AccountId: 011433970860
ContactId: 7e731364-987c-42a3-880d-3f4d7d7d6ecd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 897369 ms
Total Talk Time (AGENT): 187661 ms
Total Talk Time (CUSTOMER): 241212 ms
Interruptions: 7
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/7e731364-987c-42a3-880d-3f4d7d7d6ecd_20250127T17:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Good morning. Thank you for calling.
[CUSTOMER][NEUTRAL] Um, hi, this is [PII] calling from the provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The patient
[CUSTOMER][NEUTRAL] Sure, it is.
[CUSTOMER][NEUTRAL] 02544110.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient patient name was [PII]. Date of birth of [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you and may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] So this is for [PII] and the bill amount is $277 even.
[AGENT][NEUTRAL] OK, let me see if I can find this claim and for future you can check claim status online through our website at [PII].
[CUSTOMER][NEUTRAL] And for the future you can check my status online through our website at [PII]. Mhm.
[AGENT][NEUTRAL] And let me see, I have that claim and that was for [PII], correct?
[CUSTOMER][NEUTRAL] that was for [PII], correct.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like we uh received and processed this claim [PII] and processed [PII], and we need the explanation of benefits from the primary insurance to continue the processing of this claim.
[CUSTOMER][NEUTRAL] OK, so it looks like we uh received process for.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] For the 24.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] In my insurance of this claim.
[CUSTOMER][NEUTRAL] So is it possible to confirm who's the primary for this number?
[AGENT][NEUTRAL] Can you repeat?
[CUSTOMER][NEUTRAL] Can you repeat? Um, so who is the primary for this member?
[AGENT][NEUTRAL] Um, let me see if I have that information. Bear with me.
[CUSTOMER][NEUTRAL] So bear with me.
[AGENT][NEUTRAL] BCBS.
[CUSTOMER][NEUTRAL] CCS
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, is there any letter sent to the patient?
[AGENT][NEUTRAL] Can you repeat?
[CUSTOMER][NEUTRAL] Um, so is there any letter sent to the patient?
[AGENT][NEUTRAL] Yes, now we received the claim from the provider. We need the provider to send in the explanation of benefits from the primary insurance. The member was notified that we received the claim and that we request the explanation of benefits from the primary insurance from the provider.
[CUSTOMER][NEUTRAL] I'm the primary
[CUSTOMER][NEUTRAL] It's not a problem that we
[CUSTOMER][NEUTRAL] from the provider. OK, so may I know the claim number?
[AGENT][NEUTRAL] Um, yes, the claim number is 352-4049.
[CUSTOMER][NEUTRAL] Claim number 352.
[CUSTOMER][NEUTRAL] 4049. OK, so this is for the claim date of service [PII] and the bill amount is $277 right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] Correct. OK. So, uh, is it possible to send a copy of EUV through my fax?
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] Is the fax number. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Yes.
[AGENT][NEUTRAL] All right. Um, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, sure.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] So, um, what is the timely filing limit to submit a primary UB?
[AGENT][NEGATIVE] We don't have time filing limits for that.
[CUSTOMER][NEUTRAL] You don't have time for that. OK, so, uh, I do have one more member for claim status, so can you please assist me with that?
[AGENT][NEUTRAL] It's a different member?
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] OK, bear with me just a second.
[CUSTOMER][NEUTRAL] just
[AGENT][NEUTRAL] And you don't need any other information on this one, correct?
[CUSTOMER][POSITIVE] Have the information on this one correct. Yes.
[AGENT][NEUTRAL] Let me finalize the note.
[CUSTOMER][NEUTRAL] Finalize the note.
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] policy number. It is 02010654.
[AGENT][NEUTRAL] One moment, let me put my information.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the date of service and the amount of the claim?
[CUSTOMER][NEGATIVE] missing the amount of the claim. So this is for number [PII] and the bill amount is $277 even.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Yes.
[AGENT][POSITIVE] Thank you, one moment, let me see if I can find this one.
[CUSTOMER][NEUTRAL] Is.
[AGENT][NEUTRAL] You said it was for 277?
[CUSTOMER][NEUTRAL] 427. Yes.
[AGENT][NEUTRAL] Mm, I don't see a claim for 277.
[CUSTOMER][NEUTRAL] 77.
[CUSTOMER][NEUTRAL] OK, so may I know the patient's eligibility?
[AGENT][NEUTRAL] OK, sure. One moment.
[CUSTOMER][NEUTRAL] Sure one moment.
[AGENT][NEUTRAL] OK, we have an effective date of [PII], and it is active at the moment.
[CUSTOMER][NEUTRAL] The effective date of [PII], it is active at the moment. May I know the payer ID to submit a claim?
[AGENT][NEUTRAL] OK, this is one of our secondary supplemental plans for the major medical, so the claim needs to be faxed or mailed to us.
[CUSTOMER][NEUTRAL] Secondary supplemental plans for the major American so the claim needs to be faxed or mailed to us. Mhm.
[AGENT][NEUTRAL] Um, the fax number is [PII].
[CUSTOMER][NEUTRAL] So fax number is 1877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] And the mailing address?
[AGENT][NEUTRAL] The mailing address is [PII].
[CUSTOMER][NEUTRAL] Can we address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And may I know the timely filing when to submit a claim?
[AGENT][NEUTRAL] We don't have time limits.
[CUSTOMER][NEGATIVE] We don't have time going at the moment.
[CUSTOMER][NEUTRAL] It was a message uh for the day, uh, and I'm sorry I just missed your name. Could you please repeat your name for me?
[AGENT][NEUTRAL] Sure. My name is [PII]. That's [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] My name is [PII]. So thank you so much for assisting me. May I know the reference number for the conversation?
[AGENT][NEUTRAL] We don't have reference numbers, so you can use my name in today's name.
[CUSTOMER][POSITIVE] We don't have your full name in today's name. Thank you so much and you may have a wonderful rest of the day. Bye bye.
[AGENT][POSITIVE] You are so much and thank you for calling APM. Bye-bye.
[CUSTOMER][POSITIVE] Thanks for calling me too bye bye.