AccountId: 011433970860
ContactId: 7e467ea5-5ea8-48da-bf5c-f30d8eaa963b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424880 ms
Total Talk Time (AGENT): 165950 ms
Total Talk Time (CUSTOMER): 120794 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/7e467ea5-5ea8-48da-bf5c-f30d8eaa963b_20250520T15:24_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] Good morning, [PII]. Can I have the first initial of your last name, please?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Thank you. My name is [PII] First initial to my last name is [PII].
[AGENT][POSITIVE] OK, and how may I help you today?
[CUSTOMER][NEUTRAL] I need to check to see if you have a claim on file for a patient.
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] 8324042628
[AGENT][NEUTRAL] Thank you, you said you needed to know if a claim has been received or if it's on file? OK. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It is 994466.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name [PII], last name [PII] Date of birth [PII].
[AGENT][NEUTRAL] Thank you. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Their [PII] total charge $7,718.76.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] So for Ja you said [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, just wanted to make sure because I'm not showing any claims on file for that data service.
[CUSTOMER][NEUTRAL] OK, and what is your?
[CUSTOMER][NEUTRAL] Pay electronic payer ID number.
[AGENT][NEUTRAL] So it's 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] Muscles
[CUSTOMER][NEUTRAL] The address?
[AGENT][NEUTRAL] Address is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the zip code is [PII]?
[AGENT][NEUTRAL] But hold on one moment because I'm also showing that there's an active policy. So the 994466, that termed on [PII], but there's a policy here that's been active since [PII]. Um that's policy number 1912866. So let me look and see if there's a claim on the active policy.
[CUSTOMER][NEUTRAL] Yeah, why.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And there is. Hold on one moment.
[AGENT][NEUTRAL] So I received it twice. Let me get the dates.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] Uh oh no.
[AGENT][NEUTRAL] And then [PII]. OK. So we received it originally on [PII]?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And that was claim number 350.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] 371 2.
[AGENT][NEUTRAL] On [PII], the claim was denied.
[AGENT][NEUTRAL] Um, stating to provide an explanation of benefits if primary insurance does pay towards the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They will
[CUSTOMER][NEUTRAL] Do you have a fax number?
[AGENT][NEUTRAL] Mhm. My fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We received
[CUSTOMER][NEUTRAL] What were you about to say?
[AGENT][NEUTRAL] We received the claim again on [PII] and that was also denied requesting the explanation of benefits from primary. Did you need that claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. It's 353.
[AGENT][NEUTRAL] 421 3.
[CUSTOMER][NEUTRAL] And what is your time in filing?
[AGENT][NEUTRAL] There's no timely filing as long as the policy is active, you can file at any time, um, but this is additional information, so as soon as we receive it, we'll just continue processing.
[CUSTOMER][NEUTRAL] OK, and on this policy number, when was it effective?
[CUSTOMER][NEUTRAL] 3503712.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] 350. OK, so that's the claim number. The policy number is 191.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] 2866.
[CUSTOMER][NEUTRAL] My number my direct line is [PII].
[AGENT][NEUTRAL] And this policy has been active since [PII].
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right. Can I get a reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] All right, thank you very much you have a good day.
[AGENT][NEUTRAL] You also see, was there anything else I can help with?
[CUSTOMER][NEUTRAL] No, that'll be it. Sure.
[AGENT][POSITIVE] All right, thanks for calling API. Have a great day.
[CUSTOMER][NEUTRAL] You too, bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] A South Hospital [PII].
[CUSTOMER][NEUTRAL] 770744302
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] It is 282 November 570.
[CUSTOMER][NEUTRAL] X-ray.