AccountId: 011433970860
ContactId: 7d26e3ec-0d93-419a-a19f-7db5232ce00c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 503769 ms
Total Talk Time (AGENT): 117403 ms
Total Talk Time (CUSTOMER): 282632 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/7d26e3ec-0d93-419a-a19f-7db5232ce00c_20250409T13:11_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello, good morning, [PII]. I have a provider's office, um.
[CUSTOMER][NEUTRAL] With [PII] on the line, um, they are requesting a claim status on an insured.
[AGENT][NEUTRAL] OK. And who, who was, what was, who was the name on the phone?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, the policy number is
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Um, the policy number is 256.
[CUSTOMER][NEUTRAL] 9076.
[AGENT][NEUTRAL] Is this the insured you said?
[CUSTOMER][NEUTRAL] Uh, no, it is a provider, um, office. Mhm.
[AGENT][NEUTRAL] The printer, OK. Did you get a callback number for them?
[CUSTOMER][NEUTRAL] Uh, I did not. Um, he was requesting for a, um, an extension number to call directly to the claims department.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] As well, but uh I wasn't able to provide that for him.
[AGENT][NEUTRAL] Yeah, we don't have one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, ma'am. This is [PII]. Initial last name is [PII]. How are you doing today?
[AGENT][NEUTRAL] I'm doing fine. How are you, [PII]? Do you have a callback number I can get?
[CUSTOMER][NEUTRAL] Yeah, the callback number will be [PII]. No extension required.
[AGENT][NEUTRAL] And do you have the patient's name?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name will be [PII] and the date of birth is Set.
[AGENT][NEUTRAL] And the date of birth.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Sure. The date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you're needing claim status?
[CUSTOMER][NEUTRAL] Yes, correct, claim status.
[AGENT][NEUTRAL] OK, I can look that up for you. What's the daily service?
[CUSTOMER][NEUTRAL] Yeah, the date of service is number 18, 2024. And the bill charge amount is going to be
[CUSTOMER][NEUTRAL] $3900 even 3900.
[AGENT][NEUTRAL] And that was 8 1824.
[CUSTOMER][NEUTRAL] November 18, 2024.
[CUSTOMER][NEUTRAL] like
[AGENT][NEUTRAL] 8 1824.
[CUSTOMER][NEUTRAL] 8 1824 means what?
[AGENT][NEUTRAL] The data service.
[CUSTOMER][NEUTRAL] The date of service is number 18 2024.
[CUSTOMER][NEUTRAL] And you see the feature.
[AGENT][NEUTRAL] 8, 18 of 24, is that what you said?
[CUSTOMER][NEUTRAL] 752035.
[CUSTOMER][NEUTRAL] No, it should be November 11 11182024.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And what is one of the procedure codes on that bill?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 00813.
[AGENT][NEUTRAL] You said 00813?
[CUSTOMER][NEUTRAL] That is [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] For anesthesia.
[CUSTOMER][NEUTRAL] 4400 doctors.
[CUSTOMER][POSITIVE] Absolutely correct.
[CUSTOMER][NEUTRAL] There is anesthesia dynamic for the.
[AGENT][NEUTRAL] OK, I'm not showing we have that bill.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] OK. Give me a moment.
[CUSTOMER][NEUTRAL] They are not showing uh uh like the claiming status. There's no claim on file?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Right, no claim on file.
[CUSTOMER][NEUTRAL] Give me a moment. See, uh, we had to make this call on, you know, like.
[CUSTOMER][NEUTRAL] Give me a moment. On [PII], and we found, uh, the member policy ID is going to be stamped. So they have given me the updated policy ID which is gonna be 02569076, and they also advise the policy ID is effective plus [PII] to still active. Is it the correct information?
[AGENT][NEUTRAL] It is, but we still didn't.
[AGENT][NEUTRAL] We still didn't receive that claim. There's no claim on file for that data service.
[CUSTOMER][NEUTRAL] OK. So what I'm saying, they have given me the updated policy ID and the policy ID is going to be 02569076. Is it the updated policy ID?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK. And they are also saying like this policy ID is effective from [PII] to still active, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, we have built this policy ID on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] And we did not receive that.
[CUSTOMER][NEUTRAL] OK, give me a moment.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Come on.
[CUSTOMER][NEUTRAL] We just
[CUSTOMER][NEUTRAL] So it was denied that certain conditions are not covered.
[CUSTOMER][NEUTRAL] He stated that
[CUSTOMER][NEUTRAL] There is no claim on.
[CUSTOMER][NEUTRAL] File need to resubmit the claim once again.
[CUSTOMER][NEUTRAL] OK. How we can submit this claim? Can you help me with your fax number, mailing address?
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] That the the.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Can you spell it after the [PII]?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] City
[CUSTOMER][NEUTRAL] What is the city? OK, right?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII] would be OK. What is the abbreviation of?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] It's [PII] City.
[CUSTOMER][NEUTRAL] What is the abbreviation of the city?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] you're saying that.
[CUSTOMER][NEUTRAL] OK, abbreviation would be there, OK, right?
[AGENT][NEUTRAL] 7
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 731-24. 73124, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. And uh can you give me the uh effect period of this like when to when he was effective?
[AGENT][NEUTRAL] [PII] and it's still active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you give me the call reference number?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] What's your name?
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. It was nice talking to you and have a wonderful day. Bye. Take care.
[AGENT][POSITIVE] Thank you, [PII], for calling APLU as well. Bye-bye.