AccountId: 011433970860
ContactId: 8a2d925f-6ecc-4f1d-a0a7-eebb58e05891
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 636049 ms
Total Talk Time (AGENT): 197381 ms
Total Talk Time (CUSTOMER): 215305 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/8a2d925f-6ecc-4f1d-a0a7-eebb58e05891_20250213T16:48_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah, hi. Uh, this is [PII] calling from provider's office looking for the claims information.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] It's uh 023-37122 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's uh first name is [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information, [PII], and you said that you're checking claim status?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] Alright, what's the date of service and the total bill?
[CUSTOMER][NEUTRAL] And the rate of service would be on [PII] and the bill amount is $2,253.
[AGENT][NEUTRAL] OK, you said [PII] for $2,253?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the procedure codes on the claim or just a few of them?
[CUSTOMER][NEUTRAL] 883-128831388305.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I show the claim was received [PII], processed [PII]. No payment was made on this claim?
[AGENT][NEUTRAL] Under this particular particular policy.
[CUSTOMER][NEUTRAL] the.
[AGENT][NEUTRAL] Um, treatment in a doctor's office is not covered.
[CUSTOMER][NEUTRAL] I know the denial reason.
[AGENT][NEUTRAL] And I show that
[AGENT][NEUTRAL] Treatment in the doctor's office is not covered.
[AGENT][NEUTRAL] And let me know when you're ready for the policy number.
[CUSTOMER][POSITIVE] cool
[AGENT][NEUTRAL] I'm sorry, the claim number?
[CUSTOMER][NEUTRAL] Just something.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Claim number?
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] It is 351-580-07 and [PII], you can also check your claim status online at [PII].
[AGENT][NEUTRAL] [PII] as well. And did you have any other questions?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'll provide uh our fax number. Can you fax me that to your?
[AGENT][NEUTRAL] It actually was already mailed to the address on the claim when um when the claim was processed and it's now available to download on the website just provided. I can help you create that account if you would like.
[CUSTOMER][NEUTRAL] Yeah. Yeah.
[AGENT][NEUTRAL] It's secured, that's [PII].
[AGENT][NEUTRAL] U R E.
[CUSTOMER][POSITIVE] Secured
[AGENT][NEUTRAL] [PII] a [PII] on the end. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I I um.
[CUSTOMER][NEUTRAL] Um, that's
[AGENT][NEUTRAL] And you can search by the the quick search using the claim number.
[CUSTOMER][NEUTRAL] Uh, asking for the logins, but we don't have the logins.
[AGENT][NEUTRAL] What is it asking for specifically?
[CUSTOMER][NEUTRAL] Username and the password.
[AGENT][NEUTRAL] OK, so if you've not created an account, you have to create the account. Do you have, you have to.
[CUSTOMER][NEUTRAL] How much time it will take to get access.
[AGENT][NEUTRAL] OK, now that's dependent upon you.
[AGENT][NEUTRAL] I mean it'll once you uh once you respond to or answer the criteria so like creating a username and password then it'll let you into the site.
[CUSTOMER][NEUTRAL] You're on
[CUSTOMER][NEUTRAL] Oh, is it not possible to, uh, fax the?
[AGENT][NEUTRAL] We can, but I was just wanting to assist you in downloading it so that you'll know for future reference.
[CUSTOMER][NEUTRAL] OK, fax to your bank and provide our fax number.
[AGENT][NEUTRAL] OK, can I get a please with that?
[CUSTOMER][NEUTRAL] And the fax number is [PII].
[AGENT][NEUTRAL] Anything else I can assist with today, [PII]?
[CUSTOMER][NEUTRAL] I do have another 2 claims, uh, before that, may I know the call reference number so that we can go to the next claim.
[AGENT][NEUTRAL] You'll use my name in today's status reference. What's the next policy number? Provide the patient's name and date of birth and the date of service and the charge.
[CUSTOMER][NEUTRAL] And your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Get them up to the next number I.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the next member ID would be [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I need you to verify the information.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] You need the rate of service and the bill amount.
[AGENT][NEUTRAL] The patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is on [PII]. And the date of service is [PII].
[AGENT][NEUTRAL] What is the date of service again?
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $348.
[AGENT][NEUTRAL] And are you saying [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, I'm not showing that date of service on file for [PII].
[CUSTOMER][NEUTRAL] You're not showing.
[CUSTOMER][NEUTRAL] Just a second, uh, the bill amount is $348.
[AGENT][NEUTRAL] Yeah, I'm not showing that data service on file for this patient.
[CUSTOMER][NEUTRAL] We need to uh refile the claim.
[AGENT][NEUTRAL] OK, that's up to you. I'm just saying it's not received in our office.
[CUSTOMER][NEUTRAL] Uh, uh, may I know the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII] and of course that's to [PII] for American Public Life.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] ZIP code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the city?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So we move to the next member ID.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] It's 152-4156 M as in Mike 17.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sorry. I
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And the date of service and total charge?
[CUSTOMER][NEUTRAL] It's on [PII] and the bill amount is $1,938.
[AGENT][NEUTRAL] Procedure codes on that claim?
[CUSTOMER][NEUTRAL] 883-058831288313.
[AGENT][NEUTRAL] OK, I'm not showing that claim on file for this patient.
[CUSTOMER][NEUTRAL] We have uh accept the claim.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] They have faxed the claim to the fax number [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you repeat the fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is the correct fax number, but I don't show the claim on file.
[CUSTOMER][NEUTRAL] OK, we can resubmit it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] No, may I know the TFL for time defining number?
[AGENT][NEUTRAL] To submit the claim, there's no timely filing limit?
[CUSTOMER][POSITIVE] OK, ma'am. Thank you so much. Have a good day.
[AGENT][POSITIVE] You're welcome [PII] thanks for calling APL. Have a good day.