AccountId: 011433970860
ContactId: 97cf5403-fe8f-4522-ac8e-e933e36b3ace
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 989500 ms
Total Talk Time (AGENT): 292399 ms
Total Talk Time (CUSTOMER): 349599 ms
Interruptions: 9
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/97cf5403-fe8f-4522-ac8e-e933e36b3ace_20250421T20:43_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hello?
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][POSITIVE] How can I help you today?
[CUSTOMER][NEUTRAL] Hey, hello, this is, uh, [PII] this calling from provider's office to check on a claim status. Can you help me with it?
[AGENT][NEUTRAL] I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] and you're needing to check one. Yes, ma'am, you don't need to fill it. That's OK. And [PII], you're needing to check status on one claim, is that correct?
[CUSTOMER][NEUTRAL] R as in Romeo. O.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, maybe 2.
[AGENT][NEUTRAL] Two claims?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, are they for the same patient or two different patients?
[CUSTOMER][NEUTRAL] Um, two different patients.
[AGENT][NEUTRAL] Yes, [PII], I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] What are the last
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 4 numbers again.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Uh-huh.
[AGENT][NEUTRAL] OK. Give me, OK. Give me your extension number again.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what was the 615 number that you were giving me?
[CUSTOMER][NEUTRAL] That was the uh call back.
[AGENT][NEUTRAL] You said [PII], is that?
[AGENT][NEUTRAL] OK, extension [PII].
[CUSTOMER][NEUTRAL] Yeah, do you want me to repeat it?
[AGENT][NEUTRAL] No, ma'am. And [PII], you will use my name that I gave you along with today's date as each of your call reference numbers. Also, any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. And if we do have the claims on file, once you have the claim number, [PII], if you need a copy of the explanation of benefits, you can print those by going to our portal and the website for that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] That is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, the policy number will be 01299855 MM as in Mary, L as in Lima 82.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, I must have misheard the policy number. What is the policy number again? Because what I typed in was 0125.
[CUSTOMER][NEUTRAL] No, no. Just 012.
[AGENT][NEUTRAL] 985 5.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, yeah, uh, please note it down. 012998.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 55 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] And again the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm gonna have to wait just a moment, [PII], on my system. One moment, please.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] at
[CUSTOMER][NEUTRAL] So [PII]
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Yeah, sorry, yeah, the data service will be [PII] and the bill amount will be $3,045 even.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, and [PII], you said the date of service.
[AGENT][NEUTRAL] It's [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Again you want that?
[AGENT][NEUTRAL] I'm asking you if the date of service is [PII].
[CUSTOMER][POSITIVE] Yes, ma'am. Correct.
[AGENT][NEUTRAL] OK, there is no claim on file for this number for that data service and that bill amount.
[CUSTOMER][NEUTRAL] No claim on file.
[AGENT][NEUTRAL] Not on file.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] No claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, give me a moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, ma'am. Thank you so much for that. Um, so may I have the policy effective and term date?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] The effective date is
[AGENT][NEUTRAL] Going to be
[AGENT][NEUTRAL] [PII] and it is active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when the claim is submitted to APL for.
[AGENT][NEUTRAL] You, we will also need for you to send a copy of the company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need any other information, [PII] on this member's policy?
[CUSTOMER][NEUTRAL] Uh, I think, uh, it's, uh, is it lies between the family family life, right?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] We do not have a timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So, uh, can you give me the, uh, do you want the, uh, EUV, right?
[AGENT][NEUTRAL] You will need to send us the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, and for that, can you give me the POID or the mailing address or anything you're comfortable with?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The payer ID is 60801.
[AGENT][NEUTRAL] The claims fax number is [PII] attention claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] 94
[AGENT][NEUTRAL] 23
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Again, [PII] attention claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm. OK.
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. Can you repeat the mailing address, please?
[AGENT][NEUTRAL] [PII], [PII], [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes. [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] [PII], Okla.
[CUSTOMER][NEUTRAL] Give me a minute.
[AGENT][NEUTRAL] Mhm. The state is also [PII].
[CUSTOMER][NEUTRAL] Uh, yeah, it's [PII], [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Dash
[CUSTOMER][NEUTRAL] [PII]-day.
[AGENT][NEUTRAL] 8950.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 8950.
[CUSTOMER][NEUTRAL] OK, ma'am. So, um just uh double check with me, please. Uh, the pay ID will be 60801, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the fax number will be [PII]. Uh, attention to the claims department, mailing address will be [PII], [PII].
[AGENT][NEUTRAL] No. 2.
[AGENT][NEUTRAL] [PII], no, ma'am, the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Uh, [PII]. Yup. [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, meanwhile, can I get the call reference number?
[AGENT][NEUTRAL] My name and as I explained to you, you would use my name that I gave you and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh [PII] [PII], correct?
[AGENT][NEUTRAL] Actually, my name ends in an [PII]
[CUSTOMER][NEUTRAL] OK, [PII] and the initials will be?
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Do you have, do you have the last name initials, ma'am?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am. Thank you for that. And can we move to the next claim?
[AGENT][NEUTRAL] You're welcome. And what is your
[AGENT][POSITIVE] Yes ma'am, we can.
[CUSTOMER][NEUTRAL] Yes, ma'am. It's [PII].
[AGENT][NEUTRAL] Right. What is the policy number?
[CUSTOMER][NEUTRAL] R O S I E.
[AGENT][NEUTRAL] Yes ma'am, I already
[CUSTOMER][NEUTRAL] OK, give me a
[CUSTOMER][NEUTRAL] Yes, I'm just pulling, pulling up that for you. Please wait.
[AGENT][NEUTRAL] Yes, ma'am. I have your name.
[AGENT][NEUTRAL] What is the next policy?
[CUSTOMER][NEUTRAL] Give me a moment, I'm pulling that up for you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] Uh, so the, uh, member ID will be 02491434 M as in Mike, L as in Lima 8.
[AGENT][NEUTRAL] Thank you. Patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] You want me to spell it for you?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Date of birth will be [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] In the data service in total build out.
[CUSTOMER][NEUTRAL] Yeah, date of service will be on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the bill amount is $1720 even.
[AGENT][NEUTRAL] 1720. Is that correct?
[CUSTOMER][NEUTRAL] 1720, yes.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so this claim was received on 12-16-2024.
[AGENT][NEUTRAL] It was processed and denied on 12-18-2024.
[CUSTOMER][NEUTRAL] Um, sorry, hello.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Ma'am, can you please repeat? I'm very sorry for that.
[AGENT][NEUTRAL] Received 1216 2024.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Denied on 12.
[CUSTOMER][NEUTRAL] Hello. Sorry, ma'am. You are not.
[CUSTOMER][NEUTRAL] You're not audible. I'm very sorry for that. I'm very sorry.
[CUSTOMER][POSITIVE] Um, yes, ma'am. You can please continue. I'm very sorry. I'm very, very sorry.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello, ma'am. Hello.
[CUSTOMER][NEUTRAL] Are you there? hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, ma'am.
[CUSTOMER][NEUTRAL] Hello? Can you hear me? Hello?