AccountId: 011433970860
ContactId: 6e8a6b90-b53b-42a7-939b-5731c6a2c07d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 360570 ms
Total Talk Time (AGENT): 172293 ms
Total Talk Time (CUSTOMER): 112422 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/6e8a6b90-b53b-42a7-939b-5731c6a2c07d_20250416T17:41_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from office. I want to check the claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to assist you with the claim status and for my notes, can you spell your first name for me, please, and provide a good contact number?
[CUSTOMER][NEUTRAL] Yes, uh, it's [PII]
[AGENT][NEUTRAL] OK, [PII], may I have a good contact number and the member's policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, yes, uh, address card number is [PII].
[CUSTOMER][NEUTRAL] 35133.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is 02486015.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the member's first name is [PII], uh last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] How many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only, only, only one claim, ma'am.
[AGENT][NEUTRAL] Alrighty, and may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yes, the date of service is uh [PII] with the charge amount $569 even.
[AGENT][NEUTRAL] Thank you and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim for you, OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So I'm actually not showing a claim on file for Phillip um for [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] This claim is uh not on file right, ma'am?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Correct. I'm not showing there's a claim on file. Are you trying to do the dental claim or is this for medical?
[CUSTOMER][NEUTRAL] It's a medical.
[AGENT][NEUTRAL] OK, because that claim number, I'm sorry, that policy number is for the dental policy. Hold on one moment, let me go to the medical.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so the medical policy number is 2,486,010 and I am searching now for the claim for you.
[AGENT][NEUTRAL] But still, I don't see a claim for [PII] for [PII].
[CUSTOMER][NEUTRAL] So, ma'am, the policy is 02486015.
[AGENT][NEUTRAL] OK, are you calling in reference to a dental claim or a medical claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, it's a, a medical claim.
[AGENT][NEUTRAL] Right, so what I'm explaining to you is the policy number that is 6015 is the dental policy. The correct policy number is 2,486,010. That's their hospital indemnity policy, which is their medical policy, but there is no claim on file for the date of service, [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] However, there is no timely filing, so if you need to file this claim, you do, you can still do that because the policy was active on the data service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, do you have any correct mailing address for, for this claim?
[AGENT][NEUTRAL] Yes, the uh mailing address is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK. And what's the payer ID, ma'am?
[AGENT][NEUTRAL] 645-56.
[CUSTOMER][NEUTRAL] OK. What's the caller reference number?
[AGENT][NEUTRAL] The call reference number, there is not a call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK. Can you please get your name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Uh, ma'am, I have a question. Uh, last time I called, uh, to an insurance company, they said that this claim is not on file. They give us the mailing address to [PII].
[AGENT][NEUTRAL] If you gave
[CUSTOMER][NEUTRAL] Uh, we submit this claim to this.
[AGENT][NEUTRAL] If you gave them the dental policy number, that is the correct claims mailing address for the dental policy, but we're working with the medical policy, so it goes with IMA and that's the address that I gave to you.
[CUSTOMER][NEUTRAL] But yeah
[CUSTOMER][NEUTRAL] OK, we have to submit this claim on this mailing mailing address.
[AGENT][NEUTRAL] The claim should be submitted to the [PII] address. [PII] is not for for this policy.
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][POSITIVE] OK, OK. Thank you so much, ma'am, for your assistance. Have a nice day.
[CUSTOMER][NEUTRAL] With the rest of the.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am. Thank you so much for your assistance.
[AGENT][POSITIVE] You're welcome. Thanks for calling [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] Hello.