AccountId: 011433970860
ContactId: 97394342-450a-42f1-af50-066fc13c173a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 390170 ms
Total Talk Time (AGENT): 129947 ms
Total Talk Time (CUSTOMER): 94722 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/97394342-450a-42f1-af50-066fc13c173a_20250320T14:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Health Advocate, um, trying to assist this, um, one of your members with getting.
[CUSTOMER][NEUTRAL] Um, I'm checking to see if you received the claim for one of your members.
[AGENT][NEUTRAL] OK, I can help you with claim status. That's OK. That that's OK, [PII]. I can help you with the claim status. What is your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Last track.
[CUSTOMER][NEUTRAL] The number is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then can you please give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] 02579090
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, it should be for $27,693.
[AGENT][NEUTRAL] OK, and then what's the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Yeah, he received a bill for.
[CUSTOMER][NEUTRAL] $3270.51.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright let me look this claim up for you I'm gonna put you on a quick hold while I do that and I'll be right back.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me. [PII]. So looking at um [PII]'s policy, his policy was never actually activated.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So he, he does not have a policy with us that's active. Let me look and see if the previous policy.
[AGENT][NEUTRAL] He had a previous policy that was active from [PII]. So he was not.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Effective on the date of service.
[AGENT][NEUTRAL] No way, yes, he was.
[CUSTOMER][NEUTRAL] OK. So, OK.
[AGENT][NEUTRAL] Let me look at 7 on 7:[PII].
[AGENT][NEUTRAL] And I'm not showing that.
[AGENT][NEUTRAL] We have a claim on file for that data service, but let me give you the policy number and that might be why because it was probably sent to the other policy number that was never was really issued so the correct policy number if you want to resubmit the claim.
[AGENT][NEUTRAL] Is 246-3264.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so if it was under the old one that's termed under the incorrect ID um you wouldn't be able to like move it over to.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. So it'll need to be resubmitted.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, perfect. Alright, can I get a call reference number? And then hold on, can I ask that one?
[AGENT][POSITIVE] Yes ma'am, you can use uh huh, sure.
[CUSTOMER][NEUTRAL] Is there like a time frame um that these claims must get on file or?
[AGENT][NEUTRAL] No, ma'am, we do do not have any timely filing limit as long as the patient was active on the date of service, you can file a claim at any time.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Alright, I just need a call reference number.
[AGENT][NEUTRAL] OK, you can use my name, [PII] today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. Thank you, [PII].
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Hope you have a good rest of your day and thanks for calling APL.
[CUSTOMER][NEUTRAL] Alright, you do the same. Bye-bye.
[AGENT][NEUTRAL] Bye bye.