AccountId: 011433970860
ContactId: 8dc0d5d8-bc6c-481e-b9e2-19dc72ce0495
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 744599 ms
Total Talk Time (AGENT): 275340 ms
Total Talk Time (CUSTOMER): 233421 ms
Interruptions: 1
Overall Sentiment: AGENT=2.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/8dc0d5d8-bc6c-481e-b9e2-19dc72ce0495_20250110T20:20_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII] looking for the claim status. Could you please help me out?
[AGENT][POSITIVE] Yeah, I'd love to help you with claim status, Ms. [PII], and can I have a great callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful. And what is that policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And your name?
[AGENT][NEUTRAL] Oh, I'm sorry. My name is [PII]
[CUSTOMER][NEUTRAL] My member ID is 1, it's 01116824.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Can I have your patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Sure. It's [PII], and the date of birth is on [PII].
[AGENT][POSITIVE] OK, and I'm so sorry. What was that first name again?
[CUSTOMER][NEUTRAL] [PII], it's [PII]
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] Thank you so much and.
[AGENT][NEUTRAL] Give me 1 2nd to get to the search for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect. And what was that date of service you were wanting to look at, Ms. [PII]?
[CUSTOMER][NEGATIVE] I have to date of service. The first one is on [PII] for the amount $160 even.
[AGENT][NEUTRAL] All right, and you said, I'm so sorry, let me read it. [PII], 1060 you said?
[CUSTOMER][NEUTRAL] Yeah, 160.
[AGENT][POSITIVE] Perfect. And what was the second data service you want to look at?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] or [PII], I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII], perfect.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] and um
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] That one I can just tell you right now. I don't have any um.
[AGENT][NEUTRAL] I don't have any claims on file for that particular date of service, the one in November.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Perfect and then one second while I look into the other one for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the name of the facility on file for the 2nd 1?
[CUSTOMER][NEUTRAL] Birmingham Gastroenterology Associates.
[AGENT][NEGATIVE] OK, so unfortunately, I don't have.
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I don't have a claim on file for that date of service either.
[CUSTOMER][NEUTRAL] OK, could you please provide me the electronic payer ID?
[AGENT][NEUTRAL] Yeah, our electronic payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801. And uh could you please confirm me that the policy is active on the date of service within the policy.
[AGENT][NEUTRAL] Yeah, let me take a look at that for you and see what their effective date is.
[AGENT][NEUTRAL] Sorry, one second.
[AGENT][NEUTRAL] Alright, my friend, it looks like, actually it looks like this policy termed 901-2024, so it wouldn't have been active for either date of service.
[CUSTOMER][NEUTRAL] OK. You can provide me the effective date from when to when the policy was active.
[AGENT][NEUTRAL] Yeah, it was effective from [PII] through [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So, I just missed it.
[AGENT][NEUTRAL] Maybe I misspoke. Let me restate that. [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And timely firing to submit the claim.
[AGENT][NEUTRAL] Yeah, uh, the timely filing limit we don't have one. You're welcome to submit at any time.
[CUSTOMER][NEUTRAL] And I do have two more questions.
[AGENT][POSITIVE] Yeah, I can help you with the other two. Give me one moment on my notes here.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] And what is the.
[AGENT][NEUTRAL] I'm so sorry. What is the
[AGENT][NEUTRAL] Policy number for your next claim?
[CUSTOMER][NEUTRAL] It's 1171.
[CUSTOMER][NEUTRAL] 304.
[AGENT][NEUTRAL] And I'm so sorry, it's really hard to hear you.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Yes, that's great 11.
[CUSTOMER][NEUTRAL] 71304.
[AGENT][POSITIVE] Thank you so much and
[AGENT][NEUTRAL] Same your patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII], and the date of birth is on [PII].
[AGENT][POSITIVE] Perfect. Thank you so much.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Perfect. And can I have the date of service for wanting to look for [PII]?
[AGENT][NEUTRAL] Are you still there with me, ma'am?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, I'm so sorry, and what is that date of service?
[CUSTOMER][NEUTRAL] It is [PII] for the amount of $197 even.
[AGENT][NEUTRAL] Alright, so again, I don't have any claims on file for [PII], um.
[AGENT][NEUTRAL] I do want to let you know that this policy did term in [PII] though.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, it was terminated on [PII].
[AGENT][NEUTRAL] Mhm, yep.
[CUSTOMER][NEUTRAL] And from that time, there is no active insurance for this number.
[AGENT][NEUTRAL] No, there is not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the last member, can we move for the last member?
[AGENT][POSITIVE] Uh, yes, absolutely. Let me just finalize this note and I'll be ready in one second.
[CUSTOMER][NEUTRAL] Mhm you can provide me the reference number for this number too.
[AGENT][NEUTRAL] Yeah, so the reference numbers are all going to be the same. We don't have individual numbers, but it's gonna be my name, [PII], first initial last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][POSITIVE] Thank you so much [PII].
[AGENT][POSITIVE] Perfect. And then can I have the policy number for you?
[CUSTOMER][NEUTRAL] Sure, it's
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Um, that's our payer ID, so I don't think that's gonna be the policy number.
[CUSTOMER][NEUTRAL] OK, is that possible to search through the.
[CUSTOMER][NEUTRAL] Member name and the date of birth. I have that in my application.
[AGENT][NEUTRAL] I can search by their first and last name if you could help me with the spelling of their first and spelling of their last name.
[CUSTOMER][NEUTRAL] Search by their first
[CUSTOMER][POSITIVE] Sure. Sure. Thank you.
[CUSTOMER][NEUTRAL] Excuse me. And the first name is?
[CUSTOMER][NEUTRAL] [PII] is spelled as [PII].
[AGENT][NEUTRAL] Perfect and the last name?
[CUSTOMER][NEUTRAL] It's uh [PII]. It's spelled as [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Thank you so much. And let me start searching for him. Uh, would you happen to have the city and state of the insured?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It is the city is [PII] and the state is [PII].
[AGENT][POSITIVE] OK, perfect, thank you and.
[AGENT][POSITIVE] Wonderful. And then, um, [PII]'s date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Thank you so much. And then I do have that policy number if you'd like me to give it to you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Perfect. I do have that policy number is 02323237.
[CUSTOMER][NEUTRAL] Number is 0
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Oh yeah, it's my pleasure and
[AGENT][NEUTRAL] Let me start searching for that claim for you. What is the date of service?
[CUSTOMER][NEUTRAL] It's on [PII]. For this month I have to date service. The first one is for [PII] for the amount of $129 even.
[AGENT][NEUTRAL] OK, and I actually don't have anything for September on file for this one.
[CUSTOMER][NEUTRAL] OK. The last one is for [PII].
[AGENT][NEUTRAL] All right, and then I also don't have anything on file for the month of November either.
[CUSTOMER][NEGATIVE] Alright, and then I also don't have anything.
[CUSTOMER][NEUTRAL] OK, could you please confirm that policy is active on the data service or not.
[AGENT][NEUTRAL] OK, yeah, so, um, let me take a look. It actually looks like that policy is
[AGENT][NEUTRAL] No longer active, but it was active during the date of service from [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] There's an active coverage, right?
[AGENT][NEUTRAL] Yes, so it should have been active during that date of service for you.
[CUSTOMER][NEUTRAL] Yes, so it shouldn't been active right now.
[CUSTOMER][NEUTRAL] OK. Uh, I just repeat the um date it's [PII].
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] And will you accept the claim through electronically?
[AGENT][NEUTRAL] Uh, yes, through that electronic payer ID the 60801.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] And will you accept the claim through fax?
[AGENT][NEUTRAL] Yes, our fax number is [PII].
[CUSTOMER][NEUTRAL] Fax number
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][POSITIVE] Yeah it's my pleasure.
[CUSTOMER][POSITIVE] For your assistance and have a nice day, happy weekend.
[AGENT][POSITIVE] You too, Ms. [PII], you take care and thanks for calling APL.
[CUSTOMER][NEUTRAL] Your
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.