AccountId: 011433970860
ContactId: 6f941c2c-b0d3-4374-a37a-00b9eae7e7f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 792830 ms
Total Talk Time (AGENT): 199231 ms
Total Talk Time (CUSTOMER): 357093 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/6f941c2c-b0d3-4374-a37a-00b9eae7e7f5_20250311T13:20_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider's office to check on a claim status.
[AGENT][POSITIVE] OK, I can help you spell your name for me please.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And how do you pronounce your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII], OK, thank you. What's the policy number?
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. And the member's ID is A as in Alpha 00101000.
[AGENT][NEUTRAL] OK, do you have a copy of the card to call you that's not our policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's the policy number in my system.
[AGENT][NEUTRAL] Yeah, but that's not the APL policy number, so that's incorrect for us.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. You mean to say that the member ID is not correct. Am I correct?
[AGENT][NEUTRAL] I'm saying that's not one of our policy numbers. It may be correct for a different insurance company but not APL.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. Just.
[CUSTOMER][NEUTRAL] I'm having another insurance like you check the member's ID. Is it correct or not?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] The one you provided is not correct, ma'am, not for APL.
[CUSTOMER][NEUTRAL] yeah
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Another one member ID. Please check it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 1214388 M as in Mike, L as in Lime, 5.
[CUSTOMER][NEUTRAL] Really.
[AGENT][POSITIVE] Thank you, let me see what that is.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's last name is [PII] and the patient's first name is [PII]
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, and what's a data service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, that is a policy number for APL, but I'm showing that what's the total charge for that date of service? Is it 174?
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Just a moment, I will check.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, it's $174.
[AGENT][NEUTRAL] OK, so we did receive the claim, um, it was not payable, the date of service is after the policy termination date, um, I have the claim number ready.
[CUSTOMER][NEUTRAL] Just a moment. I want to write. Just a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna place you on a brief hold, OK? and let you document.
[CUSTOMER][NEUTRAL] OK. Can you tell the claim number?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, I thought you needed to document something. I show the claim number is 356-675-8.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was received [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Processed [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] And what is the reason why it is denied?
[AGENT][NEUTRAL] OK, can you hear me OK?
[CUSTOMER][NEUTRAL] Yes, what is the reason why it is denied?
[AGENT][NEUTRAL] OK, the policy is not, yeah, I stated it earlier, the policy is termed.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The policy termination date?
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. May I know the timely filing limit?
[AGENT][NEUTRAL] To submit a claim, submit an appeal, the timely filing for what?
[CUSTOMER][NEUTRAL] Of the claim or of the policy.
[CUSTOMER][NEUTRAL] The other
[AGENT][NEUTRAL] There's no timely filing limit to submit a claim, is that what you're asking?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, there's no timely filing limit, and can you provide your callback number for me?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, just a moment. The callback number is [PII].
[AGENT][NEUTRAL] OK. And any other questions I can assist with today, [PII]?
[CUSTOMER][NEUTRAL] Can you spell out your name for me?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] First initial last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you give me the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I'm having another one claim. Give me the status of that claim.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm having another claim. Please provide me the status of the claim.
[AGENT][NEUTRAL] Is it for the same person or a different person?
[CUSTOMER][NEUTRAL] Different person.
[AGENT][NEUTRAL] And that policy number please?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Gonna place you on a brief hold while you locate that number, OK?
[CUSTOMER][NEUTRAL] OK. Can I tell the policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Go
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Have you located the policy number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that number?
[CUSTOMER][NEUTRAL] It's 247-3107.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's last name is [PII] and the first name is [PII] And the date of birth is [PII].
[AGENT][NEUTRAL] Date of service and total charge.
[CUSTOMER][NEUTRAL] The date of services.
[CUSTOMER][NEUTRAL] [PII] and the total charge is
[CUSTOMER][NEUTRAL] It's $650.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, that claim denied. The office visit fee is not covered under the patient's policy.
[AGENT][NEUTRAL] Let me know when you're ready for the policy number.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] I'm sorry, the claim number?
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That number is 348.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] 0674.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. May I know the received it?
[AGENT][NEUTRAL] Received your life.
[AGENT][NEUTRAL] Received [PII].
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. May I know the reason?
[AGENT][NEUTRAL] Office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] On the internet.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Services are not covered by this policy. Am I correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm having another claim. Give me the status.
[AGENT][NEUTRAL] Hey, this is the last one I can do, and you can also check your status online at [PII] and what's the next policy number?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] It's 944275.
[AGENT][NEUTRAL] The patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's last name is [PII] and the patient's first name is [PII]
[AGENT][NEUTRAL] Her date of birth?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] OK, now the date of service and the total charge.
[CUSTOMER][NEUTRAL] Uh, so, uh, date of service is [PII] and the total charges, the total charges $522.
[AGENT][NEUTRAL] OK, the claim number is 3566.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] OK. Can you repeat once again? 356.
[AGENT][NEUTRAL] 356-658-4.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 584. OK.
[AGENT][NEUTRAL] Receive date [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Process data is.
[CUSTOMER][NEUTRAL] 25 M.
[AGENT][NEUTRAL] Year [PII].
[AGENT][NEUTRAL] The process date is, I'm sorry, it's [PII]. It's the pro the received date.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the process date is [PII].
[CUSTOMER][NEUTRAL] OK. [PII]. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] May I know what is the reason?
[AGENT][NEUTRAL] Treatment in the office is not covered by this policy, so it's not covered.
[CUSTOMER][NEUTRAL] Same like before the services are not covered by this policy, am I correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Can you please give me the callback num call reference number?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you for your assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome thank you for calling APL. Have a good day.