AccountId: 011433970860
ContactId: 8b9315fc-3a1d-4296-9015-c25bf0f501fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363019 ms
Total Talk Time (AGENT): 124615 ms
Total Talk Time (CUSTOMER): 125324 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/8b9315fc-3a1d-4296-9015-c25bf0f501fb_20250425T17:05_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Uh, very good afternoon. Thank you so much. My name is [PII]. I need to check claim status.
[AGENT][POSITIVE] OK, [PII], I'll be more than happy to help you with the claim status, and are you calling with the provider's office?
[CUSTOMER][NEUTRAL] Yes, provider office.
[AGENT][NEUTRAL] OK. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. It's a direct line number?
[AGENT][NEUTRAL] OK, thank you for that. And the member's policy number?
[CUSTOMER][NEUTRAL] Uh yes, policy number, that is, uh, just a moment.
[CUSTOMER][NEUTRAL] First, that is uh 02.
[CUSTOMER][NEUTRAL] 29
[CUSTOMER][NEUTRAL] 2648.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes, remember first name that is uh [PII]. Last name that is uh [PII].
[CUSTOMER][NEUTRAL] And date of birth, that is uh [PII].
[AGENT][NEUTRAL] Thank you for that 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] Uh, yes, the date of service that is from uh [PII]. And the total charge on that we have $13,836.28.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK, ma'am.
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold while I locate the claim?
[CUSTOMER][POSITIVE] Yeah, sure, sure. Take your time. No problem.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So, we only received two claims on that date. What is the name of the of your provider's office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, yes, uh, just a moment. Provider office that is, uh, Saint Francis East Side Hospital and uh I have NPI if you need, I can provide you.
[AGENT][NEUTRAL] No, it's OK. You said Saint Francis.
[AGENT][NEUTRAL] I'm typing it.
[CUSTOMER][NEUTRAL] Eastside Hospital.
[AGENT][NEUTRAL] East side, OK.
[CUSTOMER][NEUTRAL] Yes, it can be uh By or Saint Francis side as well.
[AGENT][NEUTRAL] Let me see if the other one was hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it's only this one. OK, so we've only received one claim with um for Saint Francis Hospital. What's your tax ID?
[CUSTOMER][NEUTRAL] Uh your tax ID that is 5825.
[CUSTOMER][NEUTRAL] 04
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it's the same tax ID, it's a different total bill. So this um claim was billed for 1900. Would that be the same claim or if not, we have not received your claim?
[CUSTOMER][NEUTRAL] No, no, no, we have a total amount that is 19,445. So you're providing 1000, right? So I think that was not the correct uh claim for this, uh.
[AGENT][NEGATIVE] No, no, no, no, no, no, no.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] The total bill for the claim that we received is $1900. So unless your claim has a different total bill, we have not received your claim.
[CUSTOMER][NEUTRAL] OK, OK. Thank you so much. So can you please confirm me uh policy effect date and term date so that we can reveal once again.
[AGENT][NEUTRAL] Sure, hold on one moment
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, ma'am.
[AGENT][NEUTRAL] Uh, it was active from [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, can you please confirm your, uh, claim mailing address?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK. Can you please confirm me your timely only limit for uh the submit the claim?
[AGENT][NEUTRAL] So there's no timely filing limit as long as the policy was active on the data service, you can file the claim.
[CUSTOMER][POSITIVE] OK. Thank you so much. Please confirm your call reference number.
[AGENT][NEUTRAL] Um, there's no call reference number, but you can use my name in today's date, which is [PII].
[AGENT][NEUTRAL] [PII] The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much, but for now that.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, no. Thank you so much. Bye.
[AGENT][POSITIVE] Alright, thanks for calling APO bye bye.
[CUSTOMER][POSITIVE] Thank you