AccountId: 011433970860
ContactId: 6b0071dc-e764-4053-9ece-31c914f6da0b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 361869 ms
Total Talk Time (AGENT): 143206 ms
Total Talk Time (CUSTOMER): 127092 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/6b0071dc-e764-4053-9ece-31c914f6da0b_20250110T21:46_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, hi, [PII]. My name is [PII] and I'm calling for provider CBel. Please note this call will be monitored and recorded for the quality and training purposes. And I'm calling to obtain status on a claim.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with that claim status today. What is a good callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you [PII], and the policy number for the patient please?
[CUSTOMER][NEUTRAL] Policy number is 66,944,850. And the member's first name is [PII]. It's [PII] and last name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] That is not our APL policy number. You said last name was [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And first name is spelled [PII]?
[CUSTOMER][NEUTRAL] Uh, it's [PII]
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Do you happen to have a claim number? because.
[AGENT][NEUTRAL] Or what state [PII] lives in?
[CUSTOMER][NEUTRAL] Oh, actually,
[CUSTOMER][NEUTRAL] Uh, I don't have any claim number, but I know the claim was submitted.
[CUSTOMER][NEUTRAL] On [PII]. 1 moment, let me take a look.
[AGENT][NEUTRAL] Do you know what state she lives in?
[CUSTOMER][NEUTRAL] Oh yes, one moment. Let me take a look here.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, she lives in [PII].
[AGENT][NEUTRAL] Is that in [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And this is for a medical claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. She does have a medical policy with us. Would you like for me to provide that medical APL ID number?
[CUSTOMER][POSITIVE] Oh, OK, yes, I really I really appreciate for that.
[AGENT][NEUTRAL] OK. [PII]'s medical policy number is 142.
[AGENT][NEUTRAL] 0113.
[CUSTOMER][POSITIVE] Oh thank you so much.
[AGENT][NEUTRAL] Sure, and I can check to see if we have a claim on this policy.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Uh, uh, sorry to interrupt you, but, uh, the policy number you just provided me, it is a group number, right?
[AGENT][NEUTRAL] No, this is her policy ID number.
[CUSTOMER][POSITIVE] Oh, OK. So, uh, I'm so sorry for that, uh, because someone has mentioned here it's a group number. I'm so sorry.
[AGENT][POSITIVE] Oh, got it. That's why you did that's, but you had it. That's good.
[AGENT][NEUTRAL] I'm sorry, but this is her policy ID number.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're very welcome and I'll be happy to check to see if we have a claim on file. What was that date of service?
[CUSTOMER][NEUTRAL] Oh, the date of service is [PII]. Total charge amount is $167.23.
[AGENT][NEUTRAL] Yeah, I'm checking for that claim [PII] we do not have that claim on file. Do you know where that claim was sent?
[CUSTOMER][NEUTRAL] Oh yes, uh, it was submitted on [PII].
[CUSTOMER][NEUTRAL] SC [PII].
[AGENT][NEUTRAL] OK, that is not our claim submission address either, and I can provide you that claim submission address.
[CUSTOMER][NEUTRAL] Oh, yes, may I know what is the correct mailing address to submit that claim?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], that's [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] Thank you so much. And may I know the family planing limit to submit that claim?
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEGATIVE] No, there's no timely filing limit.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And when the patient's policy, effective date and the termination date?
[AGENT][NEUTRAL] Sure, the effective date is [PII], and the policy is still active.
[CUSTOMER][NEUTRAL] And you're the primary or the secondary for the patient?
[AGENT][NEUTRAL] It is an indemnity policy.
[AGENT][NEUTRAL] And it is just provides the indemnity benefit amount. It's not major medical.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And may I know when was the last coordination of benefit was updated for this patient?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] We don't coordinate benefits. It's a standalone policy, but.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And can you provide me the call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date, and I spell my name [PII]
[AGENT][NEUTRAL] First initial last name, [PII].
[AGENT][POSITIVE] And it was a pleasure to assist you with that claim status, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Oh no, thank you so much for assisting me, [PII]. You have a wonderful day.
[AGENT][POSITIVE] Mm, thank you. I hope you do too, and a happy weekend to you, [PII].
[CUSTOMER][POSITIVE] Thank you. Bye bye.
[AGENT][POSITIVE] Thank you bye bye.