AccountId: 011433970860
ContactId: 749218f7-6a6f-429e-9368-3be27ff8e89d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553679 ms
Total Talk Time (AGENT): 206270 ms
Total Talk Time (CUSTOMER): 213625 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/749218f7-6a6f-429e-9368-3be27ff8e89d_20250501T15:35_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hello. My name is [PII] calling from the provider's office to check on the claim status. How are you doing today?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][POSITIVE] I'm doing good, thank you so much for asking. Can you repeat your name? Can you spell it for me once again?
[AGENT][NEUTRAL] Um, it's [PII]. It's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, [PII], right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thank you so much, [PII] Thanks for helping, ma'am.
[AGENT][POSITIVE] Sure, no problem. Could I please get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. Give me a minute. Callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please?
[CUSTOMER][NEUTRAL] Uh yeah, sure. Uh, give me a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Just give me a second, my system is a little bit stuck.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yeah, policy number is 2549.
[CUSTOMER][NEUTRAL] 486, M as in Mary, L as in Larry, number 8.
[AGENT][NEUTRAL] OK. Thank you. And yes, I can assist you with claim status. Um, could you please verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. Patient's first name is [PII], last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Uh, yeah, sure. Date of service is [PII] and the bill amount is $139 even.
[AGENT][NEUTRAL] OK, I apologize. I'm not showing a claim on file with that date of service. Um, how was the claim submitted?
[CUSTOMER][NEUTRAL] Uh, actually, this claim was processed by USC and, and, and, and the USA transferred to the American APL. That's, that's why, uh.
[CUSTOMER][NEUTRAL] I think in this, in this case, we need to submit the claim again, right? If the claim is not received to at your end.
[AGENT][NEUTRAL] Right, if we didn't receive the claim, you would have to resubmit the claim.
[CUSTOMER][NEUTRAL] OK. Uh, no issues, no claims. I'm not on file. Uh, OK, can you, can you put the claim?
[AGENT][NEUTRAL] But one moment, um, I do.
[AGENT][NEUTRAL] I do show a different policy number. Let me check that different policy number. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and please repeat the date of service and bill charges.
[CUSTOMER][NEUTRAL] [PII], build amount $139 even.
[AGENT][NEUTRAL] OK. No, sir. I'm still not showing that claim on file. But when the claim is resubmitted, um, it would need to be resubmitted under a different policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, different policy and so this policy number is not correct, right?
[AGENT][NEUTRAL] Not for this date of service. Um, it was this the.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] The policy number that this claim should go under um the date of dates of services are for [PII].
[CUSTOMER][NEUTRAL] OK. Well, can you provide me the claim mailing address to submit the claim?
[AGENT][NEUTRAL] Yes, it's [PII], and that's in [PII]. Mhm.
[CUSTOMER][NEUTRAL] You book
[CUSTOMER][NEUTRAL] Oh, sorry, [PII].
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's in [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the and the zip code?
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] [PII], correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh, can you provide me the payer ID? I is there any payer ID for that?
[AGENT][NEUTRAL] Yes, the pay ID is 60801.
[CUSTOMER][NEUTRAL] 60801. OK. And, and can you prove time to filing limit to submit the claim again?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] No, no time to filing?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Can you provide me the patient's eligibility when it was effective and done?
[AGENT][NEUTRAL] Um, yes, and just let me advise you that verification of coverage does not guarantee payment of claim. Um, for the policy that this claim needs to be filed up under, the effective date was [PII], and it expired on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um the [PII]. [PII] effective date and [PII] term date, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, no issue. Thank you so much. Can you give me the call reference number?
[AGENT][NEUTRAL] Do you need the policy number to file this claim under the correct policy number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Yes, please provide me.
[AGENT][NEUTRAL] Um, the policy number is 01813048.
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 01813048.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] This is the correct policy.
[AGENT][NEUTRAL] That's the correct policy number that that claim with that date of service needs to be filed under.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no issues. Yeah. Uh, can you provide me the call, call reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII] [PII], and today's date. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Uh, yes, I have one more claim. Can you help me with that?
[AGENT][NEUTRAL] Is it for the same member?
[CUSTOMER][NEUTRAL] Uh, no, no, different number.
[AGENT][NEUTRAL] Yes, I can help you with one more. Um, what's the policy number, please?
[CUSTOMER][NEUTRAL] Uh yeah, sure. Policy number is 016.
[CUSTOMER][NEUTRAL] 1181
[CUSTOMER][NEUTRAL] 7, M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK. Please repeat that policy number.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] 01611817. M as in Mike, L as in Larry, number 8.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, first name is [PII], last name is [PII], and the date, date of birth is [PII].
[AGENT][NEUTRAL] OK, and what's the date of service and bill charges on the claim, please?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII] and the bill amount is $937 even.
[AGENT][NEUTRAL] You said it was for [PII]?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] OK, and please repeat the bill charges.
[CUSTOMER][NEUTRAL] $937 even.
[AGENT][NEUTRAL] OK, I'm not showing that claim on file.
[CUSTOMER][NEUTRAL] OK. The same, same mailing address, same pay ID correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh, that there is no TFL. Uh, can you provide me the policy effective, and the term date?
[AGENT][NEUTRAL] Um, yes, sir, and again, just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII], and this policy expired um on [PII]. It expired today.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][POSITIVE] Yes, sir. That's correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. Yeah, can you give me the call reference number for this one, or the same, your name and what digit, correct?
[AGENT][POSITIVE] Yes, that's the correct, [PII]. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Uh, uh, uh, no, no. Thank you. Thank you so much. I appreciate you. Thank you so much.
[AGENT][POSITIVE] Uh, thank you, [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too. Bye.