AccountId: 011433970860
ContactId: 77ce58fc-0e32-4ba7-a678-e7a4102e020e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 660950 ms
Total Talk Time (AGENT): 251687 ms
Total Talk Time (CUSTOMER): 138782 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/77ce58fc-0e32-4ba7-a678-e7a4102e020e_20250430T21:35_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh hi, this is [PII] calling from provider's office and I'm checking on claims.
[AGENT][NEUTRAL] Sure, I can assist you with claims and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 1046105 MLA
[AGENT][POSITIVE] Thank you, one moment
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, that's now. One moment.
[AGENT][NEUTRAL] Um, that's not what I pull with that number. Can you repeat the number?
[CUSTOMER][NEUTRAL] Member number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which number are you asking for?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Yeah. 1046105 MLA.
[AGENT][NEUTRAL] Yeah, that's the one you gave me in the beginning, but it didn't pull that number that you're calling for. Do you have the copy of the card?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, do you have a claim number or any other information that I can use to pull this number?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I have a social security number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You do have a social. OK, bear with me.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead with the number.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What's the name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Based on the social, I did find the [PII]. Now, the date of birth that you have is incorrect as well. So the policy number was incorrect and the date of birth is incorrect in your system.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] One moment, let me check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Member ID is 970194362.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No. Again, um, I did find the member, so I do have the member pulled with the social you provided to me. Now, the date of birth is not matching.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can you check the date of birth one more time?
[CUSTOMER][NEUTRAL] Date of birth is [PII] only.
[AGENT][NEUTRAL] [PII]. OK, yeah, [PII] is correct. All right, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And how much is the total charge?
[CUSTOMER][NEUTRAL] $8,642 even.
[AGENT][NEUTRAL] OK, thank you. One moment, let me see if I can find this claim. For future, you can check claim status online through our website at [PII]. And you said the date of service is [PII]?
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, Ms. [PII], um.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK. All right. So I don't have that claim on file for this number, but it's probably because you didn't have the correct policy. So I can provide you the correct policy number so you can go ahead and submit that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I know your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the member ID?
[AGENT][NEUTRAL] OK, that is 0148.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0442.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] May I know the claim mailing address?
[AGENT][NEUTRAL] The address is [PII].
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Could you please spell that?
[AGENT][NEUTRAL] [PII]. It's [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] On the [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's [PII] and that is zip code [PII] I'm sorry. Let me go back because I got.
[CUSTOMER][NEUTRAL] I know the date?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] May I know the state?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII] Oak [PII] zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] May I know the time filling limit?
[AGENT][NEUTRAL] We don't have family family limits.
[CUSTOMER][NEUTRAL] Effective date?
[AGENT][NEUTRAL] And the policy effective date is [PII].
[CUSTOMER][NEUTRAL] Is there any group name or group number?
[AGENT][NEUTRAL] OK, bear with me just a second, let me pull that information.
[AGENT][NEUTRAL] OK, the group name is Professional Care Inc.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Professional.
[AGENT][NEUTRAL] Care Inc
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the
[CUSTOMER][NEUTRAL] May I know the patient plan type?
[AGENT][NEUTRAL] Do you need the group number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The group number is 15494.
[CUSTOMER][NEUTRAL] So much. May I know the plan type?
[AGENT][NEUTRAL] This is a secondary.
[AGENT][NEUTRAL] Secondary policy to the major medical.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] May I know the plan type?
[AGENT][NEUTRAL] This is a secondary policy.
[AGENT][NEUTRAL] What, what information are you trying to get with asking for the plan type?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient plan that.
[AGENT][NEUTRAL] What information you need, what exactly you're needing? Wh[PII] are you asking for the plan type? What is, what, what do you need? So I know exactly what to give you because I, I am giving you the plan type which is a secondary policy, but you're not taking that. So what exactly do you need?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much. Uh, may I know the payer ID?
[AGENT][NEUTRAL] Payer ID is 60801. Again, that's 60801. This claim needs to be faxed or mailed.
[CUSTOMER][NEUTRAL] May I know the fax number?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the call reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name and today's date if you will.
[CUSTOMER][POSITIVE] OK. Thank you so much for your assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] You as well thank you for calling APL. Bye-bye.