AccountId: 011433970860
ContactId: 74f0141e-c20a-4871-b97a-ce8ff1a390ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 589250 ms
Total Talk Time (AGENT): 152402 ms
Total Talk Time (CUSTOMER): 164001 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/74f0141e-c20a-4871-b97a-ce8ff1a390ff_20250103T18:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling you from the provider office. I just want to know the claim status. Can you please help me?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hey [PII], you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Yeah, that is correct.
[AGENT][POSITIVE] Yes, I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on today?
[CUSTOMER][NEUTRAL] Uh, let, yeah, let me check.
[CUSTOMER][NEUTRAL] American. I have only
[CUSTOMER][NEUTRAL] Two claims.
[AGENT][NEUTRAL] OK, are they for the same member or do or different members?
[CUSTOMER][NEUTRAL] No, different member.
[AGENT][NEUTRAL] OK, so you will use my name that I gave you, [PII] as your call reference number for both claims along with today's date. My name is spelled [PII]
[AGENT][NEUTRAL] Any information that I.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] OK. So as you said, your name is [PII], right?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, one moment, [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII] OK. Uh, [PII], what is your last initial name?
[AGENT][NEUTRAL] [PII], and it would be your reference number will be you're welcome, my name and today's date. Also suggested any information.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK. 010323.
[CUSTOMER][NEUTRAL] No, one moment. So as you said your name is today's date. This is the call reference number, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Got it. Mhm.
[AGENT][NEUTRAL] Any information that I provide for you on either claim will be a verification of benefits and not a guarantee of payment. And lastly, if we have the claims on file and you need a copy of the explanation of benefits on either one, you may print those from our portal at [PII].
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] The policy number, let me check. One moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The policy number is uh.
[CUSTOMER][NEUTRAL] 02446503
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is.
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you, date of service and total build amount please.
[CUSTOMER][NEUTRAL] [PII] which will amount $1,644 even.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] OK, and you said the total bill amount is $1,644 is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, we do not have a claim on file for this member and that data service, yes sir.
[CUSTOMER][NEUTRAL] OK. So you
[CUSTOMER][NEUTRAL] OK. So as you said, no claim on file on the date of service. So please check the eligibility of the member, the member was active or inactive on the date of service.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] This policy was active for that date of service. The policy effective date is [PII], term date [PII].
[CUSTOMER][NEUTRAL] Mm, [PII], OK.
[AGENT][NEUTRAL] And when the claim is submitted to APL, [PII], you must also submit the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh, by the way, I have the all information like the mailing address and also I have the payer ID number. I, I need the, I need to verify the payer ID number which I have 60801. Is that right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for giving me the information. Please stay on the call. I, I need to finish my note then I will give you the next member ID number.
[AGENT][NEUTRAL] I need, yes, I need to also finish my notes, so that's fine.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] I also need to finish my note on this policy as well.
[CUSTOMER][POSITIVE] OK, OK. Great, great. Mhm. Great.
[CUSTOMER][POSITIVE] Hello. Thank you so much for your patience.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So the next ID number, mhm, next ID number is 02446503.
[AGENT][NEUTRAL] That's the same policy number we just did.
[CUSTOMER][NEUTRAL] I think, yeah, yeah, yeah, yeah, yeah, absolutely, actually, the, it was the same uh member. So the date of service is the different, which is [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] $3,715 even.
[AGENT][NEUTRAL] OK. Thank you. One moment.
[CUSTOMER][POSITIVE] Take your time, no problem.
[AGENT][NEUTRAL] And again, that was [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yeah, that is correct.
[AGENT][NEUTRAL] OK, we do not have a claim on file for that data service.
[CUSTOMER][NEUTRAL] OK. And what is the timely filing limit to uh rebuild the claim? Yeah, uh resubmit the claim?
[AGENT][NEGATIVE] There is no timely filing with APO.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] But again, on this one, we will also have to have a copy of the primary insurance company's explanation of benefits for review as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, [PII], for giving me the information of this account. Have a wonderf[PII].
[AGENT][POSITIVE] OK, well, if that's all then that I can help you with, thank you again [PII] for calling APL and I hope you have a nice afternoon and a nice weekend.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.