AccountId: 011433970860
ContactId: 7ade150a-e08e-4eae-be82-975186623b18
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395170 ms
Total Talk Time (AGENT): 113125 ms
Total Talk Time (CUSTOMER): 150966 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/7ade150a-e08e-4eae-be82-975186623b18_20250509T17:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and I was following up on a claim please.
[AGENT][NEUTRAL] OK, is that a claim for yourself?
[CUSTOMER][NEUTRAL] I'm sorry, this is a provider call.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, what, uh, office are you with?
[CUSTOMER][NEUTRAL] Retina specialist of Alabama.
[AGENT][NEUTRAL] OK, [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, it is [PII] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And let's see, what's the policy number for that patient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, it's an old policy number. It's going to be, uh, one second.
[CUSTOMER][NEGATIVE] No, I didn't. I hope I didn't.
[CUSTOMER][NEUTRAL] I, I think I'd be great with the policy number that you had on file because I got a new policy number. Can you look at the name and date of birth because I changed the policy number to the new policy number.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have the new policy number?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 251-9.
[CUSTOMER][NEUTRAL] 724.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name and date of birth is gonna be [PII] [PII].
[AGENT][NEUTRAL] OK, and what data service are we checking on?
[CUSTOMER][NEUTRAL] OK, it's gonna be 729-2024 it may be 20, yes, it's 24, wait a minute, maybe 23, sorry, sorry, 24.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, let me pull up that other policy real quick.
[AGENT][NEUTRAL] And you said 729-2024, correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And [PII] is the patient.
[CUSTOMER][NEUTRAL] As far as the state.
[AGENT][NEUTRAL] Uh, just making sure he is the patient, correct? It looks like he's got a spouse too on the policy.
[CUSTOMER][NEUTRAL] Yes, he is [PII], yes. OK, [PII] is the patient.
[AGENT][NEUTRAL] OK, um, I, I don't have a claim for that date of service. Do you know when it was submitted?
[CUSTOMER][NEUTRAL] Uh, it, it was like, uh, [PII], but I'm thinking it's because the policy had terminated, uh, and was not effective again until [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, well, he, he, this policy was effective [PII]. So we've got an active policy for that date of service.
[CUSTOMER][NEUTRAL] You know they said, OK, OK. But you don't have a claim on file.
[AGENT][NEUTRAL] I don't have a claim on file. Do you want that policy number to file it under?
[CUSTOMER][NEUTRAL] OK, yes, please.
[AGENT][NEUTRAL] It's 237.
[AGENT][NEUTRAL] 0231.
[CUSTOMER][NEUTRAL] OK, so, OK, OK, because we definitely had another different policy number and I found it uh 019.
[CUSTOMER][NEUTRAL] 72935.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Yeah, that one's uh from [PII].
[AGENT][NEUTRAL] So any dates of service in that range.
[AGENT][NEUTRAL] This policy I just gave you, that would cover the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have a question when you find out something.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does the member policy change yearly?
[AGENT][NEUTRAL] Uh, yeah, I think when they do renewals, the number can change. It just depends on how the renewal works with the group. Sometimes it's yearly, sometimes, sometimes it doesn't change, so it just depends it depends on how the renewal goes for the group, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But we have the capability to see all policies um that have been, you know, with that patient, so.
[CUSTOMER][NEUTRAL] OK, because the problem is on our end they don't tell us when the number changed.
[AGENT][NEUTRAL] Oh, OK. Yeah, we, we send out cards for this policy, so they do get new cards.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think if they were to ask up at the front desk it would help if the insurance has changed.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's your your filing time of filing for an initial claim.
[AGENT][NEUTRAL] Uh, there's actually no timely filing limit because this is a secondary policy, so.
[CUSTOMER][NEUTRAL] Oh, OK, so we'll be OK, but to file that data service is gonna be policy number 237-0231.
[AGENT][NEUTRAL] Yep.
[AGENT][NEUTRAL] Yes, and then be sure and file that primary explanation of benefits along with this claim, since this is secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well I think that's gonna answer all the questions because we, we haven't been getting paid on the claim, so didn't know why, but now I see why, um, I understand why, so I just need to fix it so um.
[CUSTOMER][POSITIVE] OK, thank you so very much.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.