AccountId: 011433970860
ContactId: 97d56949-7cca-4a27-a79a-20663f97e53c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 237429 ms
Total Talk Time (AGENT): 73920 ms
Total Talk Time (CUSTOMER): 77014 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/97d56949-7cca-4a27-a79a-20663f97e53c_20250527T19:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, I need the claim information. Can you verify that for me?
[AGENT][NEUTRAL] Yes, I can check on a claim for you. What was your name?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] and the last [PII] is [PII]. Can you spell your name, please?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] Sure, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII], with the extension [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, policy number.
[CUSTOMER][NEUTRAL] 1,823,150
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, so I will say that this member, um, the last policy that they had with us terminated in [PII]. Did you still want me to see if that claim was received?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what was that bill amount for the claim, please?
[CUSTOMER][NEUTRAL] It's $336 even.
[AGENT][NEUTRAL] 336. OK, thank you one moment.
[AGENT][NEUTRAL] OK, no, I'm not showing that we have received this claim.
[CUSTOMER][NEUTRAL] There is no claim on file?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] It is an Aetna Crossover claim. Can you verify once again?
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] It's not direct bill to you.
[CUSTOMER][NEUTRAL] Uh, it's, it's, the claim is crossover by the Aetna.
[CUSTOMER][NEUTRAL] Still there is no claim on file?
[AGENT][NEUTRAL] That's correct we've not received this claim.
[CUSTOMER][NEUTRAL] May I know the patient effective date?
[AGENT][NEUTRAL] This policy's effective date was [PII] and it did terminate [PII].
[CUSTOMER][NEUTRAL] Is there, uh, may I know recently, uh, like patient had updated any coordination of benefits?
[AGENT][NEGATIVE] There is no coordination of benefits.
[CUSTOMER][NEUTRAL] Is this the latest, uh, uh, effective dates or any, uh, uh latest effective rates of this?
[AGENT][NEUTRAL] This, yes.
[AGENT][NEUTRAL] That's correct. This was the last policy this member had with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you know,
[CUSTOMER][NEUTRAL] Can I get the timely filing to submit the claim?
[AGENT][NEUTRAL] There is no timely filing limit. However, again, this policy terminated in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, can, uh, yeah, I do have the claim for the different patient. Can you verify that?
[AGENT][NEUTRAL] What was that? I'm sorry?
[CUSTOMER][NEUTRAL] I do have another claim for the different patient. Can you verify that?
[AGENT][NEUTRAL] This was for a different member?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, yes, give me just a moment, I'll let you know and I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Sure
[AGENT][POSITIVE] Thank you. One moment.