AccountId: 011433970860
ContactId: 5b707c17-968d-47dc-bdf6-39829f98898a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1404829 ms
Total Talk Time (AGENT): 150756 ms
Total Talk Time (CUSTOMER): 404241 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/5b707c17-968d-47dc-bdf6-39829f98898a_20250403T20:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm trying to file, um, medical providers trying to file, uh, some claims, and it says my insurance is not active, so can I, um, try them in the line so you can speak to them?
[AGENT][NEUTRAL] Uh, yes, let me get your policy pulled up. Um, do you have your policy number?
[CUSTOMER][NEUTRAL] Yeah, 018.
[CUSTOMER][NEUTRAL] 325
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Um, 20.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Oh, OK, hold on one moment.
[AGENT][POSITIVE] OK, I'm so sorry. Could you give that to me again?
[AGENT][NEUTRAL] 018
[CUSTOMER][NEUTRAL] 018325
[CUSTOMER][NEUTRAL] 20 ML 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what was your name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I just need to verify two more pieces of information. What's your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much yeah so if if you wanted to get them on the line I'd be happy to verify your benefits.
[CUSTOMER][POSITIVE] Yeah, thank you, thanks.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Hi, I have the insurance um agent on the line.
[AGENT][NEUTRAL] Hi, this is, uh, with APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, hi.
[CUSTOMER][NEUTRAL] Hello ma'am, we are in dispatch health and I'm trying to add the insurance and verifying the insurance for Miss [PII], but when you we run it through the insurance, it's coming back and it's unverified.
[AGENT][NEUTRAL] OK, um, what are you, are you trying to file a claim, or?
[CUSTOMER][NEUTRAL] Yes, ma'am. Um, she, uh, let me go back in here. OK.
[CUSTOMER][NEUTRAL] Um, we look to, we're trying to file for her daughter that was seen by Dispatch Health on.
[AGENT][NEUTRAL] And do you have that name and date of birth?
[CUSTOMER][NEUTRAL] On [PII]. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, all right, and are you uh filing it electronically or?
[CUSTOMER][NEUTRAL] Um, yes, ma'am. We just put it through the system, and can I verify the claim address and the member ID with you?
[AGENT][NEUTRAL] Yes, um, our address is [PII].
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And that's the one that we have here on the file with [PII], that is coming back as unverified. The message that we get saying that please call the insurance to verify eligibility, because the status is not available.
[AGENT][NEUTRAL] So are you, do you, what payer ID are you filing with?
[CUSTOMER][NEUTRAL] Um, that will be the same as the group number?
[AGENT][NEUTRAL] No, our, uh, payer ID is 6080.
[CUSTOMER][NEUTRAL] I don't see any in there.
[AGENT][NEUTRAL] OK. Um, our payer ID is 60801.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] And then I can give you the policy number too if you need that.
[CUSTOMER][NEUTRAL] Allow me 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead, ma'am.
[AGENT][NEUTRAL] The policy number is 01832520.
[CUSTOMER][NEUTRAL] And can you verify the the member ID? Oh yeah, 018325?
[CUSTOMER][NEUTRAL] 20
[AGENT][NEUTRAL] 20. Yes.
[CUSTOMER][NEUTRAL] And the letter, MLA is a part of that?
[AGENT][NEUTRAL] Uh, yes, that's part of it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me run it one more time and see if it makes any difference.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And can you tell me one more time the payer ID?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's coming back as the same let me see here um.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] We also have a fax number if, if you'd be able to fax the claim.
[CUSTOMER][NEUTRAL] Go ahead, ma'am, with the fax number please.
[AGENT][NEUTRAL] Uh, the fax number is [PII].
[AGENT][NEUTRAL] Um, and then just be sure to provide the primary explanation of benefits when sending the claim.
[CUSTOMER][NEUTRAL] I've done it again through um with the payer ID and it's.
[CUSTOMER][NEGATIVE] It doesn't even allow me, like, to check it. It's like a white gray box because it's saying that it's not active.
[CUSTOMER][NEUTRAL] So I'm not sure what is happening.
[AGENT][NEUTRAL] Yeah, I've got, I've got her active and.
[CUSTOMER][NEGATIVE] But it doesn't pick up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not sure why, um, if you, if you could fax it, that would, um, if you could fax it, that would be good.
[CUSTOMER][NEUTRAL] Mm, so, mm.
[CUSTOMER][NEUTRAL] Um, yes, that, that's what I'm taking a note about that.
[CUSTOMER][NEUTRAL] And let me go and try one more thing, and let's see if that make it.
[CUSTOMER][POSITIVE] Um, better
[CUSTOMER][NEGATIVE] And if you can also send the ones, um, you know, the one for me, you said it also never got processed.
[CUSTOMER][NEUTRAL] And, and my husband too.
[CUSTOMER][NEGATIVE] We were all seen at different times and, and apparently none of them were, were, were processed correctly.
[CUSTOMER][NEUTRAL] So I don't know if you need me to give you the information for those as well.
[CUSTOMER][NEUTRAL] Um, allow me one second, let me go one by one.
[CUSTOMER][NEUTRAL] I'm trying to figure it out still why it doesn't have a
[CUSTOMER][NEUTRAL] Active policy. Just give me one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Mm yeah, I'm looking that when um you spoke with someone about the same bill, they mentioned that they submit the bill, but it could never be processed because it was.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] You know what, allow me one second. And let's, what I see here, it looks like she's being active on our end, but it looks like it was submitted, even though it was inactive, and it went through. And I'm talking for [PII] on the [PII]. Can you confirm that for me?
[AGENT][NEUTRAL] Yes, [PII], that was the date of service correct?
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] OK, what were the bill charges?
[CUSTOMER][NEUTRAL] And we submitted like that.
[CUSTOMER][NEUTRAL] It was for $75.
[AGENT][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it looks like we made a payment on that for $75.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was paid on [PII].
[CUSTOMER][NEUTRAL] Correct, yes. All right. So since you verify that she's eligible with you, I will go ahead and even though it's not verifying or end, I'm go ahead and submit it and let's see if it works the same way. OK? Allow me one second. Let me go back to.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Do you have [PII]'s date of service?
[CUSTOMER][NEUTRAL] Um, just give me one second.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Just make sure we didn't have it on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't think so because the mom just provided me, um, the secondary so I can add it on her file.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] We never had that information for um [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And give me one second so I can give you the date of service anyhow.
[CUSTOMER][NEUTRAL] And the date of service for um [PII] was.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, no, I do not have a claim on file for that date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the date of service, yes, it's the same, [PII], OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so I just went ahead and submitted the claim for [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it looks like he went through.
[AGENT][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] Um, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, you mentioned that you have another person that you wanna check as well?
[CUSTOMER][NEUTRAL] Yeah, my husband.
[CUSTOMER][NEUTRAL] And what is his name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I have his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm, what is a good telephone number to get in touch with [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you, and I see that he has a balance of 75.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And it looks like the same thing happened, it looks like it's not being verified through the system with the insurance. So allow me one second.
[CUSTOMER][NEUTRAL] And that one will be for data of service, 01 22, 25.
[CUSTOMER][NEUTRAL] Alright, so I wanna let you know that I went ahead and submit also the one from [PII], from [PII], and everybody looks like settled down. In the meantime, you can disregard the bill that you received. If there is any new copays or deductibles, you will be receiving a new letter.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Well, thank you for calling the special. Is there anything else that I can help you with?
[CUSTOMER][POSITIVE] That's it. Thank you. Thank you, ma'am.
[AGENT][NEUTRAL] OK, anything else from me, [PII]?
[CUSTOMER][POSITIVE] All right, have a good day, ladies.
[CUSTOMER][POSITIVE] No, no, that's it. Thank you. Thank you both.
[AGENT][POSITIVE] Oh, OK, thank you for calling.
[CUSTOMER][POSITIVE] You're welcome, ladies, bye bye.
[AGENT][POSITIVE] Have a good evening.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.