AccountId: 011433970860
ContactId: 6826fce1-819c-4fd0-9e74-a867a1e682b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 552900 ms
Total Talk Time (AGENT): 218909 ms
Total Talk Time (CUSTOMER): 121571 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/6826fce1-819c-4fd0-9e74-a867a1e682b2_20250326T15:31_UTC.wav
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[AGENT][NEUTRAL] For contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Last initial [PII]. Could you please help me with the claims?
[AGENT][NEUTRAL] I can help with the claim status, and what is that policy number, please?
[CUSTOMER][NEUTRAL] The first policy ID is 010.
[CUSTOMER][NEUTRAL] 66938.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Member's name, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK. And you said the number was 01.
[AGENT][NEUTRAL] 0
[AGENT][NEUTRAL] 66938, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Checking again.
[AGENT][NEUTRAL] And what date of service are we looking for?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And is there a bill amount?
[CUSTOMER][NEUTRAL] It is for $40,515.35.
[AGENT][NEUTRAL] OK, let me check and while I'm doing that, if I could just have a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Claim number is 353-711-1.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like we received that.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] On the [PII], we process it on the [PII].
[AGENT][NEUTRAL] Of [PII] and what we're looking for is an explanation of benefits from their major medical because we are a secondary, uh,
[AGENT][NEUTRAL] Insurance, we need that.
[AGENT][NEUTRAL] In order to process.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the mailing address is the uh [PII]. Uh this is the correct one?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please also help me with some other claims?
[AGENT][NEUTRAL] I can do 2 more. What is the next call?
[CUSTOMER][NEUTRAL] For the same reason.
[AGENT][NEUTRAL] Is it for the same individual?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what's the next day of service?
[CUSTOMER][NEUTRAL] Next member ID is 212, sorry, sorry. It is 021.
[CUSTOMER][NEUTRAL] 669
[CUSTOMER][NEUTRAL] 97.
[AGENT][NEUTRAL] Thank you. And the insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] Member's name, [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] Thank you. And uh what is the um data service that we're looking for?
[CUSTOMER][NEUTRAL] Date of service, [PII].
[AGENT][NEUTRAL] Is there a particular bill amount?
[CUSTOMER][NEUTRAL] And the total charge amount.
[CUSTOMER][NEUTRAL] Um, 11, 1000.
[CUSTOMER][NEUTRAL] $186.91.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, it looks like we did receive your claim, the claim number for this.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] 353.
[AGENT][NEUTRAL] 7022.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like we received that on the [PII] and we processed it on the [PII]. And again, we're gonna be looking for that explanation of benefits because we are a secondary insurance, we have to have that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Shall we move to the next one?
[AGENT][NEUTRAL] Yes, and the policy number, please?
[CUSTOMER][NEUTRAL] Wait a second.
[CUSTOMER][NEUTRAL] Policy ID 024.
[CUSTOMER][NEUTRAL] 65567.
[AGENT][NEUTRAL] Thank you, and the insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] Member's name [PII]. Date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the date of service for [PII]?
[CUSTOMER][NEUTRAL] Date of service, [PII].
[CUSTOMER][NEUTRAL] And the total charge amount is 5000.
[CUSTOMER][NEUTRAL] $718.71.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm sorry that's not on file. I don't, it doesn't look like I have a claim for this individual. So, uh, let me just check one other place here.
[AGENT][NEUTRAL] Give me just a second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, it doesn't look like I have a claim on file for him.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So do you, do you know where you sent it or?
[AGENT][NEUTRAL] I'm gonna look at another place. I'm wondering if we don't have a different.
[AGENT][NEUTRAL] We may actually have a different uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like what they did was that they, uh, this is group insurance and what they do is they, they change the policy number whenever they, they renew with the group. So the most current number for this is 02.
[AGENT][NEUTRAL] 502803 and under this policy, the uh claim
[AGENT][NEUTRAL] Um, it looks like that was processed and your claim number is 350.
[AGENT][NEUTRAL] 81
[AGENT][NEUTRAL] 31
[AGENT][NEUTRAL] And it looks like at that time there was a $50 check that was sent out. Let me see if I can.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] And how much is the bill amount? The same?
[AGENT][NEUTRAL] Well, it's
[AGENT][NEUTRAL] Yeah, because I'm, I'm wondering if this is it. Well, this is where you need to send it to. OK, so here, here's, uh, here's what's happened, [PII], is that you need to send it, uh, we need, you need to resubmit it because it's, uh, under policy, um, 025028303. Now we have several claims for that data service for Jamison, um, but it looks like yours is a facility bill, and so I'm thinking that, uh, we haven't received it. I'm looking through here and I'm not seeing one facility bill for Jamison.
[AGENT][NEUTRAL] I'm seeing several things here, but I don't, there's not, there's not a facility bill, so I think it would be probably be best if you went ahead and resubmitted that, but I would do it to policy number 02.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 502803 is that's gonna be the one that it that it's uh it's listed under.
[CUSTOMER][POSITIVE] OK, no issue.
[CUSTOMER][NEUTRAL] And uh the policy which I provided, provide you earlier for this member, uh, it is active or not?
[AGENT][NEUTRAL] The, the policy is active. The number that you gave me is from, uh, is from an old, um, it's from an old uh policy. So what they do is this, because it's a group insurance, they renew it, you know, so it's.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] OK, so the new one is it ends with 803.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Not an issue.
[AGENT][NEUTRAL] OK, is there anything else?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK. OK. Well, thank you very much for contacting APL [PII] you have a very good day.