AccountId: 011433970860
ContactId: 74d1d484-1448-4495-9f18-1023b887f994
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 783059 ms
Total Talk Time (AGENT): 320664 ms
Total Talk Time (CUSTOMER): 348308 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/74d1d484-1448-4495-9f18-1023b887f994_20250514T21:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, good evening. My name is [PII]. I'm trying to get status on a claim, please.
[AGENT][NEUTRAL] OK, yeah, I can check on a client for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] 142.
[CUSTOMER][NEUTRAL] 126 7
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Uh [PII] [PII].
[AGENT][NEUTRAL] I'm so sorry, [PII]. I think I might have misheard that policy number. Could you repeat that for me?
[CUSTOMER][NEUTRAL] Uh, I've got 1421267.
[AGENT][NEUTRAL] OK, so that pulls up someone else's policy.
[AGENT][NEUTRAL] Um, let's say, the.
[CUSTOMER][NEUTRAL] Alright, so no it's it. Let me see what we got. Let's let's see if they got a card on file.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Alright insurance card, let's see if they've got one.
[CUSTOMER][NEUTRAL] No I I got the major one. I don't have their secondary one. Can you try and check it by a name?
[AGENT][NEUTRAL] Do you have her social by chance?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK, we could use that.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment. I'm sorry if you would, uh, what was the name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna read that social back, make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] Mhm, yes ma'am, that's what I've got.
[AGENT][NEUTRAL] OK. I did not get a result with that. Do you know if she's the primary?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I honestly do not know, but let me, uh, let me double check something.
[AGENT][NEUTRAL] That's OK. Let's just, that's OK. Um, her name was spelled, you said that was [PII] The last name was [PII]
[CUSTOMER][NEUTRAL] First name is [PII]
[CUSTOMER][NEUTRAL] And then the last name is [PII]
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, let's just go ahead and try to search that way.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And what was her date of birth?
[CUSTOMER][NEUTRAL] Uh, her date of birth is [PII].
[AGENT][POSITIVE] OK awesome I found her let's see.
[AGENT][NEUTRAL] OK, uh, what was the date of service for this claim, [PII], and then I can get you that correct policy number.
[CUSTOMER][NEUTRAL] Uh, let's see for this one, give me one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, you know what, actually let me double, let me do something really quick.
[CUSTOMER][NEUTRAL] Let's see this data service is gonna be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, did you want me to go ahead and give you that uh oh I'm so sorry.
[CUSTOMER][NEUTRAL] Total, total charge.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, yeah, no, no, yes, please, let me update. Let me get out of here really quick and update this really quick. Uh, yes, what's the correct policy number?
[AGENT][POSITIVE] That is perfectly fine. Well.
[AGENT][NEUTRAL] Actually,
[AGENT][NEUTRAL] So she has a few older ones um that went from like [PII] but then her newer one, it's effective date was [PII] and is currently active so it does not look like she had a policy active during that time. Let me see if it went to this one, give me just a moment.
[AGENT][NEUTRAL] I can go ahead and give you this policy number so you do have something though.
[CUSTOMER][NEUTRAL] Yeah, cause I hear, I think.
[CUSTOMER][NEUTRAL] But if, but if it, so let me ask you a question, did she have an active policy for [PII]?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] That's what I'm saying it does not look like it, um, it went from [PII] all the way to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so let me ask you, so she had a policy for [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] If she did, I'm not seeing it.
[CUSTOMER][NEUTRAL] OK, I think I may have found a policy number. Let me give you this, so this is, this is what I think may have came up. So I think it's 01618630 M like mom L like Lima, the number 7.
[AGENT][NEUTRAL] OK, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment, let's give that a try.
[AGENT][NEUTRAL] The only ones I'm able to see from her are the ones in her name like if she were the primary.
[AGENT][NEUTRAL] No, that one
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, that was 01618630?
[CUSTOMER][NEUTRAL] Does that
[CUSTOMER][NEUTRAL] Mhm. Yeah, 01618630 M like mom L like Lima, then the number 7.
[AGENT][NEUTRAL] OK, so she's not listed under this policy, this is under a different member's name.
[CUSTOMER][NEUTRAL] Is it under um [PII]?
[AGENT][NEUTRAL] It, uh, I have, uh, [PII], yes, but she is not listed. He is the only one listed under this policy.
[CUSTOMER][NEGATIVE] She's the only one on the policy, so it's not for her.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, let's do. Alright, let's do this. Let me check.
[AGENT][NEGATIVE] I'm sorry, this is a mess
[CUSTOMER][NEUTRAL] No, no, no, no, it's fine, it's OK. It's, it's just, it's just, it's just a odd. So let me do this. So can we check since, since he has a policy, can we check his claim while I do some investigation on hers?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, so you had a claim for him?
[CUSTOMER][NEUTRAL] Apparently, yes, it's for data service 211 through 213 of 2025 for 1,091,790.
[AGENT][POSITIVE] What was that amount again? I'm so sorry.
[CUSTOMER][NEUTRAL] It's like 1,091,790.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Got it. OK, give me just a moment, let's take a look.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I haven't received any claims for that date of service, so this policy, the one that you gave me ending in 630, um, the effective date was [PII], and it is currently active, so you can definitely resubmit that claim for him under this policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is the mailing address [PII]?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No, um, whenever you're ready I'll get, yes, that is uh [PII].
[CUSTOMER][NEUTRAL] OK, where does it need to go?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] And then I've also got a uh fax number and a payer ID if you'd like.
[CUSTOMER][NEUTRAL] OK, give me one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What's the fax number?
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the payer ID.
[AGENT][NEUTRAL] 60801
[CUSTOMER][NEUTRAL] And he and the patient is eligible on the data service.
[AGENT][NEUTRAL] Yes, uh, uh, [PII] is, yes.
[CUSTOMER][NEUTRAL] Do you need, I'm assuming you guys need the primary EV.
[AGENT][NEUTRAL] That's correct, as this is a secondary medical policy.
[CUSTOMER][NEUTRAL] OK, give me 1 2nd.
[CUSTOMER][NEGATIVE] Why is it that I can never find what I'm looking for?
[AGENT][NEUTRAL] It's just that time of day, I think everything's kind of winding down.
[CUSTOMER][NEUTRAL] Yeah, seriously, I know, uh, let's see.
[CUSTOMER][NEUTRAL] All right, now getting back to the mom, so on the mom.
[CUSTOMER][NEUTRAL] The ID so the so the, so we can't, so she has old policy numbers but she has nothing current.
[AGENT][NEUTRAL] She does have something current, however, its effective date was [PII].
[AGENT][NEUTRAL] So nothing during that right nothing under that date of uh service.
[CUSTOMER][NEUTRAL] And her data service is February.
[CUSTOMER][NEUTRAL] Alright, so let me do this, so let's let's see.
[CUSTOMER][NEUTRAL] So there's no active policies for February.
[AGENT][NEUTRAL] Correct, not for, uh, her, and I'm sorry, [PII], um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because what's odd, now, [PII], what was his date of birth?
[CUSTOMER][NEUTRAL] Uh, let me go back.
[AGENT][NEUTRAL] Because I see a dependent also named [PII] under this policy, so I'm wondering if
[AGENT][NEUTRAL] This other one is actually the one that you're needing because that's a completely different date of birth. Was it a a child?
[CUSTOMER][NEUTRAL] Mhm, yeah, I'm, uh, let me get back to it. So for [PII], his date of birth is [PII].
[AGENT][NEUTRAL] OK, so yes, that's not, this is a different [PII], so the one that was the uh [PII], that one that his date of birth, he's much older he's an adult, um, so the other one is under um.
[AGENT][NEUTRAL] Her policy, so the one ending in, well, I don't think I even gave you this policy number um I can give you the one that's currently active whenever you're ready.
[CUSTOMER][NEUTRAL] It, but it's only active for March. It's not active for February.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, hold on. Alright, let me, let me do something really quick then.
[AGENT][NEUTRAL] I'm so sorry I should have asked that before.
[CUSTOMER][NEUTRAL] No, no, you're fine. You're perfectly fine. It is OK, no worries at all. Alright, so so let's do this then. So the mom has, so the mom and the baby or the the child have a policy, but the policy that is active is not active for February, it's active for March.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And the policy number that I gave you 01618630 M like mom L like Lima 7 is not for the baby, it's for [PII] but an adult.
[AGENT][POSITIVE] An adult, that's correct.
[CUSTOMER][NEUTRAL] OK, so it's not his policy. OK, OK, now we've got somewhere, so we, so long story short, we have no active coverage as this for the secondary under the mom or the baby starting for the month of February. It doesn't start for the it starts from, it starts from March. Got you. OK, we're on the same page now. We are on the same and there and there is no and you and there is no active there's not even in in the older policies if that doesn't cover for the month of February.
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] Not for that date of service.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That's correct. The one prior to this, uh, terminated in [PII].
[CUSTOMER][NEUTRAL] OK, so she's got a, there's a gap in coverage between [PII].
[AGENT][NEUTRAL] So if she had active coverage.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] My guess is from what it looks like is that she might have left the employer gone somewhere else and then came back to that employer uh because that's how our policies work so I would get with her if you're able to to see um who or if she had active coverage during that time because my guess is it would be through a different provider or different carrier.
[CUSTOMER][NEUTRAL] For February.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I got you. OK, I see what you're saying. Um, [PII], is there any type of reference number for the telephone call?
[AGENT][NEUTRAL] Absolutely that would just be my first name, last initial, and today's date and so my name is spelled [PII] I'm sorry, that was so confusing. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh no, no, no, it's fine, it's fine. No, everything, everything I get exactly what you're saying now, so we're all good. No, I don't need anything else, but thank you so much. I hope you have a nice night. Thanks bye bye.
[AGENT][POSITIVE] We got there eventually.
[AGENT][POSITIVE] Of course, thanks for giving us a call. You too thank you bye bye.