AccountId: 011433970860
ContactId: 9c4e101f-1ad4-4ac3-aac6-b84fa92aabe4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 584950 ms
Total Talk Time (AGENT): 231505 ms
Total Talk Time (CUSTOMER): 186236 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/9c4e101f-1ad4-4ac3-aac6-b84fa92aabe4_20250218T15:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] My name is [PII] and initial my last name [PII]. I'm checking the status, so I need your assistance. Good morning.
[AGENT][POSITIVE] OK, sure, I can assist you.
[CUSTOMER][NEUTRAL] Calling from provider office.
[AGENT][NEUTRAL] OK, what's the name of the provider you're calling from?
[CUSTOMER][NEUTRAL] Lourdes Hospital.
[AGENT][NEUTRAL] OK. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what's the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, yeah. Could you confirm your name one more time, please?
[AGENT][NEUTRAL] My name is [PII]'s [PII].
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so right.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] OK, thank you so much sir, for confirmation.
[AGENT][NEUTRAL] You're welcome. And may I, OK, may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, yes, I have my policy number is 28019035.
[AGENT][NEUTRAL] OK. Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so it looks like um it's um too many numbers. Can you repeat that number or do you have the copy of the card?
[CUSTOMER][NEUTRAL] Card copy let me check.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, 01644590.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] My first name is [PII]. The last name is [PII].
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK. And what's his date of birth?
[CUSTOMER][NEUTRAL] Birth date [PII].
[AGENT][POSITIVE] Perfect, thank you. All right, and what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, sure. Date of service is [PII].
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Total charge is $3,162 even.
[AGENT][NEUTRAL] OK, and that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII], and that's gonna be optional. And let me pull this ELB and see if this is your claim. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And that's.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm still waiting on the EOB one moment.
[CUSTOMER][POSITIVE] OK, no worry, you can take time.
[CUSTOMER][NEUTRAL] that
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mm, OK. No, this is not your claim. Um, I don't see a claim for $3,162.
[CUSTOMER][NEUTRAL] Yeah that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Uh, OK, and it is not on your file?
[AGENT][NEUTRAL] No, I don't see one for that amount.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I have the claim ID number. Let me check for you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, claim ID number is 230.
[CUSTOMER][NEUTRAL] 43
[CUSTOMER][NEUTRAL] 253-467.
[AGENT][NEUTRAL] And that's not our claim number. That's too long to be our claim number. Our claim numbers are really short, like the policy number is like really short, like maybe 8 digits the most.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. OK, no worry. Could you confirm me the payer ID?
[AGENT][NEUTRAL] OK, so this claim needs to be either fax or mail. I can give you the payer ID for your records, but the claim needs to be um faxed or mail because we need the primary EOB attached to it, OK? Um, so the payer ID is 60801.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the timely filing limit?
[AGENT][NEUTRAL] We don't have timely filing limits. Do you need the mailing address or the fax number so you can send that claim because we cannot, it's not gonna come here electronically if it doesn't have the um primary EOB will not be processed. It will be denied asking for that information.
[CUSTOMER][NEUTRAL] OK, you need primary UV right?
[AGENT][NEUTRAL] Correct, yes. So they need to be faxed or mail.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] Every pair has own timely filing limit guidelines, but you share me you have not timely filing.
[AGENT][NEUTRAL] Correct. You don't have timely filing limits.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have the primary UOV.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so it needs to be sent to us with the claim, but it needs to be attached to the claim, so either you can fax it or mail it.
[CUSTOMER][NEUTRAL] Uh, give me your fax number.
[AGENT][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] You accept the claim, uh, paper claim or electronically?
[AGENT][NEUTRAL] Again, if you can find a way of sending both claim and EOB electronically, you can, um, but if it's easier to attach both of them together by fax or mail, it needs to be either fax or mail.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Confirm me the mailing address.
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] I don't know
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK, [PII]. Repeat me one more time please.
[AGENT][NEUTRAL] No, no, no, that's an old address. No, no, no. You need to erase that address, OK? It's [PII].
[CUSTOMER][NEUTRAL] Mailing address.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] The zip code
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII]. OK, got it. Zip code?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah why don't worry about that
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, no. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK. So, thank you so much. May I have the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like, Mr. [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] I know. Thank you so much. Have a nice day. Take care.
[AGENT][POSITIVE] You as well thank you for calling APL. Bye-bye, Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Bye.