AccountId: 011433970860
ContactId: 83837770-2386-4898-bea0-dfdcd6690322
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 641090 ms
Total Talk Time (AGENT): 244721 ms
Total Talk Time (CUSTOMER): 219587 ms
Interruptions: 5
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/83837770-2386-4898-bea0-dfdcd6690322_20250402T14:28_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning
[CUSTOMER][NEUTRAL] Let's just try and
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from product office to check the claim status.
[AGENT][POSITIVE] OK, I'm so sorry. What was your name?
[CUSTOMER][NEUTRAL] More or less spelled [PII].
[AGENT][NEUTRAL] OK, [PII], thank you and what is your callback number please?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you and the policy number, uh, well, first off, how many claims, you did say you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes, sir. I need the claim status for the 3 claims.
[AGENT][POSITIVE] Yes, I can.
[AGENT][NEUTRAL] OK. Are the 3 claims for the same patient or 3 different patients?
[CUSTOMER][NEUTRAL] No, it's uh two claims is the same patient and then one is a different patient.
[AGENT][NEUTRAL] OK, so what is, I can help you with all of those and any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. Also, I will need to verify um.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] Some information with you first and you will use my name along with today's date as your call reference number.
[AGENT][NEUTRAL] For each one and then if we T R A C I.
[CUSTOMER][NEUTRAL] OK. Could you spell your name?
[AGENT][NEUTRAL] And if we do have the claims on file, Morale, and you need a copy of the explanation of benefits, you may print that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Uh phone number.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] And what is your first patient? Yes, sir.
[CUSTOMER][POSITIVE] Yes, great. Sorry. Yes, go ahead, go ahead.
[AGENT][NEUTRAL] OK. Did you get the website for the portal?
[CUSTOMER][NEUTRAL] Yes, I get that, but I don't access for this one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it's a self registering portal so you would just go to that website and register and once you have a claim number, you should be able to print your explanation of benefits if we have the claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So first off, what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] Yes, the policy number is 02216355 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] OK, [PII], thank you.
[AGENT][NEUTRAL] And how many dates of service does this one have? 1 or 2?
[CUSTOMER][NEUTRAL] It's a one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient's name is it's uh [PII] and then date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the first day of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yes, the data of services is uh [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Billed amount is $1,037 even.
[AGENT][NEUTRAL] OK, $1,037. Is that correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And again the the service is [PII].
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] Is that correct? OK.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for this member for that data service and that bill amount.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Actually, we submitted that claim through the paper. And could you please verify the address? It's uh [PII].
[CUSTOMER][NEUTRAL] [PII], [PII]. And then PIN code is [PII].
[AGENT][POSITIVE] Yes, sir, that is correct. That is correct.
[CUSTOMER][NEUTRAL] Is that right?
[CUSTOMER][NEUTRAL] Actually, this member have the primary insurance of Cigna. The Cigna is already processed and then processed to the deductible. And then primary cross was submitted to you, but you did not receive that claim. Is that right?
[AGENT][NEGATIVE] I said that we have not received it, not that it was denied. I said we have not received a claim for this data service and the billed amount of $1,037.
[CUSTOMER][NEUTRAL] OK. May I know the member's effective date and termination date?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Effective date is [PII] and the policy is active.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And when the claim is submitted to APL for review, we will also need for you to send a copy of the primary insurance company's explanation of benefits as well. That is something we must have for this type of plan.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] No I don't OK.
[CUSTOMER][NEUTRAL] OK. Um, tell me more the next data service for the same number.
[AGENT][NEUTRAL] Yes, data service in total bill amount.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, the next data services it's uh [PII], 0 sorry.
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] And then bill amount is $783 even.
[AGENT][NEUTRAL] OK. There's also no claim on file for 928-2024 for 738.
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] Yes, sir, no claim on file.
[CUSTOMER][NEUTRAL] 415.
[CUSTOMER][NEUTRAL] OK. Uh, may I know the electronic mail ID?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] OK. Shall we move to the next one member for the different member?
[AGENT][NEUTRAL] OK, just one moment.
[AGENT][NEUTRAL] OK, and what is your next patient's policy number?
[CUSTOMER][NEUTRAL] Yes, the next patient's policy number is 02512909.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth please.
[CUSTOMER][NEUTRAL] Yes, the patient's name is uh [PII] and then date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yes, the data services uh [PII]. Bill amount is $1,037 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so for data service 926 2024 and billed out $1,057 there is no claim on file.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It's no, it's a $1,037. It's a 1037.
[AGENT][NEUTRAL] OK, there is no claim on file for 1037 either.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we will also need the primary insurance company's explanation of benefits when you submit this claim as well.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, may I know that the patient's effective date and termination date?
[AGENT][NEUTRAL] OK. The effective date is [PII] and there is no term date.
[CUSTOMER][NEUTRAL] OK, patient is active for the data service. May I know the time limit for the claim submission?
[AGENT][NEUTRAL] There's no timely filing limit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] No time like there is not 10.
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, then uh there is no claim time, no time limit for the claim submission, is that right? OK.
[AGENT][POSITIVE] That is right. Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. And [PII], could you please provide the call reference number?
[AGENT][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] As I explained to you, it would be my name along with today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, [PII]. Have a wonderful day. Bye-bye. Take care.
[AGENT][NEUTRAL] OK. All right. Well, if that is all, is that all I can help you with this morning?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, [PII], well then, thank you again for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] OK. Bye. Take care.
[AGENT][POSITIVE] No, thank you. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.