AccountId: 011433970860
ContactId: 94d8f26c-0dbf-407f-8267-735bc9ac2d2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 622260 ms
Total Talk Time (AGENT): 168137 ms
Total Talk Time (CUSTOMER): 155327 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/94d8f26c-0dbf-407f-8267-735bc9ac2d2b_20250402T20:25_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][NEUTRAL] Hi, my name is [PII] calling for claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Hello.
[CUSTOMER][POSITIVE] Yes, I'm here for you, sorry.
[AGENT][NEUTRAL] Yes, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] That is [PII] and it is a direct line.
[AGENT][NEUTRAL] OK, and the policy number?
[CUSTOMER][NEUTRAL] And that is going to be
[CUSTOMER][NEUTRAL] 01639200.
[AGENT][NEUTRAL] Thank you for that. And [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I, I have 2 claims for the day.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, once a month week again.
[CUSTOMER][NEUTRAL] Uh sorry?
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, you're asking for the data source and build amount, right?
[AGENT][NEUTRAL] No, I'm asking for the member's first and last name and date of birth to verify the policy.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Member's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Uh, data service is going to be [PII], build amount 2 $77 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[AGENT][NEUTRAL] Can you please verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, ESC physicians.
[AGENT][NEUTRAL] I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3583843.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because the services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So expenses cover, OK. After coverage terminated. Can I effective date and term date of the policy?
[AGENT][NEUTRAL] Yes, it's been effective from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. What turn down?
[AGENT][NEUTRAL] Um, hold on one moment, let me go back.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Sorry, sorry, sorry.
[AGENT][NEUTRAL] The policy terms on [PII].
[CUSTOMER][NEUTRAL] Oh, sorry, [PII]?
[AGENT][NEUTRAL] OK, sir. Please pay attention. So it's effective from [PII].
[CUSTOMER][NEUTRAL] [PII], uh, sorry, I missed out.
[CUSTOMER][NEUTRAL] Really sorry.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's great. Just make sure the claim number 3583843.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And uh received date for the claims.
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Uh, hold on one moment. Let me go back to that.
[CUSTOMER][NEUTRAL] All right, all right, all right.
[AGENT][NEUTRAL] The claim was received on [PII] and was denied on [PII].
[CUSTOMER][NEUTRAL] OK, got dinner today.
[CUSTOMER][POSITIVE] That's grateful. And uh we'll go with the next question. Can I have the call reference for this?
[AGENT][NEUTRAL] The call reference number for the entire call will be my name and today's date. Again, that's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can I place this call on hold for just one minute? I'll be back.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] We'll go the next patient.
[CUSTOMER][POSITIVE] Thank you so much for my patience. I'm back.
[CUSTOMER][NEUTRAL] We'll go with the last patient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, we'll go with the next patient. Shall I go with the next member ID?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You can provide the patient ID when you're ready.
[CUSTOMER][NEUTRAL] Or a second [PII].
[CUSTOMER][NEUTRAL] Uh, yes, the patient's member ID I have is 02446538 number.
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, first and last name, yeah [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Um, date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and again for the call, 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] OK.
[CUSTOMER][NEUTRAL] Data service I was going to be [PII]. The amount $83 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And so for Addie, we don't have a claim on file for [PII] for $83.
[CUSTOMER][NEUTRAL] No claim on file, right? OK.
[CUSTOMER][POSITIVE] That's great. And just to make sure the claim mailing address that is going to be?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh, uh, yes, right? OK. And, uh, can I have the payer ID?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] It's 60
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. That's great and the timely filing limit to submit claims?
[AGENT][NEUTRAL] Um, so there's no timely filing as long as the policy was active on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] OK. Can I have the effective date and term rate of the patient's policy?
[AGENT][NEUTRAL] Yes, hold on one moment.
[CUSTOMER][POSITIVE] All right. Take your time.
[CUSTOMER][NEUTRAL] Patient is directive from?
[AGENT][NEUTRAL] Um, so, uh, give me just a moment, it's coming up.
[CUSTOMER][NEUTRAL] OK, OK. OK, OK. Sorry, sorry.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the policy is still active and it's been effective since [PII].
[CUSTOMER][NEUTRAL] OK, just to make sure the call reference for this also, your name and today's date, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] [PII], last name.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you. That's all for the day. Bye. So sweet. take care. Bye.
[AGENT][POSITIVE] Thank you for calling APL. Bye-bye.