AccountId: 011433970860
ContactId: 6255b80a-b851-4f41-b8d5-d621c1f22ebd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 635619 ms
Total Talk Time (AGENT): 251080 ms
Total Talk Time (CUSTOMER): 140583 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/6255b80a-b851-4f41-b8d5-d621c1f22ebd_20250610T12:49_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider's office to check on the claims. clarification, can you spell your name for documentation purpose?
[AGENT][NEUTRAL] You're calling for claim clarification?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, my name is [PII] The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Mhm. Yeah, thanks for that information.
[AGENT][POSITIVE] And I'll be more than happy to.
[CUSTOMER][NEUTRAL] That
[AGENT][POSITIVE] You're welcome and I'll be more than happy to help you with the claim clarification. [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]. No extension, it's a direct line.
[AGENT][NEUTRAL] Thank you. And um may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02003015 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And his first name is [PII], last name is [PII], and the middle name is [PII], and the date of birth was on [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim you like me to look at with you or the claim number?
[CUSTOMER][NEUTRAL] I can notification.
[CUSTOMER][NEUTRAL] Yeah, the date of service, yeah, yeah, the date of service was on [PII]. So the total bill amount of $2,111 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] One moment, one moment.
[CUSTOMER][NEUTRAL] Uh, the total bill I have here is $1,694 even.
[AGENT][NEUTRAL] OK, what's the claim number that you have?
[CUSTOMER][NEUTRAL] No, I don't have such information.
[AGENT][NEUTRAL] Oh, I thought you wanted clarity on a claim you've already processed. OK, hold on one moment. So you said the total balance is 1000. What's the correct total balance?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] $1,694 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so the policy number that you gave me is no longer active. It was effective from [PII].
[AGENT][NEUTRAL] To [PII].
[AGENT][NEUTRAL] There is an active policy though. Let me get that policy number for you and see if there's a claim there. Hold on one moment.
[AGENT][NEUTRAL] OK, so the correct policy number is 246.
[AGENT][NEUTRAL] 7676
[AGENT][NEUTRAL] This policy has been active since February.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And there is a claim on file for you. Hold on one moment, let me get that information.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Memorial Hospital for Cancer and all diseases.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It may have just came over as a different name. What's your tax ID because it's showing something different.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yeah, it's the same. It was coming up David H. Koch Center for Cancer. OK. Um, so this is the same claim. So we received the claim, hold on one moment, it's coming up again.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] Claim number is 358.
[AGENT][NEUTRAL] I'm sorry, 353-813-7.
[AGENT][NEUTRAL] So again, that was [PII].
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[AGENT][NEUTRAL] Because benefits are payable only if the major medical insurance provides benefits. If this claim is later paid by major medical, please provide the explanation of benefits for reprocessing.
[CUSTOMER][NEUTRAL] So you need, uh, this claim has been denied for primary UB right?
[AGENT][NEUTRAL] No, the claim has been denied because primary did not apply anything to the claim, because we're second, we can't apply anything unless primary does. So if you have an explanation of benefits showing that primary did apply something to this claim, then you can submit that explanation of benefits and we can reprocess.
[CUSTOMER][NEUTRAL] OK. What will be the timely filing and mailing address to submit that?
[AGENT][NEGATIVE] There is no timely filing as long as the policy was active on the data service and our mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Can you spell that?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can you spell that name, [PII]?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] [PII] is OK.
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII] and the abbreviation is OK.
[CUSTOMER][NEUTRAL] OK, what is the zip?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. What will be the call reference number for this claim? I do have one more claim to be discussed.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date, and again, the first initial to my last name is [PII].
[AGENT][NEUTRAL] Is your next claim for the same member or a different member?
[CUSTOMER][POSITIVE] OK, thanks.
[CUSTOMER][NEUTRAL] That's for the different members.
[AGENT][NEUTRAL] OK, hold on one moment, let me note this one.
[AGENT][NEUTRAL] And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, that is 2.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] It's 1,352,770.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] My first name is [PII], last name is [PII], and the date of birth was on [PII] of, sorry, [PII].
[AGENT][NEUTRAL] OK, may I have the date of service and the total bills?
[CUSTOMER][NEGATIVE] Date of service was not. It's a date range of [PII], and the total bill amount I have here was 6300.
[CUSTOMER][NEUTRAL] 0 $6,369 even.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] 6360.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] So this one.
[AGENT][NEUTRAL] OK, so we don't have a claim on file for that data service or that total with that total bill.
[CUSTOMER][NEUTRAL] May I get the uh policy effective date and the mailing address to resubmit it?
[AGENT][NEUTRAL] Yes, the mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] And this policy has been effective since [PII].
[CUSTOMER][NEUTRAL] Oh, and it's still being active, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, what will be a TFL to submit the claims?
[AGENT][NEUTRAL] I'm sorry. There is no timely filing limit for any of our policies.
[CUSTOMER][NEUTRAL] What do they do?
[CUSTOMER][NEUTRAL] OK. Thanks for that information. Uh, what will be the call reference number? It will be your name and the state, right?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thanks for that information and you have a good day. Bye.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] No.