AccountId: 011433970860
ContactId: 9b92e893-f552-4d67-a42f-e70b685f673a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 577369 ms
Total Talk Time (AGENT): 145260 ms
Total Talk Time (CUSTOMER): 318558 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/9b92e893-f552-4d67-a42f-e70b685f673a_20250108T13:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for Doctor [PII] to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number is going to be 02260440.
[AGENT][NEUTRAL] OK, what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, the callback number is going to be [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, and what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The patient name is going to be [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] All right, thanks for that information, [PII], and you said that you're checking a claim status?
[CUSTOMER][POSITIVE] Yes, you're absolutely right.
[AGENT][NEUTRAL] OK, what's the date of service in charge?
[CUSTOMER][NEUTRAL] Uh, date of service is going to be [PII] and the total charge is going to be uh $263.27.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK, I'm not showing a claim on file for that date of service for [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, got that information. This claim has been submitted on [PII] through via paper to the mailing address. I'll just provide the mailing address. Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sure thank you.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes, so the mailing address is going to be [PII]. The address is correct, correct?
[AGENT][NEUTRAL] That is correct. [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That is the correct mailing address. I can also provide you the fax number.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, OK, just a moment please.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, you're having the payer ID. I don't need the uh fax number.
[AGENT][NEUTRAL] The payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801. OK, got that information. Just a moment.
[CUSTOMER][NEUTRAL] This address is [PII].
[AGENT][POSITIVE] Yeah, the mailing address is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, gather the information. And could you help with the patient policy effective date and determination date, please?
[AGENT][NEUTRAL] Showing the policy effective date is [PII]. The policy is no longer active as of [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] turned on [PII]. OK. But the patient, uh, date of birth is [PII]. That means, uh, the patient is not active for the date of service, right?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got that information. Is there any other insurance for this patient?
[AGENT][NEUTRAL] There are no active policies with APL.
[CUSTOMER][NEUTRAL] OK, that means uh the member not having any other insurance for, right?
[AGENT][NEUTRAL] Not with American public life. That's correct.
[CUSTOMER][NEUTRAL] OK. Does the policy got uh active after the termination date?
[AGENT][NEUTRAL] There is no active coverage for this patient. The termination date is [PII].
[CUSTOMER][NEUTRAL] OK, I got the information just a moment.
[CUSTOMER][NEUTRAL] There's not that for the date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I gather all the information. Just give me a moment. I'll list the payment information for this patient. If now we can move to that step.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, we didn't receive the payment also. I gathered all the information about this claim and I'm having another claim also. Could you please assist for that?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, I gathered all the information about that claim, and I'm having another claim also. Could you please assist for that?
[AGENT][NEUTRAL] I can. You can also check your status on our online service center at [PII], and it's a claim for the same patient or a different patient.
[CUSTOMER][NEUTRAL] Uh, it's for a different patient.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Policy number it's going to be 1221976 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] 1221976, it's missing one digit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, it is M as in Mike, L as in Lima 7.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Number 7.
[AGENT][NEUTRAL] Before the elm there should be 7 numbers.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I'm just having 1221976.
[AGENT][NEUTRAL] What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Question name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, that is the, that's the policy number. What's the date of service?
[CUSTOMER][NEUTRAL] OK. Date of service is going to be [PII].
[AGENT][NEUTRAL] And the amount?
[CUSTOMER][NEUTRAL] $400 even.
[AGENT][NEUTRAL] OK, let me give you the current policy number for that date of service. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Uh, yes, just a moment. Yes, I'm ready.
[AGENT][NEUTRAL] That number is 200.
[AGENT][NEUTRAL] 6254.
[CUSTOMER][POSITIVE] Yeah we do
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and I'm not showing data service [PII] for $400 on file for Elegio.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, could you help me the patient policy? Mhm. OK.
[AGENT][NEUTRAL] I show the policy.
[AGENT][NEUTRAL] Mhm. The policy effective date is [PII]. Uh, this policy is active.
[CUSTOMER][NEUTRAL] OK, still active.
[AGENT][NEUTRAL] Mailing address and fax number, payer ID number is the same.
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] OK, OK, all the information are same OK.
[CUSTOMER][NEUTRAL] The pay ID in, uh, determination.
[CUSTOMER][NEUTRAL] The patient is effective from uh [PII] and selective, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And uh checking now, uh could you help me the time limit to the uh claim?
[AGENT][NEUTRAL] There's no timely fighting limit to submit the claim?
[CUSTOMER][NEUTRAL] OK, there is no time the following OK.
[AGENT][NEUTRAL] Mhm. Any other questions?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Just note down on it and uh OK I got that all and could you could you help me the mode of submission whether we want to submit through paper or electronic or either way.
[AGENT][NEUTRAL] It's your choice.
[CUSTOMER][NEUTRAL] OK, got that. And if you're a primary or secondary insurance for this patient?
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, I gather all the information about this claim and I'm having another claim also that is the last claim. Could you please assist for that?
[AGENT][NEUTRAL] I can do one more claim, that policy number.
[CUSTOMER][POSITIVE] Sure, thank you.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] The policy number is going to be.
[CUSTOMER][NEUTRAL] Are you ready?
[AGENT][NEUTRAL] That policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's going to be 02144660.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is going to be [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Date of service in charge?
[CUSTOMER][NEUTRAL] Date of service is going to be [PII] and the total charge is going to be $220 even.
[AGENT][NEUTRAL] OK, I do not show the claim on file for this patient. Same mailing and um fax number, payer ID number showing the policy effective date is [PII] currently active.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] You're
[CUSTOMER][NEUTRAL] [PII] and still active. OK, the information and the address is the same. There is no time limit and uh one of submission is either way and the, you are a secondary insurance for this patient, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, I gather all the information about this thing and make the call reference first conversation.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] Could you help me the name, please? [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Got it. Thanks for wonderful assistance. Have a great day. Bye for now. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling AP like. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye.