AccountId: 011433970860
ContactId: 77878645-70e9-49d4-a852-b644b317f239
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 742780 ms
Total Talk Time (AGENT): 217014 ms
Total Talk Time (CUSTOMER): 299195 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/77878645-70e9-49d4-a852-b644b317f239_20250313T14:34_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling from our office in the international for the claims. Could you assist me?
[AGENT][NEUTRAL] Of course I can look at a claim for you. Um, [PII], can I get a good call back number from you first in case we're connected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure. My callback number is [PII] is the direct line.
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah, the ID number is 74647.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm sorry, you said 7.
[AGENT][NEUTRAL] 4647.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, that's not gonna be one of our policy numbers, [PII] Um, do you maybe have their social I could search for them that way.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, we don't have the social for this patient. Uh, could you please verify the patient name and date of birth?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can start with their name if you wouldn't mind spelling out the first and last name for me.
[CUSTOMER][NEUTRAL] Yeah, sure. My first name is [PII], and last name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And the date of birth is, oh yeah, yeah.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] Yeah, the date of birth is [PII].
[AGENT][NEUTRAL] OK, and then, uh, what state, uh, does [PII] live in?
[CUSTOMER][POSITIVE] Ill a nice.
[AGENT][NEUTRAL] [PII], OK, thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] OK, um, I do believe I found it, [PII], um, what was the date of service for this time?
[CUSTOMER][NEUTRAL] Uh, yeah.
[CUSTOMER][NEUTRAL] One second, 1 2nd.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, the data service is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] And the, yeah, the total charges.
[AGENT][NEUTRAL] And did you have that billed out? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, the charge amount is $188.24.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I will tell you that the last policy they had with us, [PII], uh, terminated [PII], but I can still check to see if you received this claim.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so no, we did not receive this claim.
[CUSTOMER][NEUTRAL] Yeah, sure. And the patient was done on [PII] before the data service, right?
[AGENT][NEUTRAL] Yes, that is correct. It was the only policy they had with that.
[CUSTOMER][NEUTRAL] Yeah, may I know the start.
[CUSTOMER][NEUTRAL] Yeah. May I know the starting date from that policy date range?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, the effective date was [PII].
[CUSTOMER][POSITIVE] Yeah, I got it. Thank you so much for clarify this one. Thank you. And I have uh another one patient to verify the status could assist me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With a different patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, give me one moment, I'll let you know when I'm ready to uh for the next policy number.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] You go ahead and take that next policy number.
[CUSTOMER][NEUTRAL] Yeah, sure. Yeah, the next one policy number is 02.
[CUSTOMER][NEUTRAL] 2146778
[AGENT][NEUTRAL] OK, and now what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] Yeah. Patient first name is.
[CUSTOMER][NEUTRAL] He there, last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge is $35.65.
[AGENT][NEUTRAL] $35.65. OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I didn't know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What was the name of the provider's office this was with Max?
[CUSTOMER][NEUTRAL] Uh, yeah, it's Rockford Health Physician.
[AGENT][POSITIVE] OK, thank you for verifying that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So we did receive this claim.
[AGENT][NEUTRAL] Uh, looks like we're missing a copy of the primary EOB.
[CUSTOMER][NEUTRAL] Oh, this claim will be denied for the near primary you will be, right?
[AGENT][POSITIVE] Correct
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, may I have the claim receive it and process it for this one.
[AGENT][NEUTRAL] Yes, so we received it, uh, [PII].
[CUSTOMER][POSITIVE] We're having a good day
[AGENT][NEUTRAL] And it was processed to [PII].
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] I get it
[CUSTOMER][NEUTRAL] Oh yeah, sure. And one more plan and could you please provide the claim number for this one?
[AGENT][NEUTRAL] Yes, that claim number is 3196.
[AGENT][NEUTRAL] 934.
[CUSTOMER][NEUTRAL] Yeah, I got it. And one more, one more, I uh I asked for this question for you. And we just recently, recently submitted to uh
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, to your insurance on [PII]. Could you please verify you can receive any recent EOB.
[CUSTOMER][NEUTRAL] I made recent claims for the state of service.
[AGENT][NEUTRAL] OK, I'm sorry, you said that you sent in claim information um for I'm sorry, the primary EOB for this claim?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, with
[CUSTOMER][NEUTRAL] Uh, yes, through electronically.
[AGENT][NEUTRAL] OK, and when
[AGENT][NEUTRAL] When was that sent? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, we send that on [PII].
[AGENT][NEUTRAL] OK, let me see if we received anything, give me just a moment.
[CUSTOMER][NEUTRAL] Yeah I pay $10 for the, but I was trying to remember.
[CUSTOMER][NEUTRAL] for the.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, I'm not showing that we received the primary EOB max.
[CUSTOMER][NEUTRAL] Uh, but you sure that the recent claim, right?
[AGENT][POSITIVE] Um, repeat that, I'm so sorry.
[CUSTOMER][NEUTRAL] Uh, you received any recent claim?
[AGENT][NEUTRAL] I have not we have not received the primary EOB for this claim.
[CUSTOMER][POSITIVE] OK, yeah, sure. Thank you so much for clarify. And I have another one data service for the same patient.
[AGENT][NEUTRAL] Same member? OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You ready for that?
[AGENT][NEUTRAL] Yes, go ahead.
[CUSTOMER][NEUTRAL] Yes, data service is [PII] and the total charge is $551.43.
[AGENT][NEUTRAL] OK, I'm sorry that was $551.43 correct?
[CUSTOMER][NEUTRAL] 541 and 541.42.
[AGENT][NEUTRAL] 41, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Got it thank you alright one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I did find this claim as well um and so for this claim uh we were unable to pay a benefit as office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, office if it's covered under the policy, right?
[AGENT][NEGATIVE] Right, they're not covered under this policy.
[CUSTOMER][NEGATIVE] Uh no.
[CUSTOMER][NEUTRAL] Really
[CUSTOMER][NEUTRAL] Sure. May I know the claim number for this one?
[AGENT][NEUTRAL] Yes, claim number is 32.
[AGENT][NEUTRAL] 49
[AGENT][NEUTRAL] 312.
[CUSTOMER][NEUTRAL] Yeah, I got it. When I know the claim on that claim received it and processed it.
[AGENT][NEUTRAL] Yes, this claim was received [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] Yeah, and may I know that, may I know the time refi limit for the submit the claim with primary UB and also with, uh, claim.
[AGENT][NEUTRAL] OK, so for the primary EOB there's no timely filing limit. Uh, however, to appeal a claim, it does have to be within 180 days of the process date.
[CUSTOMER][POSITIVE] Yeah, sure, thank you so much for clarify. And can I get a call reference number for this one?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] Uh, no, no, thanks. Thank you so much.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah bye.