AccountId: 011433970860
ContactId: 5c6016e9-3ae8-47b4-9ead-91890ecb3ced
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 791150 ms
Total Talk Time (AGENT): 145148 ms
Total Talk Time (CUSTOMER): 216914 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/5c6016e9-3ae8-47b4-9ead-91890ecb3ced_20250520T20:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hi [PII]. My first name is [PII]. My last name is [PII] calling you from the provider's office looking for claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the policy number for that patient?
[CUSTOMER][NEUTRAL] Uh, yes, the patient side yes uh.
[CUSTOMER][NEUTRAL] Uh yes, 02357788.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] The date of birth is [PII] and the first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] Date of service and bill charges.
[CUSTOMER][NEUTRAL] That services uh [PII] total charge is $9,393.90.
[AGENT][NEUTRAL] And you said for 9-17-2024, is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, give me just one moment.
[AGENT][NEUTRAL] Um, I don't have a claim on file for that, those charges.
[CUSTOMER][NEUTRAL] Can I have the member if I could?
[AGENT][NEUTRAL] Remember effective date is 7-1-2023.
[AGENT][NEUTRAL] Policy term is 21-2025.
[CUSTOMER][NEGATIVE] And the, uh, there is no time in filing right.
[AGENT][NEGATIVE] No timely filing correct.
[CUSTOMER][POSITIVE] OK, uh, thank you, let's move to the next patient.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And policy number?
[CUSTOMER][NEUTRAL] Alright, let me see patient study yes uh.
[CUSTOMER][NEUTRAL] 022608883.
[AGENT][NEUTRAL] Patient name and date of birth.
[CUSTOMER][NEUTRAL] Date of birth is [PII] and the first name is [PII]. Last name is [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] 6523 total charge is 3400.
[CUSTOMER][NEUTRAL] Uh, $95 even.
[AGENT][NEUTRAL] No, that claim was received on.
[AGENT][NEUTRAL] 73 2023 process 75 2023.
[AGENT][NEUTRAL] And benefit dollar amount maximum has been met for the day.
[CUSTOMER][POSITIVE] Maximum benefit rate.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, how many times can be built in a year or in a month?
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Well, we, we already paid out the max for that date of service, so there's only one date of service you can only pay out once per day.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] But you
[CUSTOMER][NEUTRAL] Uh, on this data service we haven't received any payment yet.
[AGENT][NEUTRAL] Right, we paid a different provider.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Can be built only once in a year.
[AGENT][NEUTRAL] There's a maximum payout of $75 per day that was paid out on $65 for a date of service 65-2023 to a different provider.
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] For Friday and what is the time you find limit?
[AGENT][NEUTRAL] 180 days from the process date.
[CUSTOMER][NEUTRAL] OK. And the claim number.
[AGENT][NEUTRAL] My number is 323323141.
[CUSTOMER][POSITIVE] Uh, thank you. Let's move to the next patient.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Uh, policy ID.
[CUSTOMER][NEUTRAL] Uh, the patient side is.
[CUSTOMER][NEUTRAL] 02435035.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh first name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Day of service and bill charges.
[CUSTOMER][NEUTRAL] That service uh $5324 total charge is $3,586 even.
[AGENT][NEUTRAL] Uh, it doesn't look like we've received that claim.
[CUSTOMER][NEUTRAL] I'm sorry, could you please repeat again?
[AGENT][NEUTRAL] Can you resubmit the claim we have not received it.
[CUSTOMER][NEUTRAL] OK, uh, that.
[CUSTOMER][NEUTRAL] OK. Can I have the number if I did?
[AGENT][NEUTRAL] Effective date is [PII]. Policy is active, no term date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, thank you, that's the expiration.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] 022 038 92.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII] and the first name is [PII]. Last name is [PII]
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] For [PII] total charge is 2500.
[CUSTOMER][NEUTRAL] $79 even.
[AGENT][NEUTRAL] Uh, it looks like we received this claim, but it was, uh, submitted by the member, the patient.
[AGENT][NEUTRAL] You'd have to contact them for information on it.
[CUSTOMER][NEUTRAL] Uh, but not from the provider, uh, not from the providers and crossover team.
[AGENT][NEGATIVE] No, we have not received it from the provider.
[CUSTOMER][NEUTRAL] Uh, but, uh, but we, uh, can I have the members effective.
[AGENT][NEUTRAL] Uh, effective date is.
[AGENT][NEUTRAL] [PII] termination [PII].
[CUSTOMER][NEUTRAL] OK, thank you. Uh, let's move to the next question. I have just only 2 more claims.
[AGENT][NEUTRAL] OK. Hold on one moment.
[AGENT][NEUTRAL] OK, the policy number?
[CUSTOMER][NEUTRAL] 02399312
[CUSTOMER][NEUTRAL] And the patient's uh first name is.
[CUSTOMER][NEUTRAL] [PII] Last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Day of service and bill charges.
[CUSTOMER][NEUTRAL] [PII] total charge is $3,702 even.
[AGENT][NEUTRAL] And what were the bill charges again? Sorry about that.
[CUSTOMER][NEUTRAL] Uh, the amount is.
[CUSTOMER][NEUTRAL] $3,702 even.
[AGENT][NEUTRAL] Um, looks like we don't have that on file.
[AGENT][NEUTRAL] Effective date [PII], policy is active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. OK, thank you. Let's move to the last patients.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] 02450110.
[CUSTOMER][NEUTRAL] And the patient's first name is [PII] and the last name is [PII]. Date of birth is uh [PII], and the total charge is.
[CUSTOMER][NEUTRAL] Uh, total charge is $14,788.89 for the date of service [PII].
[AGENT][NEUTRAL] Uh, it looks like I don't have any claims on file for him, so can you resubmit? Uh, effective date is [PII], term date [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and do you have any call reference number?
[AGENT][NEUTRAL] Uh, it's my name is [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much. That's what I call today and have a very blessed day ahead.
[AGENT][POSITIVE] Thank you for calling APL. You as well. Bye-bye.