AccountId: 011433970860
ContactId: 84a96c02-0431-4a14-8090-da3e98ab6101
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351559 ms
Total Talk Time (AGENT): 167931 ms
Total Talk Time (CUSTOMER): 129072 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/84a96c02-0431-4a14-8090-da3e98ab6101_20250624T14:27_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling on behalf of a provider to get a claim status information. Good morning. How are you doing today?
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] I'm good, thank you. And may I have the spelling of your name?
[CUSTOMER][NEUTRAL] That is [PII]. It's spells like [PII]. And initial for my last name is [PII]. And I missed your name. Can I have your name, please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My name is [PII]. And may I have a callback number just in case we get disconnected, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes. The callback number is um
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. And it's a direct line.
[AGENT][NEUTRAL] Thank you and you're calling from which facility for my notes?
[CUSTOMER][NEUTRAL] Holy Cross Medical Group.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number is 10605184 M Mary L Lima 7.
[AGENT][NEUTRAL] Um, let me have that number one more time.
[CUSTOMER][NEUTRAL] Yeah. That is 10605184. M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, I'm gonna change some of the numbers around because um it's too many numbers. OK, one moment.
[AGENT][NEUTRAL] Let me try the 0 in front. Um what's the name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the name of the.
[CUSTOMER][NEUTRAL] Yes ma'am. [PII], [PII].
[AGENT][NEUTRAL] OK, go ahead and switch the 0 and the 1.0 goes in front.
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $160 even.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for future. You can check claim status online through our website at [PII], and that's just optional. And let's see, may I have, let's see.
[CUSTOMER][NEUTRAL] So, have you changed your portal to OSC?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, can you repeat?
[CUSTOMER][NEUTRAL] Um, have you changed your portal to OSC?
[AGENT][NEUTRAL] Yes, I
[CUSTOMER][NEUTRAL] Like APLOC?
[AGENT][NEUTRAL] Yes, it did change and, and you need to re-register if you have registered before. It just needs to be created again.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] Yeah, but it's asking for the SSN number necessary to check a claim status.
[AGENT][NEUTRAL] It's not really required, but it's OK. Um, let me go ahead and give you the information that I have here. It looks like we're needing the explanation of benefits from the primary insurance to continue the processing of this claim.
[AGENT][NEUTRAL] Um, and we did receive this claim [PII] and process the same date requesting the primary EOB. We have not received that EOB as of today.
[AGENT][NEUTRAL] So we need that to reprocess the claim.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, claim is pending for primary. All right. Thank you so much for that. Um, so, can I have the claim number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure, the claim number is 3604213.
[CUSTOMER][NEUTRAL] 4213. All right. So as the records, who's primary for this number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you repeat?
[CUSTOMER][NEUTRAL] So, as per your insurance records, the member has um which insurance has the primary insurance?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK. Do you have the primary insurance information? Who's the primary for this member?
[AGENT][NEUTRAL] Um, let me see who's the primary bear with me.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] UHC.
[CUSTOMER][NEUTRAL] OK. Perfect. Can I have the active and the termination date?
[AGENT][NEUTRAL] Of UAC or us?
[CUSTOMER][NEUTRAL] Yes, ma'am. You would say, you would say.
[AGENT][NEUTRAL] We don't have that information.
[CUSTOMER][NEUTRAL] Um, all right, and you know.
[CUSTOMER][POSITIVE] All right. Thank you so much for that. Can I have the uh um accurate the termination of your insurance?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, yes, I can give you that one. OK, so we have an effective date of [PII] and it is active at the moment.
[CUSTOMER][POSITIVE] All right. Thank you so much for your um assistance. I appreciate that. Um, so, um, so can I have the um um fax number or um mailing address that I can send the primary?
[AGENT][NEUTRAL] You're welcome. Mhm.
[AGENT][NEUTRAL] Yes, the fax number is [PII].
[AGENT][NEUTRAL] The mailing address is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]. And do you have any timely filing limit for this?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We don't have time final limits.
[CUSTOMER][POSITIVE] And no timely filing limit. All right, perfect. Thank you so much for your assistance. I appreciate that. Can I have the um reference number for this call?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's state if you will.
[CUSTOMER][POSITIVE] All right. Thank, sorry. Thank you so much for your since have a great and wonderful day ahead. Bye-bye.
[AGENT][POSITIVE] Yes, I'm Mr. [PII]. Thank you for calling APM. bye bye.
[CUSTOMER][NEUTRAL] Bye bye.