20250513T17:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, could you spell your name again? I, I didn't catch in the beginning. My big apologize.
[AGENT][NEUTRAL] Yes, it's [PII]
[AGENT][NEUTRAL] And what is your name?
[CUSTOMER][NEUTRAL] T [PII] I sorry. uh, by the way, my name is [PII] and uh first name of my last name is [PII]. I'm calling from provider office regarding a claim status. Could you help me with the same?
[AGENT][POSITIVE] Yes [PII], I can help you. May I please get your call back number so I can help you with that claim status?
[CUSTOMER][NEUTRAL] Yeah, of course, uh the good callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] with the [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, the patient is.
[CUSTOMER][NEUTRAL] [PII] and the date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the insert ID.
[CUSTOMER][NEUTRAL] is 1451702 M as in Mary, L as in Lima, and the number 8.
[AGENT][POSITIVE] Thank you. I appreciate you giving me that information, [PII], and may I have the data service and the charge amount?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That is [PII].
[CUSTOMER][NEUTRAL] And the total charge amount, 10,100.
[CUSTOMER][NEUTRAL] $73.67.
[AGENT][NEUTRAL] And the charges after the primary insurance paid?
[CUSTOMER][NEUTRAL] Yes, the primary is United Healthcare, and they already processed and paid the claim.
[AGENT][NEUTRAL] OK, and what is the balance after the primary paid?
[CUSTOMER][NEUTRAL] The primary paid uh.
[CUSTOMER][NEUTRAL] Let me check primary paid the amount.
[CUSTOMER][NEUTRAL] $69.01 and applied the deductible for $1,563. And the coinsurance, $29 total balance.
[CUSTOMER][NEUTRAL] Transfer to secondary $4592.57.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, and that's the balance after the primary paid?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's 45,000.
[CUSTOMER][NEUTRAL] Not 45,000. It's $4592.57 even.
[AGENT][NEUTRAL] OK, thank you very much. And then may I have the name of the facility you're calling from, [PII]?
[CUSTOMER][NEUTRAL] Yes, the facility is
[CUSTOMER][NEGATIVE] I sent sent uh means uh my mistake that is endoscopy surgery center.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. All right, I'm gonna put you on a quick hold while I look up this claim for us and I'll be right back, sir.
[CUSTOMER][NEUTRAL] Sure. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So looking on data service of [PII], I do not find a claim on file for the amount that you have given me.
[CUSTOMER][NEUTRAL] Oh. Can you also verify uh if the policy is active on the date of service?
[AGENT][NEUTRAL] Uh, yes, sir. The policy effective date is [PII] and the policy is still active and current.
[CUSTOMER][NEUTRAL] OK, let me check further what is the way of submission to this claim. Uh, let me confirm the address, uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] January
[CUSTOMER][NEUTRAL] On this screen.
[CUSTOMER][NEUTRAL] Just allow me a moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, as you can see here.
[CUSTOMER][NEUTRAL] It's this claim was billed via paper.
[CUSTOMER][NEUTRAL] And the claim address that we have used that is.
[CUSTOMER][NEUTRAL] PO Box 925.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] MS 39205, is that correct?
[AGENT][NEUTRAL] No sir, that's not correct. Let me give you the good claims address.
[AGENT][NEUTRAL] You just let me know when you're ready.
[CUSTOMER][POSITIVE] Yeah. I'm ready.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] The claims address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] And if.
[CUSTOMER][NEUTRAL] Let me repeat and please confirm. I got it as [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] City and here I missed the state name.
[AGENT][NEUTRAL] The state name is [PII].
[CUSTOMER][NEUTRAL] What is the short form for [PII]?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Thank you. And the zip code is [PII]?
[AGENT][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] We.
[CUSTOMER][NEUTRAL] [PII]. Thank you for making the correction and do you have any electronic payer ID that we can submit directly as electronically?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, um, it is 60801.
[CUSTOMER][NEUTRAL] You can
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 60801. And what is the timely filing for submit an a claim?
[AGENT][NEGATIVE] We do not have a timely filing limit.
[CUSTOMER][NEGATIVE] Oh dear.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you for your assistance and please provide me the reference for this conversation.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you, [PII], for your assistance and that's all for the day and you have a lovely day.
[AGENT][POSITIVE] Thank you very much, [PII]. I hope you have a wonderful day and thanks for calling APL. You take care, sir.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] That same dream