AccountId: 011433970860
ContactId: 9869e791-9df5-4642-b89d-7b1634fd94a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 825159 ms
Total Talk Time (AGENT): 170321 ms
Total Talk Time (CUSTOMER): 256734 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/9869e791-9df5-4642-b89d-7b1634fd94a9_20250516T14:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I need the claim information. Can you verify that for me?
[AGENT][POSITIVE] Yes, I can help you with claim status. Could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yeah. My name is [PII] and callback number is [PII] with the extension [PII]. And um can I get your, uh, can you spell your name, please?
[AGENT][NEUTRAL] Yes, it's [PII]. It's [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and um do you have the policy number for that patient, [PII]?
[CUSTOMER][NEUTRAL] Sorry, could you repeat that once again?
[AGENT][NEUTRAL] the policy number for the member.
[CUSTOMER][NEUTRAL] Yeah. It's 02344566.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Native service and bill charges.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And charge amount is, it's $444 even.
[AGENT][NEUTRAL] Um, I don't have a claim on file for that date of service. Can you resubmit that?
[CUSTOMER][NEUTRAL] Uh, actually, we submitted it on [PII]. Can you verify with that date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, no, we haven't
[CUSTOMER][NEUTRAL] And it is a unit, uh unit.
[CUSTOMER][NEUTRAL] And it is a United uh Insurance crossover claim.
[AGENT][NEUTRAL] Yeah, we, we have not.
[CUSTOMER][NEUTRAL] It's a crossover claim.
[AGENT][NEGATIVE] We haven't received it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the TFL to submit the claim?
[AGENT][NEUTRAL] Um, I'm sorry, the address, is that what you're needing?
[CUSTOMER][NEUTRAL] I'm asked for the TFL timely filing.
[AGENT][POSITIVE] Timely filing, there's no timely filing limit.
[CUSTOMER][NEUTRAL] OK. Can I get the mailing address and the payer ID?
[AGENT][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And payer ID?
[CUSTOMER][NEUTRAL] And is there any payer ID?
[AGENT][NEUTRAL] Yes, it's 60801.
[CUSTOMER][NEUTRAL] Thank you. And can I get the patient effective dates?
[AGENT][NEUTRAL] Patient effective date is [PII].
[AGENT][NEUTRAL] Policy is active, no term date.
[CUSTOMER][POSITIVE] Yeah. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Thank you for the information. I do have another claim for the same patient. Can you verify that?
[AGENT][NEUTRAL] Uh yes, give me one moment.
[AGENT][NEUTRAL] Is the date of service and bill charges?
[CUSTOMER][NEUTRAL] It's [PII] and the bill amount is $383 even. It's 383.
[AGENT][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Uh, it looks like we don't have that claim either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And the same patient uh member ID and payer ID, uh, yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] As it is. So, I do have 3 claims. Can you verify that?
[AGENT][NEUTRAL] Uh, for different people or?
[CUSTOMER][NEUTRAL] It's for the different people. The 3 claims are for the different people.
[AGENT][NEUTRAL] OK, do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is
[CUSTOMER][NEUTRAL] 01444815 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] of service and bill charges.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] $336 even.
[AGENT][NEUTRAL] OK, you said [PII]?
[CUSTOMER][NEUTRAL] Yes, it's 426-2024. That's right.
[AGENT][NEUTRAL] Um, we don't have that claim on file, but I do show that the policy terminated [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I, uh, can you update any cop? Do you have that information?
[AGENT][NEUTRAL] Any what?
[CUSTOMER][NEUTRAL] like coinage of benefits. The patient have updated that.
[CUSTOMER][NEUTRAL] In the recent time?
[AGENT][NEUTRAL] Uh, no, I don't have any information after that date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, this effective dates like [PII], uh, the patient has found that it is is the latest uh effective dates of the patient?
[AGENT][NEUTRAL] Uh, the effective date for this is [PII] and then termination [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] May I know, may I know the uh the patient have any another insurance?
[AGENT][NEUTRAL] Uh, we show the primary was UnitedHealthcare.
[CUSTOMER][NEUTRAL] 426
[AGENT][NEUTRAL] That was for [PII] so I don't, I don't know about that.
[CUSTOMER][NEUTRAL] Can you recheck one
[CUSTOMER][NEUTRAL] OK, it is for the [PII].
[CUSTOMER][NEUTRAL] OK. You do not have any information. Does the patient have any secondary insurance, right?
[AGENT][NEUTRAL] Yeah, I don't have any information past [PII] beyond that date. I don't know anything.
[AGENT][NEUTRAL] In the future.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. So there is no claim on file.
[CUSTOMER][NEUTRAL] On your side?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you. And can we go with the another claim?
[AGENT][NEUTRAL] OK, the policy number?
[CUSTOMER][NEUTRAL] Yeah, I, I need, I need to open.
[CUSTOMER][NEUTRAL] The policy ID is
[CUSTOMER][NEUTRAL] 01867061
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Date of service and bill charges.
[CUSTOMER][NEUTRAL] 51 2024 $270 even.
[AGENT][NEUTRAL] They don't show that claim on file.
[CUSTOMER][NEUTRAL] Can I get the effective dates of the patient?
[AGENT][NEUTRAL] Effective [PII] policies active no term date.
[CUSTOMER][NEUTRAL] Sorry, uh, it's [PII].
[AGENT][NEUTRAL] Yes, so [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] like
[CUSTOMER][NEUTRAL] Yeah. Can you go with the last name?
[AGENT][NEUTRAL] Yes, that's the number?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 30
[CUSTOMER][NEUTRAL] [PII] [PII] [PII] [PII], number [PII].
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] 5 to 2024 $201 even.
[AGENT][NEUTRAL] I don't show that claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I get the number?
[CUSTOMER][NEUTRAL] A moment. It is a crossover from the uh Humana. Still, you are unable to find edit?
[AGENT][NEUTRAL] Uh, looks like this policy term 12.
[CUSTOMER][NEUTRAL] It is a first name.
[AGENT][NEUTRAL] This policy terminated 12-1-2023.
[AGENT][NEUTRAL] Uh, let me see if there's another policy.
[AGENT][NEUTRAL] You said 5:20, 2024?
[CUSTOMER][NEUTRAL] It's 52
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, yeah, I don't have that on file. Let me give you the right policy number though.
[AGENT][NEUTRAL] Are you ready?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2452069.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Actually your voice was broke when you speak. Is it 452-069 Policy ID?
[AGENT][NEUTRAL] 245-2069.
[CUSTOMER][NEUTRAL] OK. This is the correct policy ID for the patient, right?
[AGENT][NEUTRAL] Yeah. 2452069.
[CUSTOMER][NEUTRAL] And you said
[CUSTOMER][NEUTRAL] Yeah. You said like the uh plan was termed on [PII]. And may I know the uh is that the patient uh like updated any er benefits?
[CUSTOMER][NEUTRAL] And is there any latest, uh, effective date or this is the last uh latest effective date for the patient?
[AGENT][NEUTRAL] Yeah, this is the latest one. It was effective [PII], terminated [PII].
[CUSTOMER][NEUTRAL] Uh, within the, uh, sorry, it is within the
[CUSTOMER][POSITIVE] Effective dates doses.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, yes.
[CUSTOMER][NEUTRAL] Yeah. And I got the information.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can I get the call to this number?
[AGENT][NEUTRAL] That's my name is [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you. Yeah, I got the information. Thank you for assisting me today.
[AGENT][POSITIVE] Thanks for calling HO.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Have a good day. Bye-bye.
[AGENT][NEUTRAL] OK. Bye-bye.