AccountId: 011433970860
ContactId: 6459b24e-da80-48f0-8ed2-35c900da474f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274579 ms
Total Talk Time (AGENT): 93376 ms
Total Talk Time (CUSTOMER): 121052 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/6459b24e-da80-48f0-8ed2-35c900da474f_20250619T18:53_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from private office. I just want to know the claims and design information. Can you spell out your name? It's [PII]
[AGENT][NEUTRAL] OK, yes, my name is [PII]
[AGENT][NEUTRAL] And you said you're calling
[CUSTOMER][NEUTRAL] What, do you have last initial name?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] You're welcome, and you're calling for a claim denial status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and uh may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's going to be [PII].
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, the member policy number is going to be 01975791.
[AGENT][POSITIVE] 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] Yes, ma'am. My first name is [PII], last name is [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [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 claim number for the claim you'd like me to look at?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Actually, we don't have a claim number because the claim was processed for the uh primary and crossover to the APL so we don't have the claim number for the APL.
[CUSTOMER][NEUTRAL] We only claim number for the primary insurance. So you need the primary claim number?
[AGENT][NEUTRAL] Well, hold on. You, so you said that you were calling for claim denial, so I thought you had a claim. Um, what's the date of service?
[CUSTOMER][NEUTRAL] No, no, I just said the claim and denial information. So if you, if the claim was process for denial, so the claim, the date of service is going.
[AGENT][NEUTRAL] May I have the date of service?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII].
[CUSTOMER][NEUTRAL] And the charge amount is $889 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so there's no
[AGENT][NEUTRAL] There's no claim on file for the data service [PII]. We don't do crossover claims. Once you receive the explanation of benefits from the primary, did you all submit the claim to APL secondary?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes. Yes, we have to send the claim to time on [PII]. And again, we have to send to claim 519-2025.
[CUSTOMER][NEGATIVE] When you say that you are not received yet.
[AGENT][NEUTRAL] And where are you sending it to?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] We have to send electronically.
[AGENT][NEUTRAL] What payer ID do you have?
[CUSTOMER][NEUTRAL] But the paper claim, you have to send it.
[CUSTOMER][NEUTRAL] Pay ID you mentioned out there is going to be 60801.
[AGENT][NEUTRAL] OK, and that's where it was sent?
[CUSTOMER][NEUTRAL] 60801. It's correct?
[AGENT][NEUTRAL] Yes, that's correct. I was asking if is that the payer ID that it was sent to? The reason I'm asking is because we don't have a claim on file. So I'm just confirming the information with you.
[CUSTOMER][NEUTRAL] So we can need to be bill again to you?
[AGENT][NEUTRAL] Yes, because there's no claim on file for [PII].
[CUSTOMER][NEUTRAL] Because.
[AGENT][NEUTRAL] Did you need our mailing address or fax number?
[CUSTOMER][POSITIVE] No problem. We have to bill again.
[CUSTOMER][NEUTRAL] Yes, we have the mailing address and fax number. We have, I'll confirm to you, uh, the mail, the address is going to be [PII].
[CUSTOMER][NEUTRAL] [PII] City, [PII], uh ZIP code [PII], and fax number is going to be [PII]. Is it correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, thank you. We have to send the claim. Can you have a call the person for this call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. The first initial and my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. Thank you very much. Good day. Take care, bye.
[AGENT][NEUTRAL] Yeah