AccountId: 011433970860
ContactId: 5a763ec0-830d-468c-ab56-2376ee099a5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 730460 ms
Total Talk Time (AGENT): 166211 ms
Total Talk Time (CUSTOMER): 318132 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/5a763ec0-830d-468c-ab56-2376ee099a5f_20250409T17:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, [PII]. Yeah. Good afternoon. I'm [PII] calling from every Healthcare regarding claim status.
[AGENT][POSITIVE] All right. I'm happy to check on a claim for you today. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Oh yeah. Um, uh, so, yes. Uh, 01861678.
[AGENT][POSITIVE] Thank you for that. And then if I can get a good callback number.
[CUSTOMER][NEUTRAL] Yes. Uh, callback number would be [PII]. That will be the direct line.
[AGENT][NEUTRAL] Thank you for that. And then what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Oh yeah, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] One
[AGENT][NEUTRAL] Let me repeat back this policy number. I copied down 01861678.
[CUSTOMER][NEUTRAL] Um, no, it's a different one.
[CUSTOMER][NEUTRAL] 01057608.
[AGENT][NEUTRAL] And what was the date of birth again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for that and then you service?
[CUSTOMER][NEUTRAL] Number 22, 2024 and be the month $478.74.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] Not showing any claims on file for [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 4 $78 70s. There's no claim, right?
[AGENT][NEUTRAL] No claim, correct.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Let me check why it's gonna be.
[CUSTOMER][NEUTRAL] Mm, can you check that the patient is effective for date of service?
[AGENT][NEUTRAL] Yes, they are. Patient's policy effective date is [PII] still active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] Let me check if the PO box is in wrong gonna away. We built to [PII]. Is that the correct one, OK?
[AGENT][NEGATIVE] No, it is not.
[CUSTOMER][NEUTRAL] Oh, that's the issue.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. What's the correct one.
[AGENT][NEUTRAL] Uh, so Plains mailing address is going to be [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, patient ID is correct, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] [PII] yes.
[CUSTOMER][NEUTRAL] Hm, OK, then I will resubmit the claim. What's the time filing for initial submission.
[AGENT][NEGATIVE] No time in the filing.
[CUSTOMER][NEUTRAL] Yes, OK. Uh, what's your name? I didn't get your name.
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Uh, [PII], thank you. And what's your last name, initial, and the card number for this patient? I do have one, another two claims of different patients.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, last name initial is going to be [PII]. Call reference will be my name with my last initial and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's it. OK, sir. Thank you very much for that information. We can move on to the next one as you're ready.
[AGENT][NEUTRAL] Uh, yeah, let me just finish noting this one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] and some up and see.
[CUSTOMER][NEUTRAL] Is.
[AGENT][NEUTRAL] OK. What's the next policy number?
[CUSTOMER][NEUTRAL] OK. It's 02485251.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name.
[CUSTOMER][NEUTRAL] OK, give me a minute to log in.
[CUSTOMER][NEUTRAL] Uh, a different kind of name.
[CUSTOMER][NEUTRAL] A BB.
[CUSTOMER][NEUTRAL] Mass cream, yeah.
[CUSTOMER][NEUTRAL] Scre my BP. Date of birth, [PII].
[AGENT][NEUTRAL] All right, thank you for that. And then what is the date of service?
[CUSTOMER][NEUTRAL] Um, for this patient, there are 2 claims. There are 2 claims, so.
[CUSTOMER][NEUTRAL] The first one, yeah, both date of service [PII]. And the first bill amount is $79.31. And the second,
[CUSTOMER][NEUTRAL] 787.49.
[CUSTOMER][NEUTRAL] $787.49.
[AGENT][NEUTRAL] Both same data service, is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No claim on file for those dates of service.
[CUSTOMER][POSITIVE] Patient is effective service.
[AGENT][NEUTRAL] Yes, they are. Policy effective date on this looks like uh [PII]. Patient is still active.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] Uh, primary or secondary care?
[AGENT][NEUTRAL] We are the secondary.
[CUSTOMER][NEUTRAL] Secondly, for what? Do you have the information?
[AGENT][NEUTRAL] No, we do not have that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, OK. Yes, right.
[CUSTOMER][POSITIVE] Thank you very much, that's one. we have to build to again the previous one, previous PO box, right?
[AGENT][NEUTRAL] Yeah, correct, same PO box.
[CUSTOMER][NEUTRAL] C PMO.
[CUSTOMER][POSITIVE] OK. OK, sir. Thank you very much. Uh, well, um,
[CUSTOMER][NEUTRAL] Just checking whether there is
[CUSTOMER][NEUTRAL] Where they are, hm.
[CUSTOMER][NEUTRAL] Are you show another two claims for different patient?
[CUSTOMER][NEUTRAL] So, when you are ready, I can go with that member ID.
[AGENT][NEUTRAL] OK, go ahead with the member ID when you're ready.
[CUSTOMER][NEUTRAL] Yeah. It is 247-4401.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, data service.
[CUSTOMER][NEUTRAL] Yes, um, date of service is [PII].
[CUSTOMER][NEUTRAL] For the particular bill amount.
[CUSTOMER][NEUTRAL] $618 even.
[AGENT][NEUTRAL] No claims on file for [PII].
[CUSTOMER][NEUTRAL] [PII], uh
[CUSTOMER][NEUTRAL] [PII], yeah, [PII], no claim, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] Still not play uh.
[CUSTOMER][NEUTRAL] No time limits, we can submit, resubmit, yeah.
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][POSITIVE] Spacious plan effective dates.
[AGENT][NEUTRAL] Uh, policy effective date is [PII], still active.
[CUSTOMER][NEUTRAL] Do you have that information?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] A second.
[CUSTOMER][NEUTRAL] No claims.
[CUSTOMER][NEUTRAL] Uh, for that date of service also, the PO box is the same, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] No different.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I think we have reached to the last one, last claim. When you are ready, tell me I can go to the, yeah.
[AGENT][POSITIVE] OK, thank you for calling APL then I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] No, uh, I do have uh only one claim list.
[AGENT][NEUTRAL] 01 claim left. OK, one moment, yeah.
[CUSTOMER][POSITIVE] You got right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's the next patient ID?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I don't know this. [PII]
[CUSTOMER][NEUTRAL] Like that, did you have?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] [PII], no?
[AGENT][NEUTRAL] Ours would be just numbers, no letters, yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. Let me check if that's the
[CUSTOMER][NEUTRAL] Member ID card.
[CUSTOMER][NEUTRAL] OK, I'm showing.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Sorry about that. This is, I think, uh, IBA oh sorry, this is not real. Uh thank you very much for understanding and uh patience. Have a great day. Um, [PII], thank you very much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] This is for another insurance.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK, yeah.