AccountId: 011433970860
ContactId: 9b0c3f8e-c2c9-4587-95ee-4c6ea47df8d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 987820 ms
Total Talk Time (AGENT): 269568 ms
Total Talk Time (CUSTOMER): 398594 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/9b0c3f8e-c2c9-4587-95ee-4c6ea47df8d9_20250407T21:04_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] Hey, hi, this is [PII] calling from the office to check on the general claim status.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, and a good callback number will be [PII]. It's a direct line.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] To be.
[AGENT][NEUTRAL] Can you give me the last number? I made a mistake and typed it in where the policy number goes. It was 844608.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 24
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 08. OK. And the policy number?
[CUSTOMER][NEUTRAL] Uh, yes, the policy number will be 02565852.
[CUSTOMER][NEUTRAL] And I do have uh the claim number with me.
[AGENT][NEUTRAL] OK, and what's the claim number?
[CUSTOMER][NEUTRAL] 3554299
[AGENT][NEUTRAL] OK, and that was um policy number 256-585-2?
[AGENT][NEUTRAL] Was that correct?
[CUSTOMER][NEUTRAL] 0256.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it is 02565852.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, and the member's name is [PII] and the last name is [PII]. And the 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. And I have the claim here and um did you need a claim status or you have particular questions about it?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, so, actually, I need uh the general claim status like when did you receive and yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so the claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 4299.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, actually, we send the primary via fax, and can you please uh verify and check from your end whether you have received the primary OB or not.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] As of now, this is the only claim that we've received um for this data service, so we have not received the fax.
[CUSTOMER][NEUTRAL] OK. Give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. Uh, so, may I get the fax number, please?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] And, and also let me know the uh mailing address as well.
[AGENT][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] And what is the timely filing to submit this primary OB?
[AGENT][NEUTRAL] Um, there's no timely filing as long as the policy is active, you can file at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. And uh give me a moment. And on one call, how many claims you're going to provide?
[AGENT][NEUTRAL] Um, how many claims do you need to go through?
[CUSTOMER][NEUTRAL] That I'm
[CUSTOMER][NEUTRAL] Actually, I do have 4 claims with me and almost I have completed with 1 and you can provide 1 another 3 claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, I can assist you with the other 3. Just let me note this one and we can move on to the next one. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh let me know what the call reference number.
[AGENT][NEUTRAL] For the entire call will be my name and today's date. The first initial to my last name is [PII], my first name is [PII]
[CUSTOMER][POSITIVE] Thank you so much for that information.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] It is 01663489.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And yes, the member's uh first name will be?
[CUSTOMER][NEUTRAL] [PII] and it is [PII] and the last name is [PII]. It is [PII] OK. And the member's date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill?
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yes, it was [PII] and the total bill amount was $6,354.35.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Alright, so we received the claim on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 6338.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] of the
[AGENT][NEUTRAL] Requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK, and uh to the same mailing address and the fax number you have provided.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. I'm just going with the another claim, OK?
[AGENT][NEUTRAL] I I have to note each policy. Hold on one moment.
[CUSTOMER][POSITIVE] Sure. Take your own time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Uh, give me a moment.
[CUSTOMER][NEUTRAL] OK. The next policyholder on uh number will be?
[CUSTOMER][NEUTRAL] 02444783
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes. And uh the member's first name is [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you and again just for the call, the information.
[CUSTOMER][NEUTRAL] And you
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][POSITIVE] Sure, yeah, uh, no issue. Go ahead.
[AGENT][NEUTRAL] It's OK, go ahead.
[AGENT][NEUTRAL] What's the date of service for the claim?
[CUSTOMER][NEUTRAL] Yes, yes. I'm just providing the same information. So the details service we do have on file is [PII] with the bill amount $749 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing that this claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3566495.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, and I need to ask you one more thing, and for all the members, uh, the time you calling will be same or it will be different?
[AGENT][NEUTRAL] The time we file them is the same.
[CUSTOMER][NEGATIVE] OK, and one more last account I'm just flapping with that, uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] um
[AGENT][POSITIVE] Alright, I'm ready for the next number when you are.
[CUSTOMER][NEUTRAL] Yes, I'm ready with that and uh the member ID is 1152749.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And his first name is uh [PII] and the last name is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you for that and 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 bills?
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Yes, and the total bill amount is uh $47,481 even. And uh the date of service is [PII].
[CUSTOMER][NEUTRAL] Uh, it was 2024.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] Be done.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, now for this data service, [PII], I'm not showing any claims on file for [PII].
[CUSTOMER][NEUTRAL] OK. And I'll just confirm with the address for bill via mailing address. OK. It was [PII] and uh give me a moment. And the city is [PII] and the ZIP code is [PII]. Is this the correct mailing address we billed you?
[AGENT][NEUTRAL] No, the correct mailing address is, um, that's our old claims mailing address. It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh do you have any payer ID?
[AGENT][NEUTRAL] Yes, it's the same, 60801.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 60801. OK. And may I know the member's effective and the termination date, please?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] It is not available on us.
[CUSTOMER][NEGATIVE] Not delivered.
[AGENT][NEUTRAL] The policy is still active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, what is the termination date?
[AGENT][NEUTRAL] The policy is still active.
[CUSTOMER][NEUTRAL] OK, no term date, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, what is the timely filing?
[AGENT][NEUTRAL] Again, there's no timely filing as long as the policy is active on the date of service, you can file at any time.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Sorry for that. Uh, do you have any group name?
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Let me go I'm ready.
[AGENT][NEUTRAL] The group name is Healthy Mothers.
[AGENT][POSITIVE] Healthy babies.
[CUSTOMER][NEUTRAL] Of
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Healthy mothers and baby, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what is the group number, please?
[AGENT][NEUTRAL] 16312.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And uh may I know the plan type?
[AGENT][NEUTRAL] This is a Metlink policy. Is there a secondary gap insurance?
[CUSTOMER][NEUTRAL] Uh, sorry?
[AGENT][NEUTRAL] This is a secondary insurance or a secondary gap insurance policy.
[CUSTOMER][NEUTRAL] Secondary gap insurance policy.
[CUSTOMER][NEUTRAL] OK, and uh, the member is a policy holder or he's a subscriber?
[AGENT][NEUTRAL] [PII] is the policyholder. She's the policyholder.
[AGENT][POSITIVE] She's a well subscriber as well.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK. Uh, and thank you so much for all the information you have provided on the call. Have a great day ahead. I got all the information.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Uh, enough for this, OK. I do have only the 4 claims on file with me. I have, uh, all the information. Thank you so much for this information. Have a great day ahead.
[AGENT][POSITIVE] All right, you also thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.