AccountId: 011433970860
ContactId: 7a7dd29d-b47f-457d-af8a-a3d89aac7cb2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 627780 ms
Total Talk Time (AGENT): 217312 ms
Total Talk Time (CUSTOMER): 224269 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/7a7dd29d-b47f-457d-af8a-a3d89aac7cb2_20250418T15:20_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, and now, could you please help me with the claim status? I'm calling from provider office.
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Yeah, of course. My name is [PII] [PII]. Initial is [PII].
[CUSTOMER][NEUTRAL] And my callback number is [PII].
[CUSTOMER][NEUTRAL] And the extension number will be [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, of course, please note down that that will be.
[CUSTOMER][NEUTRAL] Yeah, that will be 02446533.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, of course, member's name is [PII] and the first name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the name is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, and all the information provided is a verification of benefits, not a guarantee of payment. So on this policy, it's an individual policy for [PII]. um, [PII] is not added to this policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm, I'm confirming you again the member's name is.
[CUSTOMER][NEUTRAL] Uh, yeah, the last name is [PII] and the first name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Area zone.
[AGENT][NEUTRAL] OK, this is an individual policy. There's no other person added on this policy except the policyholder.
[CUSTOMER][NEUTRAL] This was an individual policy, right?
[CUSTOMER][NEUTRAL] No, no other person I know. Yes, please.
[AGENT][NEUTRAL] The policy
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] So what do we have to do in this claim, uh, I need to confirm that we have billed that claim, so it was on file uh it was denied or rejected.
[AGENT][NEUTRAL] OK, I can just check and see if there's a claim on file here. May I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, of course, that will be yours.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] And the total, total charge amount is $58755875 even.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hey
[AGENT][NEUTRAL] Um, can you verify the policyholder's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, I was already provided as uh [PII] Yes, please.
[AGENT][NEUTRAL] Not
[AGENT][NEUTRAL] I'm not asking for the dependent. I'm asking for
[AGENT][NEUTRAL] The um policyholder.
[AGENT][NEUTRAL] You provided
[CUSTOMER][NEUTRAL] OK, let me check.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, please. Give me a second.
[CUSTOMER][NEUTRAL] Yeah, that will be [PII] and the first name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] That will be
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So searching on the the policy for [PII] for $5875 even though the, it's under [PII] nation.
[CUSTOMER][NEUTRAL] Yes I.
[AGENT][NEUTRAL] The claims that we received are only from [PII]. [PII] is the only person on this policy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So you would have to reach out to [PII] and let her know that the dependent is not on this claim, this policy.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then she can go from there with her, with her employer.
[CUSTOMER][NEUTRAL] OK. So we need to add the dependent on this claim, right?
[AGENT][NEUTRAL] On the policy.
[CUSTOMER][NEUTRAL] Yeah, on the policy.
[CUSTOMER][NEUTRAL] So there is no claim on file.
[AGENT][NEUTRAL] There is no claim on file on [PII] for your total bills or for [PII]. [PII] is not on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK, so what will be the policy effective on term date?
[CUSTOMER][NEUTRAL] Well you still active or not?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So the policy is still active, it's been effective since [PII].
[CUSTOMER][NEUTRAL] And what was the timely filing limit to submit the claim?
[AGENT][NEUTRAL] There's no timely filing to submit the claim as long as it's a covered person on the policy and the policy was active on the data service.
[CUSTOMER][NEUTRAL] OK. What will be the mailing address to submit the claim?
[AGENT][NEUTRAL] Is the claim for [PII] or [PII]?
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] You cannot submit a claim to us. [PII] is not on this policy. So the policyholder.
[CUSTOMER][NEUTRAL] No, but
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Continue, I'm sorry.
[CUSTOMER][NEUTRAL] No, no, I'm saying that uh if you add the, add the dependent in this policy, then we have to build the claim. So what will be the mailing address for that?
[AGENT][NEUTRAL] If you add the dependent to the policy, the the
[AGENT][NEUTRAL] The mailing address is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII] City.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] Once she's added to the policy if she's, go ahead.
[CUSTOMER][NEUTRAL] Is it?
[CUSTOMER][POSITIVE] Yes, yes, please.
[AGENT][NEUTRAL] May I continue?
[CUSTOMER][POSITIVE] Yes, please go ahead.
[CUSTOMER][NEUTRAL] No, I'm asking for the PR ID. Is there any PR ID?
[AGENT][NEUTRAL] The payer ID is 60801.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So uh before billing this call, we need to add the add dependent on this policy, right?
[AGENT][NEUTRAL] As I was trying to explain to you, it depends on what the effective date is if she's added to the policy. If they add her and they backdate it to where it covers this date of service, yes, the claim can be filed, but if she's being added like from [PII] moving forward or you know, from a date now moving forward, then the policy wouldn't have been active on the date of service.
[CUSTOMER][NEUTRAL] OK. You mean, uh, the main was not added on the data service, so we can't build this claim, right?
[CUSTOMER][NEUTRAL] Uh, this claim will be not paid if dependent will uh add after the date of service.
[AGENT][NEUTRAL] If [PII] is added to this policy and is not active on the data service, the claim will be denied because the policy wasn't active for her. But if she's added and
[AGENT][NEUTRAL] They like go back.
[AGENT][NEUTRAL] To where it could be covered this data services covered, then yes, she could be, um, you could file the claim, so it depends on the effective date.
[AGENT][NEUTRAL] Once she's added to the policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I got the point. I can order issue. What will be the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, you can use my name in today's date.
[AGENT][NEUTRAL] On the first initial to my last.
[CUSTOMER][NEUTRAL] Please, can you please spell out your name for me?
[AGENT][NEUTRAL] My name is [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, now, that's all for today from my side. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.